Academic journal article Social Work

Testing the Sexually Abused Child for the HIV Antibody: Issues for the Social Worker

Academic journal article Social Work

Testing the Sexually Abused Child for the HIV Antibody: Issues for the Social Worker

Article excerpt

There is increased concern about human immunodeficiency virus (HIV) infection occurring as a result of pediatric sexual abuse (PSA) noted in the public health literature (Gellert & Durfee, 1989; Gellert, Durfee, & Berkowitz, 1990). The prevalence of this condition, however, remains unknown. One report found 18 children infected with HIV whose risk factors included sexual abuse (Gellert et al., 1990). A recent study identified 28 children infected with HIV from PSA who had no other risk factors and gathered situational and sociodemographic data on this mode of transmission (Gellert, Durfee, Berkowitz, Higgins, & Tubiolo, 1993). The American Academy of Pediatrics' Committee on Adolescence (1988) made no mention initially of testing for the HIV antibody in its recommended procedures and tests for evaluating adolescent victims of rape, but this omission was subsequently corrected (Gellert & Mascola, 1989; Schonberg, 1989).

The frequency of HIV transmission to children and adolescents through sexual abuse is lower than transmission by other routes. The deficient database on child sexual abuse and risk of HIV infection is partly attributable to the early developmental stage of the field of child abuse prevention. Because the incidences of HIV infection and reported sexual abuse are increasing (Krugman, 1986; U.S. Department of Health and Human Services, 1987), the transmission of HIV to children by this route may increase. Social services agencies and social workers may have expanding roles in the decision-making process for testing and subsequent management of children infected with HIV through sexual assault. This article provides clinical background on HIV antibody testing of PSA victims and explores issues social workers may encounter in child abuse casework.

HIV Testing and Pediatric Sexual Abuse

The benefits of identifying children who have become infected with HIV from sexual abuse relate primarily to the public health imperative to control disease spread; prompt treatment, including the administration of appropriate immunizations, medical follow-up, and provision of prophylaxis early in the course of illness; identification for medicolegal purposes of abusers who may be HIV infected; and management of transmission risk associated with sexual acting-out behaviors directed at other children. Universal testing of PSA victims has been endorsed in view of recent therapeutic advances in the clinical management of acquired immune deficiency syndrome (AIDS) (Finkel, 1990). Early patient identification facilitates follow-up and expedites the initiation of therapy to HIV-infected children. The frequent lack of physical evidence indicating the form of sexual abuse and the high frequency of incomplete victim disclosure and recanting in assessment of abuse also favor a universal testing strategy (Summit, 1983).

Data on this practice issue must be collected prospectively to demonstrate the frequency with which HIV infection follows abuse, stratified by variables specific to the abuse such as type and duration. Until such data exist, definitive guidelines for HIV antibody testing of children who have been sexually abused will not be forthcoming. Based on a consensus among practitioners of PSA medical evaluation, a set of interim testing guidelines has been proposed (Gellert et al., 1990). Major indicants for HIV antibody testing were recommended according to characteristics of the victim and the abuser. The guidelines recommend testing a PSA victim if the abuser is known to be HIV positive, has clinical findings compatible with AIDS, or is known or suspected to have engaged in high-risk behaviors. Testing would also be recommended if the victim has clinical findings compatible with AIDS or is an adolescent with a history of high-risk behaviors (including prostitution, survival sex, injection drug use, or same-sex behavior). The guidelines also recommend testing if a parent or the victim (particularly an adolescent) persistently requests testing despite counseling that the risk of infection is low. …

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