Homeless/runaway/street youth throughout the world share histories of rejection and betrayal by families and society whether it be for reasons of poverty or family and parental difficulties. Though they leave their families in search of improved material, physical and emotional conditions they are met on the streets by a world of further rejection, violence, rape prostitution, drug abuse mental and emotional disturbance economic marginality and hunger. Stigmatized, alienated and exploited, the risks children face for violence, drug abuse and HIV dramatically increase when they come to the street. While all three of these risks are deeply intertwined, no child’s life should be reduced to the issues they face. The challenges of HIV prevention are complex and many and should not be divorced from the entire set of needs of each child as a whole and from HIV treatment itself.
As child care providers, you spend your lives providing a safe and loving environment to children. You try to make your home a haven where children can grow and learn free from the world’s perils. But sometimes the realities of the world can even knock on the door of home child care settings.
Did you know:
- The Pediatric AIDS Foundation estimates that between 10,000 and 20,000 children are infected with HIV (human immunodeficiency virus)—and only 28 states require reporting of children with HIV?
- The Centers for Disease Control (CDC) reports that the incidence of HIV is growing most rapidly among women of child-bearing years?
- The CDC also reports that the number of people with HIV in suburban and rural areas is growing?
There is a greater need for providers of HIV-positive children than you may think. After all, parents of children with HIV have to work, too, and for many, the cost of a nanny or private nursing care would be prohibitive. Are you prepared for the task?
HIV in Child Care—Is there a risk?
As the number of HIV-positive children grows, at some point you may be asked to accept an HIV-positive child into your care. Should you consider it? What are the risks?
“To date, there are no documented cases of transmission of HIV in a child care setting, even through biting,” reports the Child Care Law Center, a San Francisco-based non-profit legal services organization.
“Skin in a wonderful protective covering,” says Elaine Gross, a clinician at the National Pediatric and Family HIV Resource Center in New Jersey. Children rarely bite hard enough to break the skin—but even if they did, “the child doing the biting will get the other child’s blood in his mouth.” So it is unlikely that an HIV-positive child could transmit the disease by biting another child.
“I can’t say that [HIV transmission] could never happen. But we have been dealing with this epidemic since the late ’70s, and there has not been a single case of transmission in a child care [setting],” Ms. Gross says. “This has to be reassuring to people.”
Transmission Facts
Since HIV was identified in 1981, the virus has been investigated intensively. And all major research organizations agree that there are three main ways HIV can be transmitted: during unprotected sexual intercourse; from an infected mother to her child during pregnancy, delivery, or from breast milk; and through the contact between the blood of an infected person and the mucous membrane or blood of an uninfected person.
HIV is not transmitted through casual contact such as touching, hugging, light kissing, sharing food, being sneezed or cried on, or using the same toilets. Tears, urine, saliva, vomit, and sweat are harmless as long as there are no signs of blood.
However, providers often do see blood on the job. A child may fall and scrape a knee, get a paper cut, have a bloody nose, or come to your home with a bandaged injury that re-opens during play. That’s when “universal precautions” can help.
Universal Precautions
Universal precautions are a standard set of routine practices that providers can follow to prevent the spread of any blood-borne disease. The precautions have been outlined by the Centers for Disease Control (CDC), Occupational Safety and Health Administration (OSHA), and other organizations involved in HIV education.
There are three very strong reasons why child care providers should follow universal precautions:
First, under the Americans with Disabilities Act of 1990, a child’s parents have the right to not disclose information regarding the child’s HIV status. Therefore, you may not know whether a child in your care has HIV.
Second, since July 1992, OSHA has put out regulations that any child care center that employs at least one aide or volunteer, full-time or part-time, must adopt and practice universal precautions.
Third, the universal precautions prevent any inadvertent contact with the blood-borne pathogen and keep the day care environment safe and free of germs for all children.
Even if you are not required to follow the universal precautions as enforced by OSHA, it’s still a good idea to follow the precautions for safety’s sake. Keep in mind that HIV is not the only blood-borne disease.
Care for the Child with HIV
You can keep other children safe from harm by taking universal precautions. But are you capable of caring for a child with HIV? The answer is that most HIV-positive children will not need more intensive care than the other fully healthy children.
“From the perspective of a communicable disease, universal precautions are sufficient,” says Ruth Neil, who teaches a seminar on caring for children with HIV at the National Resource Center for Health and Safety in Child Care in Denver, Colorado.
“[Special training] is not necessary unless the child requires certain medications,” she says. However, “it is useful for the provider to have knowledge of the course of the disease.”
If you are concerned about your ability to care for a child with HIV, you can take training courses offered through your state child care agency or, with the parent’s permission, contact the child’s physician or a public health official to determine how you can best accommodate the child’s needs.
A Right to Know/A Right to Privacy
Because children with HIV pose no direct threat to others, their HIV status does not need to be public knowledge.
According to the Child Care Law Center, “a direct threat is a condition which poses a significant risk to the health or safety of others, and such a determination must be based on current medical or other objective information.”
Medical professionals must assess the child’s risk to others and inform the child’s parents. If the child is deemed as no direct threat (and children with HIV are rarely considered a direct threat), the parents can choose not to tell a provider. In other words, parents of the child with HIV are not required to tell you if their child has HIV.
But can you ask about a child’s HIV status when filling out medical forms? “Providers are allowed to ask for medical information, and many states require information, but the ADA says it must be relevant to care,” says Ms. Gill de la Madrid. And since children with HIV pose no direct threat, parents are under no obligation to respond. Moreover, inquiring about HIV status may be construed as an invasion of privacy.
However, should the child’s health deteriorate to the point that they do become a direct threat, the parents of the child must inform the provider. But they still needn’t say the threat is due to an HIV infection.
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