HIV in children: disclosing status and diagnosis (Risk factors (No HIV…
HIV in children: disclosing status and diagnosis
A high viral load, especially during labour and delivery. A mother with high viral load is more likely to transmit HIV,
and transmission is most likely to occur during labour and delivery.
However, though transmission is rare in mothers with undetectable viral load, it does still occur.
A low CD4 count or CD4 percentage.
Advanced HIV disease or previous AIDS-defining illness.
Older age of mother.
Smoking during pregnancy.
Use of recreational or illegal drugs during pregnancy. The biological relationship between drug use and mother-to-baby transmission is not understood.
Frequent unprotected sex, especially with multiple partners, during pregnancy.
No HIV therapy during pregnancy or delivery.
Waters breaking more than four hours before delivery.
Prolonged or difficult labour.
Cervical or vaginal infection (e.g. bacterial vaginosis).
Inflammation of the membranes which separate the foetus from the mother at the time of birth (chorioamnionitis).
A low birth-weight baby. Infants with a birth weight below 2.5 kg
Breastfeeding or mixed feeding (breast or formula).
Causes of transmission
Via the placenta during pregnancy,
Through blood contamination during childbirth, or
• Disclosing HIV-positive status to children The decision to tell a child about his or her positive HIV status is a difficult one, and the health professional should always be guided by the parents.
• However, the UN Convention on the Rights of Children as well as our Patients' Rights Charter states that all patients,
including children, have the right to participate in decisions relating to their own healthcare,
and knowing about HIV-positive status is included in this right.
• Much depends on the age of the child and his or her ability to absorb and cope with knowing his or her HIV-positive status.
• In the case of infants and very young children, disclosure is made to the parents and post-test counselling is carried out with the parents as outlined above, the chief difference being that the advice is tailored for the child.
• Children need to be assured of the on-going love and care of their parents.
They also need to be assured that the disease is not their fault, that it is not some kind of punishment for being naughty.
• The child should be taught how the HI virus is transmitted but the complexity and level of the information will depend on the age and cognitive development of the child.
• The health professional should be honest with the child and should answer the child's questions openly.
The language used should be appropriate. Where necessary, an interpreter can be used.
• The health professional should try to anticipate the possible impact of the disclosure on family, friends, the school and the community.
• Following disclosure and counselling, it is important to monitor the child's reaction.
• Behavioural changes such as an altered sleeping pattern,
problems at school and withdrawal can indicate depression requiring more support and intervention to help the child cope.
• The child's feelings, responses and expressed needs should always be treated with sympathy and respect.
A variety of social grants and other forms of financial assistance are available for children.
• The health professional should inform the parents of these and if necessary refer the family to the social worker,
who will facilitate the process of accessing this social assistance.