HIV / AIDS in Educational Settings Directive
INFORMATION BULLETIN ON ACQUIRED IMMUNODEFICIENCY SYNDROME IN EDUCATIONAL SETTINGS
Current public awareness of the acquired immunodeficiency syndrome (AIDS) and changing patterns of the infection have prompted an update on guidelines for managing the educational setting in which students or staff may be infected with the human immunodeficiency virus (HIV).
This information bulletin is intended to provide information and advice to school boards and Regional Health Authorities in meeting their joint responsibility to provide educational programming to all eligible children and to protect the general public from communicable diseases.
BACKGROUND
AIDS is the end phase of an infection with HIV. This virus attacks the body's natural defense mechanisms, the immune system, steadily weakening one's ability to resist various infectious diseases and cancers. It often takes ten to twelve years or longer for adults infected with HIV to develop AIDS; in infants and children, AIDS may progress much more rapidly. There is no vaccine to prevent HIV infection and therefore no drugs to cure AIDS once it develops.
Clinical management aims at preventing the onset of the most common of the so-called "opportunistic infections", an unusual lung disease known as Pneummocystis carinii pneumonia, or PCP. With successful efforts to reduce the impact of other opportunistic infectious diseases and cancers, persons with AIDS can maintain productive, relatively healthy, lives for several years. However, once HIV infection has developed to "full-blown AIDS" it is currently considered to have an invariably fatal outcome.
Among adults and adolescents in Canada, HIV is spread mainly through sexual contact (both heterosexual and homosexual) and by sharing of needles and syringes to inject drugs - this can include injection of steroids by athletes or body-builders. Since November 1985, all blood donors in Canada have been tested for HIV and the risk of being infected through a blood transfusion has been virtually eliminated. Laboratory tests have shown that HIV is present mainly in blood, semen and vaginal secretions; although the virus has been detected in small amounts in saliva and tears, there are no documented reports of HIV spread from contact with these fluids.
Casual contact such as hugging, shaking hands or sharing a glass, does not result in transmission of HIV.
There are reports of relatively small numbers of health care workers who have been infected with the HIV in the workplace. Exposure to the virus has usually taken place through penetrating injuries with needles or other sharp instruments contaminated with blood. Other forms of contact such as having blood splash into the eyes or mouth or prolonged contact with blood on skin damaged by disease or open wounds have rarely resulted in HIV infection. Caution is urged for anyone handling blood or other body fluids that may contain HIV, since it is usually not known that a particular individual is infected.
Despite more than a decade of knowledge gained about how HIV is and is not spread, some persons are still very fearful of becoming infected with the virus through day to day activities and contact with people in the workplace. Efforts should be made to recognize that the fear is very real for those people and should be dealt with through patience, understanding and improved education about HIV transmission.
HIV INFECTION IN CHILDREN
The majority of children with HIV infection acquired the virus from their infected mothers. HIV may spread from mother to infant during pregnancy, during the delivery or, less commonly, through breast-feeding. A few children in Canada were infected through transfusion of contaminated blood or blood products (e.g., hemophiliacs). A few, isolated reports of HIV spread to children in a household where there is someone known to be infected have revealed unusual situations that probably accounted for unrecognized exposure to blood.
As of October 1994 there were only 112 cases of AIDS reported in Canada among children less than 15 years old, and most of these have died. The number of infants and children currently infected with HIV is not known.
None of the identified cases of HIV infection in children in the United States or Canada has been transmitted in school, day-care and foster care settings, or through casual person-to-person contact. There is no evidence that the types of interaction usual among school children pose any risk of transmitting the virus, nor is there any reason to believe any risk exists from the type of blood exposure possible in a school setting. When children/infants are unable to control bodily functions due to illness or have behavioral problems such as biting, precautions should be taken.
GUIDELINES
HIV / AIDS is covered under the Communicable Diseases Regulation of the Alberta Public Health Act and there is no legal basis on which to prevent children infected with HIV from attending school. The medical record of the child cannot be divulged by medical or health personnel without the permission of the parent or unless this is required for protection of the child or the public, as considered necessary by the local Medical Officer of Health. No notification of school authorities is necessary except in these instances. Similarly, there is no basis on which to exclude HIV infected teachers or other school staff from the work setting provided they are well enough to perform their usual duties. There is no need for notification of this diagnosis to school authorities. Should school authorities become aware of the diagnosis of HIV infection, the right to privacy of the student or employee must be respected. The information must be kept strictly confidential and the number of persons who are aware of the diagnosis must be on a need-to-know basis only.
The following guidelines have been established on the advice of Alberta Health officials and draw upon those recommended by the U.S. Center for Disease Control (CDC). Guidelines based on the recommendations of the CDC have been drawn up by Provincial and State Departments of Education and school boards in many cities across North America. Policies of Alberta school boards regarding HIV / AIDS should be consistent with these guidelines and should be developed with the assistance of local health personnel. A mechanism for ongoing communication between school boards and Regional Health Authorities should be established. The provincial government will review these guidelines and, on a regular basis as more information becomes available, revisions or modifications may be made.
- The child's educational setting should not be restricted.
For most HIV infected school-aged children, the benefits of an unrestricted setting would outweigh the risks of their acquiring potentially harmful infections from other children (e.g., chicken pox), and the extremely low or non-existent risk of transmission of HIV through casual contact. HIV infected children should be allowed to attend school and ECS programs in an unrestricted setting unless, in the opinion of the Medical Officer of Health and the child's physician, in consultation with the Director of Communicable Disease Control, there are special circumstances which necessitate some restriction. The need for any possible restricted environment should be reassessed periodically by the Medical Officer of Health and the attending physician.
- The setting should be based on the child's needs.
