5.1.6 HIV/AIDS Guidance

HIV/AIDS

The HIV virus may infect children in the following ways:

1. By vertical transmission during pregnancy from an infected mother, the risk to the child is thought to be approximately 1 in 8;
2. By treatment with infected blood or blood products notably of haemophiliacs and children given blood transfusions. In the UK, blood is now screened and blood products heat-treated and screened. Any risk from blood products is now considered minimal for children treated in the UK;
3. By sharing needles when injecting drugs;
4. By unprotected penetrative sexual activity.

Injecting drugs by itself is not necessarily indicative of exposure to risk of HIV infection - it is the sharing of drug using equipment that is risky. It may be a rare consideration in assessment of risk where family members have a casual attitude to the disposal of such needles. Information relating to the nature and extent of the parent's drug use should be sought from the parent and from other agencies with the knowledge of the parents.

In circumstances where children and parents share concerns about HIV, these should be responded to by sensitive discussion of the reasons for their concern. If penetration or oral sex has not taken place, then reassurance can be given that it is highly unlikely that the child will have been exposed to HIV.

Where it is known that penetration or oral sex has taken place, it is still unlikely that the child has been exposed to HIV.

In either situation, the child and/or parents may require specialist advice and counselling to help them weigh up the potential risks and to make future decisions.

It should be borne in mind that children may not talk about the full extent of the abuse they have experienced, especially during the initial investigation.

The decision to have a HIV test is a major step and poses many moral dilemmas. Any such decision should only be made therefore after a balanced consideration of all advantages and disadvantages lead to the conclusion that it would be in the best interests of the child.

The advantages are:

1. Knowledge of HIV status allows access to medical care and support;
2. If the child is not infected, it can remove doubt and prevent unnecessary stress and anxiety;
3. If the child is infected, the child and family can be helped to cope and be encouraged to respond constructively.

The disadvantages are:

1. There is no cure for AIDS;
2. The side effects from treatment can be severe and have a profound effect on the child;
3. Awareness can be harmful to the emotional well-being of the child and family;
4. Knowledge of HIV status may lead to stigma and isolation;
5. There is an obligation to disclose the results of the test;
6. Testing for babies or young children is unlikely to be accurate or reliable particular in children under the age of 2;
7. Having been tested, regardless of the outcome, can cause difficulties later in life in obtaining insurance and some other services.