3.9.1 Children and HIV

1. Introduction

Child protection services should be provided for children who are HIV positive on the same basis as for any other child.

HIV in itself is not a reason for considering safeguarding procedures and it is important that this is known both by staff and by those who need services. Similarly behaviour deemed "high risk" in relation to HIV is not on its own sufficient for safeguarding procedures to be invoked. Consideration should be given to providing services to the young person as a Child in Need. See Referrals Procedure for more information.

Where children have been sexually abused, the possibility of HIV Infection may be raised. Workers will need to consider issues of testing, confidentiality, counselling and consent. These decisions will be taken in consultation with relevant Health practitioners. See Child Sexual Exploitation Procedure for more information.

Where children are concerned the information in question may relate to the HIV status of the child, to the presence of HIV infection in the child's family or to the HIV status of the alleged abuser.

2. Disclosure of Information

The question of whether to disclose information about HIV may arise following a detailed assessment where there is a need to access specific services for the child and/or family and these can be gained only by disclosing details of the assessment.

Before disclosing information about HIV, practitioners should be satisfied that the following criteria are fulfilled:

• The child and/or the child's parents have given their written consent to the transfer of information;
• The disclosure of the information would be in the best interests of the child and would benefit the welfare of the family in a specific way or the disclosure would protect an individual at risk of infection;
• The person(s)/agencies receiving the information are aware of its confidential nature and are able to maintain the confidentiality of the information provided.

If consent is withheld, this should only be overruled if any of the following applies:

• The child is at risk of significant harm if disclosure is not made;
• There is a legal requirement for the information to be disclosed (see Underlying Principles and Values Procedure, Information Sharing and Confidentiality);
• Public interest requires disclosure in order to prevent others being put at risk.

3. Undertaking an HIV Test

When it is thought that a child may have been at risk of HIV infection, it may be necessary to become involved in counselling the child or family about the appropriateness of HIV testing. A particularly sensitive approach will be required where the child has been sexually abused. Where penetrative vaginal or anal intercourse has taken place it may be appropriate to consider from the outset that any perpetrator may be HIV positive and to inform parents and child as a matter of routine of the possibility of HIV or other sexually transmitted infections and to offer counselling so that they can decide whether or not to take appropriate tests.

Other circumstances in which testing may become an issue are where the child is considered to be at risk because other family members have tested positive or where the young person is pregnant and is offered a test for HIV as part of routine antenatal care.

Where a young person is aged 16 or over he or she must give consent before a HIV test is undertaken. They should be presumed to have Mental Capacity to give consent, unless a Mental Capacity assessment shows that they lack capacity. The young person should receive counselling so that the nature of the test and the implications of a positive test are fully understood.

For a child or young person under 16 years the guidelines used to determine if a young person is Fraser Competent should be used. If the child is of sufficient age and understanding to be capable of giving consent, their permission must be sought. It will also be necessary to decide who has the parental responsibility to give consent to a HIV test.

There may be several parties with Parental Responsibility for the same child. Wherever possible there should be consultation with all those who share parental responsibility.

Where the child is being Accommodated by the local authority, consent to testing should be as outlined above.

Where the child is the subject of a Care Order, Parental Responsibility will be shared between the parents or guardians and the local authority. If there is disagreement about testing between those parties the extent to which the parents or guardians may meet their Parental Responsibility will need to be determined.

The final decision will be for the local authority which will need to be satisfied that seeking (or not seeking) an HIV test is necessary in order to promote the child's welfare.

If it is decided that testing should be carried out, it is recommended that this should be done through the paediatric services already involved with the child to avoid repeated interviewing and examination of the child.

The legal framework on consent to medical investigations or treatment for children and young people is covered in detail by the General Medical Council publication 0-18 years: Guidance for all doctors. It addresses children and young people's capacity to consent; the need to encourage those with capacity to involve their parents in making important decisions, whilst respecting their rights; and the law regarding those who lack capacity to consent.

In a Child Protection Conference, discussion of a child's HIV status or that of any member of the family should only take place if it is absolutely necessary for a full consideration of the need to protect the child.

Issues concerning this should be discussed with the Chair of the Child Protection Conference prior to the meeting being held.

The above guidance may be applicable when dealing with other blood borne viruses and sexually transmitted infections.