Table 3.

Challenges in the provision of counselling and testing services to HIV-infected children*

Difficulties	Frequency (n = 59)**	Percentage
Institutional related
Few staff & heavy workload	20	33.9
Lack of testing kits and other logistical support	12	20.3
Occupational hazards (pricking self and infections)	7	11.9
Lack of prior sensitization before referral for testing	6	10.2
Poor motivation of staff	3	5.1
Lack of ARVs	2	3.4
Lack of child-friendly environment	2	3.4
Caretaker related
Unwillingness of caretakers to disclose to child	15	25.4
Caretakers refusing children to be tested	7	11.9
Caretakers look at HIV-infected children as a burden	3	5.1
Sick and weak parents	3	5.1
Clients not sympathetic to health workers due to desperation	2	3.4
Some parents deny parenthood (stigma)	2	3.4
Lack of consistency by caregivers	2	3.4
Child related
Children cannot express themselves easily	8	13.6
Dependency nature of children	6	10.2
Children require more time for counselling	5	8.9
Most children are needy & orphans	4	6.8
Need a lot of support to adhere to treatment	3	5.1
Children have many fears - death and abandonment	2	3.4
Health worker related
Failure to cope with knowledge demand for HIV care	14	23.7
Lack of specialized skills in paediatric counselling & management	10	16.9
Difficult of dealing with non-parents	7	11.9
Difficult to draw blood from children	4	6.8
Difficult to disclose to children	3	5.1
Caretakers refuse other monitoring tests for ART	2	3.4

*Responses to open-ended questions posed to healthcare providers were coded into categories. Multiple responses were noted.

**One respondent did not respond to the question on challenges.