Le secret qui entoure la maladie des parents et des enfants infectes par le virus de l'immunodeficience humaine (VIH) est a l'origine d'isolement psychoaffectif et de difficultes de communication intrafamiliale. Une prise en charge psychologique peut-elle faire evoluer la question du secret entre parents et enfants? Nous avons analyse dans un service de pediatrie l'organisation et la dynamique du secret autour des enfants contamines par leur mere. L'analyse etait prospective et reposait sur des entretiens semi-directifs et des dessins. Nous avons suivi, sur une periode de deux ans, dix enfants (moyenne 4 ans; extremes 4 mois-12 ans), d'ethnie et de milieu socio-economique varies. Dans chaque famille, l'enfant etait destinataire du secret, le pediatre depositaire et la mere (ou son substitut) detentrice. L'organisation du secret autour des autres depositaires potentiels variait d'une famille a l'autre. Deux modes de communication intrafamiliale existaient: le secret (reserve aux plus petits) et le non-dit. Un enfant souffrait d'une maladie liee au secret; les autres presentaient des symptomes depressifs reactionnels. Au terme de l'etude, la maniere d'aborder et, surtout, de traiter la question du secret a evolue sensiblement dans chaque famille : revelation a l'entourage familial (trois cas), passage de l'enfant du secret au non-dit (deux cas), questionnement facile au pediatre dans tous les cas. Neanmoins, la levee du secret n'a jamais ete totale pour l'enfant. Quatre enfants ont demande a poursuivre une prise en charge psychologique. L'evolution de la dynamique du secret et l'apaisement des familles observes dans cette etude suggerent de recommander une aide psychotherapeutique aux familles dont un enfant a ete contamine de facon verticale par le VIH.
The secrecy surrounding the disease of parents and children infected with HIV leads to psychic and affective isolation and difficulties of communication within the family. Psychological management may possibly help to resolve the problem of secrecy between parents and children. We analyzed the organization and dynamics of the secret surrounding children contaminated by their mothers. The analysis was prospective and was based on semi-directive interviews and drawings. We followed up, over a period of two years, ten children (mean age: 4 years, range: 4 months to 12 years) with different ethnic and socio economic backgrounds. In each family, the child was the target of the secret, the pediatrician the guardian, and the mother (or her substitute) the keeper. The organization of the secret around the other potential guardians varied from one family to another. Two modes of intra-family communication were observed: the secret (reserved for the youngest children) and the tacit. One child suffered from a disorder related to the secret, the others had depressive and reactional symptoms. At the end of the study, the manner of approaching, and especially dealing with, the question of the secret had changed appreciably in each family: disclosure to the family circle (three cases), passage of the child from the secret to the tacit (two cases), and easier questioning of the pediatrician in all of the cases. Nonetheless, in no case had the secret been completely lifted for the child. Four children asked to continue psychological management. The changes in the dynamics of the secret and the appeasement observed in the families suggest that psychotherapeutic aid should be offered to families where a child has been contaminated with HIV by the mother.