SCOPE OF THIS CHAPTER
This chapter provides an overview of the issues to be considered when working with children and families who may be affected by HIV, including those who have suffered sexual abuse and for whom a HIV test may be required.This chapter was added to the manual in March 2019.
HIV is not in itself an issue for child protection, and there is no evidence that abuse is more likely in families affected by HIV.
If issues and concerns about HIV arise during a Section 47 (Child Protection) Enquiry, it is important that workers feel confident in responding to such concerns, and therefore they will need access to information, training and support.
As HIV is such an emotive issue, it is vital that agencies adopt a balanced and consistent approach in considering whether HIV should be a factor in any assessment, enquiry or work with children and families.
The issues need careful consideration, and there is no need for hasty decisions or actions. Workers should take time to seek specialist advice and guidance.
Confidentiality is extremely important in relation to HIV, both legally and ethically. Agencies have a duty to ensure the protection of information about all parties in relation to HIV - any breach of confidentiality can have very serious social, psychological and financial implications.
No information about anyone's known or suspected HIV status should be shared without their written consent.
This includes children who are of sufficient age and understanding to give their informed consent, and who understand the implications of doing so. Otherwise, consent should be sought from the parent.A written consent form is essential, clearly specifying to whom and why the information would be given. It is anticipated that only in exceptional circumstances would such information be shared at a Child Protection Conference. 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.
3. When Should HIV be a Consideration?
HIV can only be transmitted by specific activities, and it may need to be considered in the following situations:
- Penile penetration (vaginal and anal);
- Oral sex (although this represents a much lower risk);
- Used needles and syringes - therefore, it may be a rare consideration in assessment of risk where family members have a casual attitude to the disposal of such needles.
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, as 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.
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 advice and counselling themselves 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 agreed between workers.
In cases of suspected organised or multiple abuse, it may be helpful to invite a specialist worker to assist the Strategy Group 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. If the final decision is to reveal the person's HIV status, a full written explanation should be given to the perpetrator explaining what is to be shared and why.
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.
Where an HIV test is being considered, Pre-test Counselling will be offered by staff from the Genito-Urinary clinic. This must address the needs of each individual child/family arising from race, gender, religion, language and disability.
Informed Consent can only be given by someone who has had pre-test counselling. If the child is of sufficient age or understanding to give informed consent to a test, then this permission must be sought. Otherwise, consent should be sought from the parent.
The testing of any perpetrator would require their consent.
The Test Itself
This involves the taking of a blood sample; arrangements could be made to take the sample at the most appropriate place and time for the individual child. The Centre for Sexual Health, based at Leeds General Infirmary, which provides a same day testing service for HIV would take responsibility for the testing which should guarantee the confidentiality of the individual child and family.
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.
This is essential whether the test has proved positive or negative to make future decisions and plans.See also Practice guidance: supporting young people with HIV testing and prevention (NCB, 2016).
5. Specialist Advice
In taking time and carefully considering all the issues surrounding HIV, workers will need specialist advice and support from outside their normal agency structures.
This may be obtained from:
- Centre for Sexual Health, Wirral University Trust Hospital; or
- Lead officers within each agency.