3.6.7 HIV/AIDS

1. When should HIV be a Consideration?

In circumstances where workers believe that a Child may have been placed at risk of HIV, an informed decision must be made about whether to raise the concern with the child or Parents.

Before taking this initiative, workers must seek specialist advice to ensure that this would be an appropriate course of action. In discussing the situation with others, no identifying details should be given.

Where a number of children are involved, a consistent approach to the raising of issues about HIV is important and must be coordinated and agreed between workers.

2. Testing for HIV

The repercussions for the child's future life of being tested for HIV, regardless of the outcome of the test, should not be regarded lightly.

The HIV antibody test can only show that a person has been infected by HIV and has developed antibodies to it. The test is only accurate three months after the time of possible infection. It is not a test for AIDS, and it cannot be used to predict when and if AIDS will develop.

Where the child, parent or workers have raised HIV as an issue, it is important to access specialist advice to consider whether there has been a real risk of infection and whether there is anything to gain from testing. Any advice received should be obtained in writing.

Testing should only be carried out where there is substantive evidence of exposure to HIV, and not purely on the grounds of the sexuality or life-style of a child or parent.

There should be clear reasons for the test, related to serious concern about exposure to the virus or undiagnosed poor health/developmental delay.

Where the child's HIV status is not known, testing should never be carried out solely at the request of the foster carers or as a routine examination or assessment.

Where an HIV test is being considered, staff must offer and arrange pre-test and post-test counselling from a trained specialist for parents and children. This must address the needs of each individual child/family arising from race, gender, spirituality, language and disability.

Testing should take place wherever possible at the Genito Urinary Clinic as this provides confidentiality for the child and family, although it should be noted that it is an adult-based service and may not be orientated towards the counselling or needs of children.

3. Consent to HIV Testing - all Children

The informed Consent of a child aged 16 or over must be given before testing.

If a child under 16 has sufficient age and understanding, his or her permission must be given before testing.

There should be no attempt to test a child under 16 without seeking the consent of the parents. Wherever possible, the Consent of the parents should be obtained.

In order for children and parents to be able to participate in decision-making in an informed way, they must be provided with adequate information and given appropriate support including access to specialist counselling both before the test and in the event of a positive diagnosis.

Where parental consent is not forthcoming but there is a clear medical recommendation that testing is in the child's best interests, legal advice should be obtained as to whether and in what circumstances the test can proceed.

4. Decisions to Test Children in Care

It is not the policy to test children routinely prior to placement in the LAC service, including with prospective adoptive parents. The HIV status of every child placed cannot be guaranteed, and foster carers and adoptive parents should be made aware of this.

Any decision to test a Child in Care before a placement must be as a result of this being in the child's interests, for example that they are from a high-risk background and early diagnosis would ensure appropriate preventative treatment.

As well as the consents of the child and the parent, all requests for HIV testing of LAC should be referred to the Team Manager. Testing can only proceed on a Child in Care if the written consent of the Team Manager is given following discussion with the Head of Service.

5. The Test Result 

There is a need for discussion before any test takes place, clarifying who will have access to any test results. If a child is of sufficient age and understanding to give informed consent, then the result will be given to the child directly.

In other situations, the results will be given to the Team Manager who gave consent for the test to take place. Even if workers have been involved in the initial discussions, they do not have any automatic access to the test results.

It is essential, whether the test has proved positive or negative, to make decisions and future plans which include post-test counselling.

Whatever the outcome of the test, the child concerned should receive the same level of service. The only difference in treatment should be where it is necessary to protect the child.

6. Confidentiality and the Disclosure of HIV Status

Confidentiality is extremely important in relation to HIV, both legally and ethically. The decision to disclose a person's HIV status must always be guided by the best interests of the child. Generally disclosure should only take place with the consent of the person concerned, unless there is a risk of Significant Harm to the child and this has a direct bearing on the assessment of the risk, or where there is a legal requirement to disclose.

Where a LAC is known to be infected with HIV, the immediate carers of the child must be informed. Wherever possible, the parent's consent to this will be obtained before the placement.

Foster carers are asked to consider carefully whether their own children should be told as well depending on their age and level of maturity to hold the information in confidence.

Where a child is placed in residential care, only those members of staff who have a special involvement with the child and where their knowledge would enhance their work with the child need be informed of the child's HIV status. This includes the Registered Manager.

In exceptional circumstances, when a child is deliberately trying to infect others, specific training and advice should be obtained and additional staff in a residential placement should be made aware of the child's HIV status.

The only other professionals who may be told of the child's HIV status are the child's GP and Health Visitor.

Before disclosing information about HIV to any other agency or individual, the following criteria must be satisfied:

1. Written consent to the disclosure must have been given by the Team Manager, parents and the child (where appropriate);
2. The disclosure is considered to be in the best interests of the child;
3. Those receiving the information are aware of its confidential nature and their procedures for maintaining confidentiality are appropriate.

A completed form of written consent is essential, and should clearly specify to whom and why the information would be given.

It is anticipated that only in exceptional circumstances would information that a child is infected with HIV be shared at a Child Protection Conference. The issue should be discussed with the Chairperson in advance of the meeting.

Normally, no written record should be made of a person's known or suspected HIV status. Where, exceptionally, there is a written record, this should be filed with confidential papers and kept secure.

7. Placements of Children in Care Infected by HIV

Where it is known that a child is infected with HIV, he or she should not, as a general rule, be placed in a home where there are other children under the age of eight.

This is because:

1. Children under eight are more prone to general infection and therefore may pose a risk of infection to a child infected with HIV;
2. There is an increased risk of accidents and rough and tumble with a possibility of blood spillage;
3. Younger children will probably cope least well in the event of the death of a child from AIDS.

Where a child infected with HIV is to be placed for Adoption, prospective adoptive parents must be informed and have access to specialist advice about the short and long term implications.

Where any placement occurs, carers must be informed of the child's status and Health professionals should be consulted for advice about health care, including medication and nutrition. The carer must have a telephone number to contact should the child's health deteriorate.

The child's Care Plan will need to address the issue of the child's transmission and involve a thorough assessment of risk of the child's behaviours to the child and others.

Helping a child infected with HIV to maintain confidentiality may be a key issue for carers. Formal counselling may be required. Experience of Neglect or Abuse often leads to difficulties for a child in maintaining appropriate physical and emotional boundaries. The child may disclose his or her HIV status inappropriately.

Foster Carers and residential staff will need advice and support in order to care for a seriously ill child and cope with the possibility of death and bereavement. Careful initial matching should take place to ensure that the carers will be able to cope.