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* The only reportable exposure categories for human immunodeficiency virus (HIV) infection of children are vertical transmission from an HIV-infected mother or receipt of infected blood or blood products. Although sexual transmission of HIV among adults is the subject of intense concern, sexual transmission of HIV to children during child sexual abuse has received almost no investigative attention. This review discusses factors contributing to the exclusion of sexual transmission of HIV to children from studies of the epidemiology of HIV infection. Difficulties occur in screening and confirming abuse in nonselected populations of children, perceived and real barriers exist to the evaluation for HIV of sexually abused children, and problems occur in the assessment for child sexual abuse of HIV-infected children. Impediments to the understanding of the relationship between sexual abuse and HIV infection in sexually abused, HIV-infected children are considered, and measured that can allow these barriers to be overcome are discussed. (AJDC. 1993;147:775-780), The AIDS virus can be transmitted to children through sexual abuse, but this problem has not been adequately addressed. The possibility of HIV infection is not always considered in sexually abused children, and conversely, sexual abuse is not always considered as a possible cause of HIV infection in children. HIV testing may not be considered for a sexually abused child due to lack of risk-factor information about the perpetrator. Legal considerations, such as consent requirements, may also prevent HIV testing. HIV-infected children may not be evaluated for sexual abuse for several reasons. Vertical transmission from the mother may be assumed if the child is very young. Transmission by consensual sex may be assumed if the child is a teenager. Sexual abuse has not been officially included as a risk factor for HIV infection. Policies need to be developed to increase awareness of the risk of HIV infection due to sexual abuse. Also, protocols should be established for HIV testing of sexually abused children and for evaluating HIV-positive children for possible sexual abuse.

The incidence (number of new cases) of both human immunodeficiency virus (HIV) infection and AIDS is increasing in children. Children infected with HIV, the AIDS virus, often need day care. Day care centers are faced with the enrollment of HIV-infected children. The public has unfounded fears concerning the infectivity of HIV, partially due to their lack of knowledge about the virus. The knowledge and attitudes of parents whose children attend day care centers and day care providers were assessed. Questionnaires were completed by 219 parents whose children attended 4 day care centers and 176 day care providers who worked in 12 day care centers. More than 98 percent of those who answered the questionnaire knew that HIV can be transmitted through sex and contaminated needles. Eighty-four percent of the parents and 77 percent of the care providers knew that HIV can be transmitted in blood. The respondents knew that HIV can not be transmitted by holding hands, touching doorknobs and sharing sleeping mats. However, the respondents were not certain whether HIV could be transmitted by activities in which bodily fluids could be exchanged, such as biting, kissing, sharing of food and eating utensils, or through urine, stool, tears, vomit, or in diaper changing areas. The scientific data showing infectivity through blood, bodily fluids, and bodily fluids containing blood (such as oozing skin lesions) are not conclusive. Only 43 percent of the parents would allow their child to be in the same room as an HIV-infected child. Fifty-two percent of the day care providers would not take care of children with HIV infection. Further education of parents and day care providers is necessary to enhance the acceptance of children infected with HIV in day care centers and to reduce the fears that are associated with HIV transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)

The disclosure of diagnosis in the case of children with HIV, which is helping them to cope up better and have lesser psychological problems, is discussed and informed about their illness and its consequences. The 10-step process for disclosure of diagnosis for children with HIV is also highlighted.

Since the first case of AIDS in a child was reported to the New York City Department of Health in 1982, there have been 672 cases of AIDS diagnosed in children younger than 13 years of age, accounting for 2.4 percent of the AIDS cases in New York City. Ninety-five percent of AIDS-afflicted children contracted the disease from their mothers. The mother was an intravenous drug user in 60 percent of cases, or had sexual contact with an intravenous drug user in 20 percent of cases. Of 235 cases of AIDS in children who contracted it from their mothers, 13 AIDS patients belonged to 10 sets of twins. This is considered a surprisingly high rate of twin births. Three cases in which only one twin was afflicted with AIDS have been previously described. Some possible explanations for the greater incidence of twins among pediatric AIDS cases include: a greater incidence of twins among AIDS-afflicted women who use narcotics; the ability of the human immunodeficiency virus (HIV), which causes AIDS, to increase the frequency of twin births; increased susceptibility of twins to HIV infection; and stresses, such as low birth weight and competition for nutrients, experienced by twins in utero and after birth that may predispose to developing HIV infection. Further studies are needed to clarify whether twin births are more prevalent among HIV-infected women because of drug use or other factors; whether twins are more susceptible to HIV infection than infants born singly; and whether twins have a more severe prognosis when they develop HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hemophiliacs are at considerable risk for harboring and transmitting the human immunodeficiency virus (HIV). The National Hemophilia Foundation and the Public Health Service have recommended that hemophiliac men, who have tested positive for HIV or who have not been tested, refrain from unprotected sexual intercourse. It is also recommended that their partners not become pregnant until more is known about the transmission of the virus. Despite these warnings, there are many pregnancies among sex partners of hemophiliac men who are HIV-positive. In a study of 24 completed pregnancies, it was determined that 37.5 percent of the pregnant women learned of their partners' HIV-positivity and received counseling prior to the fifth month of pregnancy, when abortion was an option; at least nine women knew they were HIV-positive prior to their fifth month of pregnancy. Despite recommendations to the contrary, the pregnancies were carried to term; 37 percent of these pregnancies had been planned. Thirty percent of the children born were HIV-positive. Breast milk was considered an important source of HIV transmission. Three infants contracted pneumonia and two died. Two children had HIV-related symptoms of lymphadenopathy (lymph node disease) and idiopathic thrombocytopenic purpura (abnormal decrease in blood platelets). These findings are thought to represent the minimal level of HIV transmission, since they were based solely on clinical symptoms; there is increasing evidence that infected children, unlike infected adults, may test negative. This study demonstrates that infants of HIV-infected women are at extremely high risk for HIV infection, even if the infected mother is healthy, and does not engage in high risk activities such as sexual promiscuity or intravenous drug use. (Consumer Summary produced by Reliance Medical Information, Inc.)

There is some concern over the possibility of transmission of the human immunodeficiency virus (HIV) to the people taking care of children with acquired immunodeficiency syndrome (AIDS). This group includes caretakers in schools, day care centers and households. The transmission of HIV by infected blood is well established, but there have been no reports of HIV transmission to non-high-risk individuals in families, day care, workplace (excluding health facilities) or schools. Most studies have examined the transmission of HIV from infected adults or older children to household members. Since younger children have less control over bodily fluids and excretion, they are more likely to transmit the infection to household members through biting, drooling, mouth toys and diaper contents. The transmission of HIV was studied among 89 household members caring for 25 HIV-infected children. Household members came in contact with items likely to be soiled with infected blood and body fluids such as toys, toothbrushes, eating utensils, toilets, nail clippers, combs, towels, bedsheets and bathtubs. In addition, hugging, kissing, bed sharing, and bathing together were common. Caregivers began HIV blood testing four months after initial contact with an HIV-infected child. All 89 participants were HIV-negative. It is concluded that the risk of HIV transmission among household members is extremely low. (Consumer Summary produced by Reliance Medical Information, Inc.)