Decisions regarding the type of educational and care setting for HIV infected children should be based on the behavior, neurologic development, and physical condition of the child and the expected type of interaction with others in that setting. These decisions are best made using the team approach including the child's physician, public health personnel, the child's parent or guardian, and personnel associated with the proposed care or educational setting. In each case, risks and benefits to both the infected child and to others in the setting should be weighed.
- A few children may need special settings.
For the infected preschool-aged child and for some neurologically handicapped children who lack control of their body secretions or are behaviorally impaired, a more restricted environment may be required as determined by the Medical Officer of Health.
- Mandatory testing inappropriate.
Mandatory testing for HIV infection as a condition for entry into school or ECS programs is not warranted. Neither students nor staff should be subjected to such tests.
- Informing school authorities.
Providing that the routine hygienic practices and policies are in place, the HIV infected student does not present a risk to other students or staff. Consequently, there is no need to inform school authorities or other staff of the diagnosis except in instances where it is required for the protection of the child or the public. In the unlikely event that this notification is necessary, the number of personnel who are made aware of the child's condition must be kept to an absolute minimum. Should persons involved in the care and education of such students become aware of the HIV infection, the child's right to privacy must be respected and any record kept must be strictly confidential. Confidentiality of information is required by the Public Health Act.
- First Aid Procedures
School personnel should be aware of first aid procedures. Proper equipment, including gloves, should be part of first aid kits. Review first aid procedures with local public health staff.
- Establishing hygienic practices and policies.
Routine hygienic practices and policy regarding the cleansing of materials and surfaces contaminated with blood or body fluids should be reviewed with local public health staff to minimize the risk of transmission of any infection (including HIV). These should be encouraged for all contact with blood or body fluids regardless of whether the school has any children known to be infected with HIV. All educational activities involving the extraction and analysis of samples of human fluid or tissue are now prohibited in Alberta schools.
- Staff should not be restricted.
School staff with HIV infection do not present a risk to either students or other staff. There is no need for any restrictions on their employment provided they are well enough to perform their usual duties. There is no need for notification of this diagnosis to school authorities.
- Implementing provincial guidelines.
School jurisdictions, with the assistance of local public health personnel, should develop policies which are consistent with provincial guidelines regarding HIV / AIDS and other infectious diseases. Such policies should be reviewed regularly by school boards and local health authorities and regular communication maintained on all health matters.Additional information on HIV / AIDS or other health related matters is available from theProvincial AIDS Program and Communicable Disease Control, Alberta Health,
9th Floor, 10025 Jasper Avenue
Edmonton, AB T5J 2N3
phone: 427-0836
fax: 422-6663Information is also available from the local health authorities located throughout the province. Please contact your Regional Health Authority for information on health services in your region.
Regional Health Authorities
| Chinook Regional Health Authority P.O. Box 817 Fort MacLeod, AB T0L 0Z0 phone: 553-4141 fax: 553-3434 |
Palliser Health Authority P.O. Box 1120 Medicine Hat, AB T1A 7H3 phone: 529-8042 fax: 529-8998 |
| Health Authority Region #3 5609 - 9 Avenue West High River, AB T1V 1B3 phone: 652-0104 fax: 652-0190 |
Calgary Regional Health Authority 1213 - 4 Street, S.W. Calgary, AB T2R 0X7 phone: 541-3670 fax: 541-3681 |
| Health Authority Region #5 P.O. Box 429 Drumheller, AB T0J 0Y0 phone: 823-5245 fax: 823-7589 |
David Thompson Regional Health Authority Foothills Building 5004 - 50 Street, P.O. Box 2099 Rocky Mountain House, AB T0M 1T0 phone: 845-5600 fax: 845-5849 |
| East Central Regional Health Authority P.O. Box 1780 Stettler, AB T0C 2L0 phone: 742-7922 fax: 742-5842 |
WestView Regional Health Authority Suite 204, Provincial Building 111 - 54 Street Edson, AB T7E 1T2 phone: 723-8919 / 723-8918 fax: 723-2536 |
| Crossroads Regional Health Authority 5511 - 50 Avenue, P.O. Box 6627 Wetaskiwin, AB T9A 2G3 phone: 352-3766 fax: 352-3988 |
Capital Health Authority 1710 Standard Life Centre 10405 Jasper Avenue, Box 104 Edmonton, AB T5J 3N4 phone: 427-6031 fax: 427-4964 |
| Aspen Regional Health Authority #11 Provincial Building, P.O. Box 2308 Westlock, AB T0G 2L0 phone: 349-8705 fax: 349-4879 |
Lakeland Regional Health Authority P.O. Box 248 Smokey Lake, AB T0A 3E0 phone: 656-2030 fax: 656-2033 |
| Mistahia Regional Health Authority 3301, 10320 - 99 Street Grande Prairie, AB T8V 6J4 phone: 538-5387 fax: 538-5455 |
Peace Health Region Room 306, Provincial Building P.O. Bag 900-13, 9621 - 96 Avenue Peace River, AB T8S 1T4 phone: 624-7120 fax: 624-7122 |
| Keeweetinok Lakes Regional Health Authority Provincial Building 5226 - 53 Avenue High Prairie, AB T0G 1E0 phone: 523-6748 fax: 523-6642 |
Northern Lights Regional Health Authority 612 Provincial Building 9915 Franklin Avenue Fort McMurray, AB T9H 2K4 phone: 743-7347 fax: 743-4734 |
| Northwestern Health Services Region 10207 - 103 Street, P.O. Bag 400 High Level, AB T0H 1Z0 phone: 926-3791 fax: 926-4149 |
REFERENCES
Please refer to the following for additional information:
See Section 7 for information on where the above document(s) may be obtained, and for Department / Branch addresses, phone and fax numbers.
Revised: February 1997
