School Personnel Should Be Prepared to Help HIV-Infected Children, Pediatricians Say
By Meghan Fay, Assistant Editor

In renewing a 1991 policy that said HIV-positive children should be educated in mainstream schools, the American Academy of Pediatrics (AAP) has called on school administrators and teachers to receive training on the disease and the potential long-term needs of the HIV-positive children attending school. Ryan White, the Indiana teenager who sued in 1985 after he was blocked from attending school, prompted the earlier policy. 

The revision differs from the AAP’s 1991 policy statement on Education of Children with HIV, because prior to antiretroviral therapy, many children with HIV suffered significant developmental setbacks and were unable to function normally in the classroom. New drug treatments mean more children with the HIV Infection can function normally in the classroom for longer periods of time. The AAP also says that pediatricians, parents and schools must stay in communication to monitor children with HIV, and provide them with the drug therapies they need and with access to special education and other related services if their disease progresses. 

“This is a consistent position, a renewal of policy,” said Catherine M. Wilfert, M.D., FAAP, and Chair of the AAP Committee on Pediatric Aids. ”Children who are receiving the benefits of treatment are feeling better, living longer and going to school longer.”

Laws On The Books

Although one would think that being HIV-positive is a private matter between a child and his/her family and their doctor unless they choose otherwise, laws in both South Carolina and Illinois, require families to inform the school community if a child attending school is HIV-positive. According to Wilfert, this is not a stance the Academy supports. Unfortunately, “not everyone has changed their minds about having them (HIV-positive children) in schools,” she said.  “Ideally, you want to observe confidentiality,” said Martin Sklaire, M.D., FAAP and consultant for the policy.

The following are recommendations from the Education of Children with HIV Infection policy statement.

1. All children and youths with HIV infection should have the same rights as those without infection to attend school and receive high-quality educational services.

2. Children and youths with HIV infection should have access to special education and other related services in accord with their needs as the disease progresses.

3. Mechanisms for administration of medications, including confidential methods for HIV infection, should be in place in all schools. This includes appropriate facilitation of specific needs for fluids or bathroom privileges.

4. Continuity of education must be ensured for children and adolescents with HIV infection and encompasses the spectrum of traditional school, medical day treatment programs and home schooling.

5. Confidentiality of HIV infection status should be respected and maintained, with disclosure given only with the consent of the parent(s) or legal guardian(s) and age-appropriate assent of the student.

6. The pediatrician/medical home provider should maintain appropriate communication with the school to facilitate the education of children in their care.

Little Difference Seen

According to Sklaire, HIV-positive children are functioning so well in school that it is increasingly difficult to distinguish between HIV-positive and non HIV-positive students. Therefore, he believes it is important to acquaint both children and teachers with the disease so that they foster an informed and accepting environment. Sklaire suggests that every school needs a good AIDS Education Program as part of Health Education, good access for students to special services, a good school nurse who can administer medicine and communicate effectively with the HIV-positive student and his/her parents and a good school medical advisor who can communicate effectively with the pediatrician.

“It’s an optimistic message that the new treatments for HIV infections are working and allowing students to function in school for longer periods of time. I think this is very encouraging,” said Sklaire, who believes that schools that are effectively providing services to HIV-positive students are an, “example of how we all have to work together to help these children.” It is also a positive example of how education and medicine can work together to help kids with chronic diseases. 

The policy statement is published in this month’s Pediatrics, the journal of the AAP. 

AAP – Sheryl Cash, 847.981.7131
Catherine M. Wilfert, M.D., FAAP, and Chair of the AAP Committee on Pediatric Aids, 919.968.0008
Martin Sklaire, M.D., FAAP and consultant for the policy, 203.245.7341
159 Burgin Parkway | Quincy, MA 02169
617-471-4445 | Fax 617-770-3339