As with adults, most asymptomatic HIV-infected children do not know that they are infected. They continue to lead their daily lives. Simple infection control procedures can protect all family members or institutional workers from transmission of the virus. Testing has been advocated both mandatory and voluntary to determine the HIV status of orphans. However, there are serious ethical issues involved in testing and disclosure to children. Issues which need to be determined include: Who wants to know and why? Will it benefit the child to be tested and know? How? Who should determine this and how? Can a child give informed consent to testing? Public policy needs to be drawn up in this area.

Infants and children with HIV-related illnesses may have special care needs. Meeting these is more difficult where one or both of the parents is also infected or has died.

Components of this programme element could include:

 

• Support to families with a sick child. One of the most effective ways of supporting a sick child is by providing support to the family caring for it, particularly by helping them deal with the trauma of the diagnosis. An infant with an HIV-related condition like many other sick children often suffers from chronic diarrhoea, fever and respiratory infection. As with adults, however, the provision of a healthy diet and basic medications can improve the quality of its life. A child’s illness may be the first indication to its parents that they are infected with HIV.

• Promotion of non-discrimination policies and programmes. Enforcement of existing laws or establishment of new ones may be necessary to ensure the rights of HIV-infected children. For example, inheritance laws, both customary and modern, may have to be reviewed or enforced to ensure that infected children have access to their parent’s property for support, adoption laws may need to be made more flexible to facilitate care for their children and antidiscrimination laws will need to be established and/or enforced. Creating a community environment where HIV positive children can be placed with families can help reduce discrimination against these children. Families of children with an infected child should be supported if they desire to stay together.