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4.14 HIV/AIDS

RELATED CHAPTER

This guidance should be read in conjunction with HIV and AIDS Procedure.


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.

Liaison with Health Service Providers

Work with families affected by HIV/AIDS obviously involves liaison with a variety of health professionals. For details of the key Health Professionals and their roles please refer to the Divisions HIV/AIDS Policy.

Children’s Services/Health Joint Care Planning Process

The Health Service has appointed a Named Worker for HIV.

The Children with Disabilities social worker should liaise with the Named Worker (Health) during the assessment process.

Where the overall health and social needs of the family are complex, the Social Worker will call a Co-ordinating Meeting or a Network Meeting as set out in HIV and AIDS Procedure.

It is vital to share information about changes in physical and mental/emotional health, in household membership or concerns about child protection. Joint working between Children’s Services and Health is important. Clearly, where family members are terminally ill, close liaison and co-ordination becomes particularly necessary.

Working with Extreme Feelings

Most families welcome support when they feel less able to care for their children due to illness or frequent hospitalisation. Nevertheless, accepting help can necessitate facing their or their child’s increasing illness or impending death, which is extremely painful. Expect parents to react at times by showing fear, anger, denial or depression. If parents are enabled to express feelings, the effects upon their children may be minimised. Try to ensure that parents are supported within their community.

Each individual develops a way of coping with the severe stress or a life threatening illness. A common need can be to feel in control. Therefore Social Workers should work towards empowering families wherever possible.

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