SCHOOL ATTENDANCE BY CHILDREN WITH ACQUIRED IMMUNE DEFICIENCY

Facts About the Transmission of HIV:
HIV can be transmitted through unprotected sexual intercourse, through blood-to-blood contact (such as the sharing of injection drug needles and syringes), and from an infected woman to her baby at or before birth. A large body of research has demonstrated that HIV is not transmitted through casual contact such as in a school setting. Therefore, except in very rare cases (Appendix A), there is no legitimate public health reason to exclude students with AIDS or HIV infection from attending school.

Guidelines for Disclosure:
The student’s parent(s) or guardian(s)* are the gatekeepers of information relating to the student’s AIDS/HIV status. They are not obliged to disclose this information to school personnel. A student who is diagnosed with AIDS or presents evidence of being immuno-compromised is at a greater risk of contracting infections. This means there may be good reasons to inform the school nurse or school physician of a student’s AIDS diagnosis or HIV infection status. This student’s parent(s) or guardian(s)* would benefit from information from the school nurse or school physician about the occurrence of threatening contagious diseases such as chicken pox or influenza when making a decision regarding school attendance. The school nurse or school physician may also need to attend to the particular needs of HIV-infected students regarding immunization schedules and medications. In consultation with the student’s primary care physician, the student’s parent(s) or guardian(s)* may decide to inform certain school personnel about the student’s AIDS/HIV status, particularly the school nurse or school physician. If they so choose, the following guidelines are recommended:
  1. The student’s parent(s) or guardian(s)*may inform the school nurse or school physician directly
  2. Alternatively, the student’s parent(s) or guardian(s)* may request that their primary care physician make the disclosure. In this case, specific, informed, written consent of the student’s parent(s) or guardian(s)* is required
Further disclosure of a student’s HIV status by the school nurse or school physician to other school personnel requires the specific, informed, written consent of the student’s parent(s) or guardian(s)*.

Statutes Governing Disclosure:
As a general rule, a student’s health records related to AIDS/HIV should be regarded as confidential (not to appear on health records). The Massachusetts General Laws, c111, s.70F, prohibit health care providers, physicians, and health care facilities (including school-based clinics) from disclosing HIV test results, or even the fact that a test has been performed, without the specific, informed, written consent of the person who has been tested. This statute prohibits testing persons for HIV antibodies without their permission and protects against the nonconsensual release of medical records (including school health records) which contain such information. These statutory requirements apply specifically to health care providers. However, case law in Massachusetts and other states leads to the conclusion that other school staff members beside health care providers may be liable for civil damages in the event of nonconsensual disclosure of information related to HIV status or AIDS diagnosis. In short, information about an individual’s AID/HIV status should be treated as highly confidential and released only with the specific, informed, written consent of the individual’s parent(s) or guardian(s)*.

*Under state public health statute M.G.L.c112, s.12F minors may consent to their own dental care and medical testing, diagnosis, and treatment in certain circumstances (including HIV infection). This law mandates confidentiality of medical information and records except when an attending physician or dentist reasonably believes that the condition of the minor is so serious that the minor’s life or limb is endangered. Accordingly, if an adolescent student has sought HIV antibody testing independent of parental consent, that student has the right to keep this information confidential, and any disclosure of this information would require the student’s specific, informed, written consent.

Conclusion
All school staff should be informed about and understand these updated medical guidelines and should be trained in the observance of universal precautions.

Medical Guidelines Regarding Students who Bleed in an Uncontrollable Fashion in a School Setting:
As a public health measure, students who exhibit the following conditions should be advised not to attend school until such time as these conditions are resolved:
  1. If a student has weeping or bloody skin or mouth sores that cannot be successfully covered or controlled with medications
  2. If the student exhibits biting of an unusual frequency or severity that would be accompanied by actual transfer of blood from the biter as might happen only from a student with chronically bloody gums or mouth
  3. If the student exhibits bloody diarrhea

These conditions are grounds for the exclusion of any student from a school setting regardless of whether he/she is known or suspected to harbor a blood-borne infection.

Universal Precautions for School Settings:
Universal precautions refer to the usual and ordinary steps all school staff needs to take in order to reduce their risk of infection with HIV, the virus that causes AIDS, as well as all other blood-borne organisms such as the Hepatitis B virus. Appropriate equipment (mops, buckets, bleach, hot water, hand soap, disposable towels, and latex gloves) must be readily available to staff members who are responsible for the clean up of body fluid spills.
  1. Treat human blood spills with caution.
  2. Clean up blood spills promptly
  3. Inspect the intactness of skin on all exposed body parts especially the hands. Cover any and all open cuts or broken skin or ask another staff member to do the clean up. Latex gloves contribute an added measure of protection, but are not essential if skin is intact.
  4. Clean up body spills with a solution of one part household bleach to ten parts water, pouring the solution around the periphery of the spill. Disinfect mops, buckets and other cleaning equipment with fresh bleach solution.
  5. Always wash hands after any contact with body fluids. This should be done immediately in order to avoid contaminating other surfaces or parts of the body. Be especially careful not to touch your eyes before washing up. Soap and water will kill HIV.
  6. Clean up other body spills (urine, vomit, feces), unless grossly blood contaminated, in the usual manner. They do not pose a significant risk of HIV infection.

ADOPTED: Prior to 2013