By Joe Huber

Pediatric AIDS: A New Professional Challenge

Since acquired immune deficiency syndrome (AIDS) was first identified in 1981, no single individual has helped to bring more national attention to the disease than Ryan White. Once school officials learned that White, a hemophiliac, had contracted the virus, he was banned from attending Classes in Kokomo, Indiana. Fearful students and parents rejected health authorities assurances that the disease, although transmittable and infectious, cannot be spread through casual contact.

The Whites moved to Cicero, Indiana, where the school board sponsored several conferences about the disease and residents rallied in support of Ryan. Until his death in April, 1990, Ryan was viewed as a national spokesperson for AIDS, appearing at Congressional hearings and fundraisers.

The White case cannot be viewed in isolation. Although most AIDS patients are gay men or intravenous drug users (IVDUs), the Federal Center for Disease Control reported a 38% increase of cases among newborns (547 in 1989), which was faster than the increase among gay ot bisexual men (11 %; 19,652), IVDUs (20%; 7,970), or heterosexuals (36%; 1 ;562). In the early to mid1980s the pediatric population with human immunodeficiency virus (HIV) infection was primarily comprised of children requiring blood transfusions (e.g., hemophiliacs). Today, the majority of children with HIV infections are born to mothers who are either IVDUs or the sexual partners of IVDUs.

In previous years anxiety about AIDS caused administrators, teachers, and parents of some school districts to urge exclusion of HIV infected students from school for fear of spreading the disease-as in the case of Ryan White. Today, however, there is an increasing amount of information available upon which to base recommendations concerning the risks posed by school children with HIV. The American Academy of Pediatrics' Task Force on Pediatric Aids (Pediatrics, November 1988) states that with proper precautions, there is no danger of HIV infected children infecting other children and that HIV children can be admitted freely to all activities pending approval of their physicians.


Transmissibility of HIV appears quite narrow. Epidemiologic evidence has implicated only blood, semen, vaginal secretions, and possibly breast milk inthe transmission of HIV. HIV has been isolated from a variety of body fluids with which teachers are most apt to come into contact; namely saliva, tears, and urine. Medical experts have indicated that these three fluids are unlikely vehiclesin the transmission of HIV because no cases have been attributed to these body fluids.

The American Academy of Pediatrics' Report of the Committee on Infectious Diseases (1988) states that there are some factors which may pose increased risk to others and should be considered by school authorities as reasons to exClude an infected child from school. Children who display biting behavior of an unusual frequency or severity or who have open, weeping, or bloody skin or mouth sores that cannot be covered require a more restricted school environment until more is known about the transmission of the virus.

Some children who are HIV infected may be asymptomatic and may not meet the definition of handicapped children found in the Education of All Handicapped Children Act (pL 94-142). Because of a weakened immune system, children who are symptomatic may initially display mild illnesses such as repeated ear infections, chronic diarrhea, or swollen glands. As the disease progresses, more serious illnesses will appear such as frequent blood stream infections, meningitis, or pneumonia. Such illnesses will often cause prolonged absenteeism from school. Children will also frequently show signs of central nervous system dysfunction causing developmental delays or loss of some of the developmental milestones already achieved.

Disclosure of HIV status and ethical issues surrounding confidentiality pore additional questions. Because children with HIV infection pose little harm to other children, confidentiality is an important goal because of the social stigma associated with AIDS; most often only persons involved in the education or health care of such children are informed.

Professional Concerns

HIV is a threat to the public health of children and school staff and deserves serious attention. In-service education programs concerning HIV and AIDS need to be planned and implemented in schools to assure staff policies and health procedures. Has your school, college, or university addressed this issue? Since a child with HIV infection may need isolation from other children, has your state education association established appropriate medical guidelines to qualify HIV infected children as handicapped under PL 94-142? Are you prepared to deal with HIV students who are currently in your classroom or who will be as the incidence of HIV increases? Further, what steps have you taken to become an informed professional about HIV and AIDS and how do you remain abreast of the ever changing body of knowledge in this area?