[Disclosure of infant HIV status: mothers' experiences and health workers' interpretations in Burkina Faso].

Disclosure of HIV status in infants is a special case which does not correspond to general recommendations for counseling as defined for adults, and few norms exist. Whereas preventing mother to child transmission (PMTCT) programs should result in 700,000 annual disclosures regarding infants born to HIV-positive mothers in Africa, the actual figures are much lower and the conditions for disclosure implementation and its social dimensions in the field are not precisely documented. The aims of this article are to describe and analyze the experience of HIV status disclosure for infants and children on the basis of interviews held with mothers and PMTCT teams in Burkina Faso. The method was based on repeated interviews with 37 mothers and with health workers. Their discourses show the complexity of disclosure in a context characterized by uncertainty. They show delays due to difficulties in venipuncture and in methods for laboratory diagnosis and information management in health services. HIV disclosure is implemented by PMTCT physicians and also other professionals, sometimes in other services. The mother plays a key role, sometimes by requesting disclosure; the father is generally informed only secondarily, in spite of his legal responsibility for the child. Interactions analysis reveals some ambiguities of disclosure, regarding information that doctors keep secret, reciprocal expectations of communication between doctors and mothers, mothers' interpretation of apparent signs regarding their child's health, and uncertain information being given. The information often contains guilt-inducing elements for mothers; communication about follow-up does not reduce this effect. These results encourage the elaboration of a model for specific counseling that should provide mothers with general information, and personalized interaction and support that they need in order to receive and manage disclosure of their child's HIV status.