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1.5.4 HIV and AIDS

SCOPE OF THIS CHAPTER

This Procedure should be read in conjunction with HIV/AIDS Guidance.

RELEVANT GUIDANCE

NCB / Hamblin Practice Guidance: supporting young people with HIV testing and prevention (2016)

AMENDMENT

This chapter was updated in March 2017 by adding a link to NCB/Hamblin, Practice Guidance: supporting young people with HIV testing and prevention (2016). (See Relevant Guidance above).


Contents

  1. Introduction
  2. When should HIV be a consideration?
  3. Testing for HIV
  4. Consent to HIV Testing - All Children
  5. Consent to HIV Testing of Looked After Children
  6. The Test Itself
  7. The Test Result
  8. Confidentiality and the Disclosure of HIV Status
  9. Placements of Looked After Children Infected by HIV
  10. Management of Cases Involving Children Infected by HIV


1. Introduction

HIV is not in itself an issue for child protection, and there is no evidence that Significant Harm is more likely to occur in families affected by HIV.

As HIV is such an emotive issue, it is vital that a balanced and consistent approach is adopted in considering whether HIV should be a factor in any assessment, enquiry or work with children and families.

The issues need careful consideration, and workers should take time to seek specialist advice and guidance.


2. 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.

In discussing the situation with others, no identifying details should be given.

Social workers can seek advice in these circumstances from the Children with Disabilities Team.

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.

In cases of suspected organised or multiple abuse, it may be helpful to invite a specialist worker to assist the Strategy Meeting in considering any HIV risk involved.

On extremely rare occasions, a perpetrator may be known to be HIV positive. If the welfare of the child could benefit, it may be appropriate to consider sharing this information, even if the perpetrator will not give consent. In these circumstances, it is crucial that workers take time to consider the decision and seek specialist and legal advice, without initially identifying the person concerned. The final decision to reveal the person's HIV status in these circumstances can only be made by the Designated Manager (HIV and AIDS), and a full written explanation should be given to the perpetrator explaining what is to be shared and why.


3. 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.

The usual test for HIV is not adequate for babies, as they retain their mother's antibodies for up to 18 months.

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. Social workers can seek advice from the Children with Disabilities Team about the availability of specialists. Any specialist 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 of the needs of children.


4. 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. Where the consent of the parents is not forthcoming, legal advice should be sought. 

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.

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 from trained counsellors both before the test and in the event of a positive diagnosis.


5. Consent to HIV Testing of Looked After Children

It is not the policy to test children routinely prior to placement in the Looked After 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 Looked After Child 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 Looked After children should be referred to the Designated Manager (HIV and AIDS) who will discuss the case with the HIV/AIDS Lead Officer for the Social Services Department.

Testing can only proceed on a Looked After Child if the written consent of the Designated Manager is given.


6. The Test Itself

This involves the taking of a blood sample and arrangements should be made to take the sample at the most appropriate place and time for the individual child. The Genito-urinary Clinic will take responsibility for the testing which will guarantee the confidentiality of the individual child and family.


7. 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 whoever gave the 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.


8. 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.

See also Children's Policy, Values and Underlying Principles of Principles of Recording, Confidentiality and Consultation.

Where a child is Looked After, the child's social worker must ensure the immediate carers of the child are informed if it is known that the child is infected with HIV. 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.

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 should 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, for example a nursery or playgroup, the following criteria must be satisfied

  1. Written consent to the disclosure must have been given by the 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.


9. Placements of Looked After Children 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 8. This is because:

  1. Children under 8 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. 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.


10. Management of Cases Involving Children Infected by HIV

In general, cases involving HIV/AIDS are dealt with by the Children with Disabilities Team where a child is either infected or affected, and by the Adult HIV Team where there is a single adult. 

Where appropriate, the Referral and Assessment Teams will undertake Child Protection Enquiries but case responsibility will remain with the Children with Disabilities Team. In these cases, joint working will be necessary.

The majority of cases are dealt with by a social worker from the Children with Disabilities Team but where cases are more complex, professionals meetings are held. These meetings are detailed below.

Co-ordinating Meetings

The allocated social worker will call a Co-ordinating Meeting (if one has not already been held) of relevant workers from the Social Services Department, Health and the voluntary sector to be chaired by the social worker's line manager, the HIV Adviser or the Paediatric HIV Co-ordinator (Health). The parents and child (if old enough) will be invited but if not in attendance, all decisions will be communicated to them in writing.

The purpose of the co-ordinating meeting is to:

  • Listen to family members
  • Share information including any assessments
  • Co-ordinate roles and tasks
  • Discuss the Relevant Children's Plan, care package and funding, and
  • Establish a Core Group, including representatives from Social Services, Health and the Voluntary Sector.

Core Groups

The Core Group will:

  • Agree the process of communication and joint working;
  • Record the Relevant Children's Plans and recommendations of each agency;
  • Update the list of involved professionals and their role every three months;
  • Distribute updated plans every three months to the relevant professionals;
  • Agree a process of sharing information with the family.

It is important to maintain contact to ensure consistency of service, including liaison between the Adult's and Children's Divisions. Where circumstances change or difficulties arise, any member of the Core Group can request a Core Group, Co-ordinating or Network Meeting.

Network Meetings

These are professionals only meetings.

Setting up Care Packages

Community health professionals are responsible for meeting the family's medical needs at home. 

The Adults HIV Team is responsible for setting up an individual care package to provide domiciliary care for an infected adult who could not otherwise manage at home.

Children with Disabilities Team social workers are responsible for setting up any essential care package which either meets children's needs or which assists the adult with child care because the adult is incapacitated due to HIV related physical and/or mental ill health.

The four components of a care package

1. Assessing the family's priority needs.

2. Identifying the various organisations, relatives or friends who can provide the service(s) required.

3. Securing any necessary funding for each component of the care package.

4. Implementing the plan.

Assessing the Family's Needs

The Single Assessment should identify any necessary or preliminary care package requirements in particular any urgent health care services. The allocated social worker should implement this as part of the Relevant Children's Plan. The care package may need to be altered once a Single Assessment has been completed and it also may require updating if/as needs change. The Core Group will also be able to inform the social worker about any changing needs in a family.

Where to find service providers and obtain funding

The Division's HIV/AIDS Policy identifies the main organisations offering services to families affected by HIV/AIDS. The policy also clarifies access to funding including the AIDS Support Grant (ASG).

For a more detailed description of services see the 'NAM AIDS Reference Handbook' (the Children with Disabilities Team should have this.)

For relatives and friends who help affected families by providing home support, respite, transport and other assistance, funding can be accessed via ASG.

The Role of the Adults HIV Team 

The role of the Adults HIV team is to provide services for adults who are infected by HIV and other adults closely affected, such as partners and carers. The team provides a range of advice such as information about voluntary agencies, welfare benefits, counselling, legal and health services.

The HIV Team social worker will refer cases to the Children with Disabilities Team usually when a child is born into an HIV affected family, following consultation with the family. The need for parental Consent should only be disregarded where there are child protection concerns.

Any child protection concerns should be shared immediately with the Children's Division. Where a Child Protection Enquiry is undertaken, the social worker involved should keep the Adult's HIV Team social worker informed of the progress.

End