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Adolescent pregnancy is associated with potentially serious health risks and poor social, educational, and economic outcomes for both adolescent parents and their children [18, 19]. Best practices focus on delay of sexual activity, particularly in younger adolescents, while promoting effective methods of contraception for those adolescents who are or plan to be sexually active. However, unprotected sex is common among adolescents. Nearly half of US high school students have had sex, with less than 60 percent of that group reporting condom use at last sex and less than 30 percent of sexually experienced female students reporting contraceptive use at last sex . While an individual adolescent expressing a desire to become pregnant or disclosing unprotected sex is something a clinician must address (and, ideally, encourage the patient to consider delaying), that does not, in and of itself, rise to a level of harm that would compel Dr. Wilson to break confidentiality.
The ethical arguments supporting confidential care for adolescents are strong and focus on respect for emerging autonomy, recognition of evolving decision making capacity, allowing teens to learn responsibility in health decision making, and improving safety and access to care. Adolescence is a time of intense developmental transition. During adolescence, an individual will move into a peer group, develop intellectually and emotionally, enter the workforce or higher education, and, in many cases, become socially or financially independent. When physicians provide confidential care for adolescents, they are giving them the opportunity to learn how to interact with clinicians and to become responsible for their own health care, and they are respecting and supporting the development of an emerging autonomous self. Research supports this claim: when clinicians discussed sensitive topics with a group of surveyed adolescents, the adolescents reported that the clinicians listened to them and that they felt more engaged in their own health care .
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The “pact” is a splashy and newsworthy topic; adolescent pregnancy is an age-old problem whose amelioration will take concerted efforts by communities, schools, families, and medical and health care professionals. Confidentiality is a tool that clinicians can use to engage adolescents in their care and provide access to effective sexual health services, such as long-acting reversible contraceptives. Dr. Wilson’s best chance at engaging Jennifer in pregnancy prevention thus lies in building a therapeutic alliance upon the foundation of confidentiality.
Among the challenges faced by families, the disclosure of the diagnosis of parents’ HIV status for their children stands out. It is a process influenced by factors related to the family and to the child, as well as to society and health professionals. It requires the involvement and availability of those involved in children's and adolescents’ health. Disclosure of the diagnosis can bring many benefits, but there are family members who are afraid that children will not be fully prepared to understand and handle it –, leading the family to delay disclosure. In this context, this study has as its objective the evaluation of scientific evidence available in the literature regarding the factors that influence the decision to disclose the diagnosis of parental HIV to children.
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32. Kyaddondo D, Wanyenze RK, Kinsman J, Hardon A. Disclosure of HIV status between parents and children in Uganda in the context of greater access to treatment. Sahara J. 2013;10(1):37-45. [ ]
Where the rubber will meet the road will be in how the Federal Reserve and other agencies act on specific disparities at specific lenders, including as these are formally raised to them in timely comments on merger applications. See, Inner City Press / Fair Finance Watch's other studies of the 2004 HMDA data: . For or with more information, .
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Studies have shown that several factors contribute to disclosure of the parents’ diagnosis to their children. Therefore, the importance and the need to prepare parents for this revelation, which becomes more effective when shared with health professionals, is highlighted. This preparation, following the concept that disclosure is a process that culminates at the time of the announcement itself, needs to be covered by the strategies guided by the discussion of the benefits of disclosure, in order to minimize the negative factors and enhance the families’ attributes. It is also recommended that support strategies be developed for parents and children, because of the possible repercussions following disclosure of the diagnosis.
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The fear of losing parental power, the respect of their children, or that their own children might form negative judgments about them ,, is shown as another cause leading to the postponement of disclosure. Knowing that their parents are HIV-positive, some children may consider them unable to take parental responsibilities. It has been reported that some children began to have relationship problems with their parents after becoming aware of their HIV status. It is possible to believe that the problems derive, predominantly, from paternalistic relationships, with interference in the child's and/or adolescents’ autonomy.
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Gaps in the production of knowledge were: lack of description of the place of disclosure, how is the family relationship between parents and children in this process, how parents’ preparation for the disclosure was developed and its repercussions. Therefore, it is necessary to invest in research with outlines that present strong evidence regarding the topic investigated, especially in the practice of health care. It is also important to make efforts to empower health teams to help parents experience this delicate process in the best possible way.
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How to disclose was a common stumbling block/obstacle, because parents did not know how to approach the subject. Parents were afraid that they might be asked questions they would not be able to answer –, and that they would not be able to adequately describe the disease. As regards to how this process develops, the act of informing boils down to the initial moment of disclosing the disease. However, all information should be included in the communication between parents and children, passing through the various moments faced by both during the process of disclosure. Communication can also be associated with professional support and sharing among those involved.
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