The struggle most mothers in the room faced was deciding the 'right age' to tell their children the Big secret: Mum has HIV.
Parents feared a child might be too young to understand the distressing news, they would be unable to keep the secret, or they would begin to fear parental death and being alone.
Most parents simply said they would disclose once their children were older without specifically defining the 'right age'.
The mothers were gathered separately at the Kenyatta National Hospital, five Nairobi City county facilities and one facility in Kisumu county, for discussions organised by researchers from KNH and the University of Washington.
The idea was to find out when parents living with HIV disclose their own status to their children.
Most parents keep mum until their children are in their late teens.
Some said they kept it secret because children might think their parents are dying soon, which would cause the child stress and anxiety.
“It is not so fair because you might make them lose hope in their life. If they are schooling, they might think that our parent is dying before we finish our education. You know sometimes some children think that if you have HIV you might die the next minute. It might kill their hopes,” said one mother of one.
Some parents said they would only disclose their status when their children reached puberty.
“I think my child has the right to know what is going on, what the mother is going through and I think I would be saving his life, maybe at that time he would be thinking of having a girlfriend …He would think, ‘Ok fine, I am going but I will use protection’,” another mother said.
The 493 caregivers were interviewed between 2013 and 2016. The study found that most children at 13 years did not know their parents were living with HIV.
Typically, in sub-Saharan Africa, children living with HIV have their own HIV status disclosed to them at a median age of 13 years.
The researchers wrongly assumed that the age of parental disclosure would follow this pattern.
But they were surprised by the low prevalence of parental HIV status disclosure to children at this age.
The study, titled 'Experience and perceptions of parental self-disclosure of HIV status to children in Nairobi, Kenya,' was published last week in the BMC [Biomed Central] Public Health journal.
Men who were interviewed were most sceptical about revealing their HIV status to children.
They feared the child would reveal the secret to others in the community.
“You know if I tell them…they are going to tell others and when they tell others out there, people will start talking about me. You know when people are talking about you out there, it will come back to me and you know I will start getting stressed,” said one father of 10 children.
Previous studies that interviewed parents and children after parental disclosure had mixed findings.
Negative reactions in children can be up to 50 per cent, but overall, most children cope well with the disclosure in the long term.
Some studies in Burkina Faso and Uganda found that many children already knew or suspected their parent’s HIV status before the disclosure, but did not disclose the information to others.
Psychologists usually advise that it is better to tell your children as early as possible about HIV diagnoses, especially once they start asking questions.
In 2011, WHO released a guideline on HIV status disclosure in children. The guideline recommends that disclosure process should start when the child is six years old and be completed at the age of 12 years.
However, WHO has no guidance on parental disclosure. Some experts say it is best when a child is 15 years old.
(Edited by V.Graham)