Table 3.

Disclosure themes from the wider community domain.

Theme	Illustrative quote
HIV being associated with immorality or sexual promiscuity	. . . many of them think [HIV] infects immoral people; if you are one of the victims, you are seen as immoral. There is a way in which you misbehaved and became infected. “Caregiver, not disclosed”a
HIV as a fatal disease	The first impression people got about HIV is that it kills, and it has never been reversed. Many people know that, for HIV victims, their days are numbered. “Caregiver, not disclosed”
	Many children don’t like telling other people their HIV status because people say HIV kills, so one is isolated. Playing with other children is a problem; you stay alone and become stressed. I was told having HIV is the end of your life. “Child”b
Stigma and discrimination from community	In our place, they say the one with HIV should not interact with other children or sleep with others. He or she should sleep alone. “Child”
Negative experiences with religious institutions	When the pastor came to preach, instead of encouraging her or even giving her hope, he condemned her, saying she misbehaved and that [HIV] was her punishment. “Caregiver, not disclosed”
	There are some [pastors] who rebuke and talk about you. They don’t care about you, but only about their status. “Child”
Positive experiences with religious institutions	If [the pastor] knows one is HIV positive, they encourage people to love them and not isolate them. Initially, pastors could isolate a person, and say ‘so and so should not sit in front but [should] sit in the back.’ . . . [Now] they are so loving and the victims feel accepted. “Caregiver, not disclosed”
	Sometimes you are called and prayed for in front of the congregation. The pastor doesn’t disclose but says the spirit of God has directed him to pray for your healing. They also love and assist you if you come from a poor family. “Child”
Child learning about HIV in school	This disease is even taught at school so [the children] know a lot of things in regard to this disease. The way [the child] asks questions about his disease, you realize that they have known this disease . . . Even those 10 years-old, they know about HIV. “Caregiver, disclosed”
HIV in school as a barrier to disclosure	I always think about it and conclude they are taught about HIV in school. They might be told and he/she thinks he/she is not one of them . . . So the day you will disclose that he/she is one of the people infected with HIV . . . yet they have been told the dangers of having HIV, you will have stressed him “Caregiver, Not disclosed”
HIV in school as a facilitator of disclosure	But me, I was the first one to tell the child. The doctor told me that I should just start by asking those questions they learn from school like, ‘What is HIV?’, ‘How is it transmitted?’ Just start with those. Then from there you can gradually disclose to the child. “Caregiver, disclosed”
HIV in the media (e.g. radio, TV, newspapers)	For me, there was a time [a TV program] featured ARVs and my son was watching. He became curious and asked me, ‘Are those not the drugs I am taking? Does it mean that I am sick?’ Even though I tried to change the channel, I realized he was stressed and wanted to find out more. It was aired for four consecutive days in the evenings and he was always watching. It really affected him. “Caregiver, disclosed”

^aDenotes caregiver disclosure status: not disclosed – the caregiver had not disclosed to any of their children; disclosed – the caregiver had disclosed to one or more of their children.

^bAll child participants in this study were disclosed to – i.e., knew their HIV status.