Introduction

Children with HIV infection spend very little time in hospital; they live, learn, grow and play in different settings in the community. Despite significant advances in the understanding of HIV infection, misconceptions continue to harm children with HIV infection. These misunderstandings have led to ostracism in situations which present no risk to others. A major challenge for those caring for children with HIV infection is to promote acceptance of HIV-infected children in the community. Healthcare providers bear an important responsibility to educate children, their caretakers, and the community at large on the risk of transmission of HIV and other infections. Recommended practices for reducing the risk for transmission should be implemented without exaggeration of risk for transmission. Every effort should be made to promote understanding and compassion, and to maintain confidentiality for children with HIV infection [1–3].

Transmission of HIV

Transmission of HIV requires a sufficient quantity of virus. The risk for transmission of HIV is directly related to exposure to contaminated body fluids [1]. HIV has been isolated from many body fluids (see Table 36.1), but HIV transmission is most commonly associated with exposure to blood or semen, which are rich in lymphocytes and monocytes [1]. There are four major modes of HIV transmission: (a) between sex partners; (b) from an HIV-infected mother to her child during pregnancy, delivery, or breastfeeding; (c) by direct inoculation of infected blood or blood-containing tissues, including transfusion, transplantation, reuse of contaminated needles, or penetrating injuries with contaminated needles; (d) splattering or spraying of mucous membranes or non-intact skin with infected blood [4].

Introduction

Children with HIV infection spend very little time in hospital; they live, learn, grow, and play in different settings in the community. Despite significant advances in the understanding of HIV transmission infection, a number of misconceptions continue, spawning misunderstandings that can harm children with HIV infection. In some circumstances, these misunderstandings have led to fear and the ostracism of children with HIV infection in situations which present no discernible risk to others. A major challenge for those caring for children with HIV infection is to promote an acceptance of HIV-infected children in the community. Healthcare providers bear an important responsibility to adequately educate children, their caretakers and the community at large on the risk of transmission of both HIV and other infections. Recommended practices for reducing the risk for transmission should be implemented in a balanced manner and should neither minimize nor exaggerate the relative risk for transmission. Every effort should be made to promote understanding, confidentiality, and compassion for children with HIV infection [1, 2].

Transmission of HIV

Risk for transmission of HIV is directly related to exposure to contaminated body fluids [1]. Since HIV preferentially replicates in cells expressing CD4+ and its co-receptors, transmission is highly associated with exposure to infected cells bearing the CD4 antigen (e.g. T-lymphocytes and monocytes) [3, 4]. HIV has been isolated from many body fluids (see Table 44.1), but HIV transmission is most commonly associated with exposure to body fluids, such as blood or semen, which are especially rich in lymphocytes and monocytes [1].