Circular 1999/21 - HIV/AIDS and other blood-borne diseases

Date: 1 March 2004
Circular Number: 1999/21
Category: Operations

HIV/AIDS and other blood-borne diseases

This circular is about: Managing the risks associated with Human Immune deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and other blood-borne viruses such as Hepatitis B and C. In particular managing the difficult balance between the rights of students living with HIV/AIDS and responsibility for providing a safe school environment.

The action required is: Note guidelines for schools. Review the school's policies and practices related to HIV/AIDS and other blood-borne virus infection control.

It is intended for: Boards of trustees, principals and staff in all schools.

For further information: See below for contact postal and email addresses, phone/fax numbers and website details.

Introduction

These guidelines contain information and guidance on how to manage the risks associated with HIV/AIDS and other blood-borne viruses such as Hepatitis B and C. They set out the responsibilities to boards of trustees, principals and staff, and the rights and responsibilities of parents of infected children.

Boards of trustees and staff need to make themselves well informed regarding the management of HIV/AIDS and other blood-borne viruses.

Guidelines:

• Identify principles for the management of students with HIV/AIDS and other blood-borne viruses;
• Identify policies boards of trustees should adopt and procedures staff should follow to control infection in the school;
• Provide key points for staff to consider when developing health education programmes;
• List the board's legal and contractual obligations;'
• Include specific procedures for infection control; and
• Provide useful information about HIV/AIDS and other blood-borne viruses and where to go for further help.

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Principles and good practice

Key principles and related good practices for meeting the needs of children and families affected by HIV/AIDS and other blood-borne viruses:

A child's health status should not affect their right to an education.

About 20 New Zealand schools have had students who were HIV positive in the past few years. Hepatitis B is more common and vaccine preventable. Those working with children with blood-borne virus should support them so they can live as normal lives as possible.

Children with HIV/AIDS and/or Hepatitis B infection should be able to participate in all activities in schools to the extent that their health permits. Should their health deteriorate, special programmes or inter-agency support (health professionals, Specialist Education Services may be necessary so the children can remain in the school setting.

A special situation may arise for students with HIV infection because they may be at greater risk if their classmates are carrying infectious diseases such as chickenpox, measles or mumps. Schools should keep parents of HIV positive children informed if and when there are outbreaks of other infections in the school.

In dealing with any injury, all children should be treated as if they have a blood-borne virus.

You will not always know whether a child who is bleeding is infectious, therefore it is important that anyone who treats a child follows established safety procedures when dealing with any injury, all blood should be treated as if it is infectious.

Children have a right to privacy

The following points should be noted:

• There should be clear policy guidelines about how the school will deal with matters of privacy. Schools should include clear statements about disclosure of personal information in the policy on HIV/AIDS and other blood-borne viruses. The policy should clearly define those people who `need to know' and what they need to know. Parents and the child, (if he/she is of an appropriate age and maturity to express a view on the privacy of their information), should be made aware of this policy when the child is enrolled at school.
• It is recommended that parents disclose information related to a child's infection status to the principal for two reasons. Firstly, it will be to the student's advantage for parents to give the principal; this information so that the school can work with the parents to provide the best possible support. Secondly, it is important that those who `need to know' are informed.
• There is no need to seek parents' consent for disclosure if parents have been advised about the school's HIV/AIDS and other blood-borne viruses policy, it is published and it clearly defines:
  • The purpose for which the school collects and uses the information; and
  • Who needs to be informed and what they `need to know'.

  Partnership with parents and the local community is vital

  Health education programmes are more likely to succeed if there is partnership with parents and support from the local community. This is particularly true of issues, such as HIV/AIDS, that can generate an emotional, response. A successful education programme wills reassure schools and their communities about the nature of the disease and create a more accepting environment. Parents of all students will also be reassured that an HIV/AIDS student represents a minimal risk to the health and safety of other students.

  Effective communication strategies should be developed to deal with any adverse publicity that can arise if it is known a student with HIV/AIDS is attending the school. Boards should:

  • invite health professionals to work with the school community;
  • provide opportunities for open discussion eg. A parent meeting;
  • talk to students; and
  • develop a strategy for dealing with publicity.

  See section 5 of these guidelines for one school's experience dealing with an HIV positive child in their community.

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  Policies and procedures

  Policies

  Boards of trustees should ensure school policies are underpinned by the principles noted in section 1. Schools should have a range of up-to-date health and safety policies to meet the requirements of National Administration Guideline 5 which states:

  "Each Board of Trustees is required to:

  • provide a safe physical and emotional environment for students;
  • comply in full with any legislation currently in force or that may be developed to ensure the safety of students and employees."

  Polices should address issues of privacy, behaviour, discipline, human rights, complaints, HIV/AIDS, prevention of the spread of infection/disease, and health and safety of students in the school and staff in the workplace.

  Schools should develop a policy on infection control issues surrounding HIV/AIDS and other blood-borne viruses (See section 1 c for details).

  Procedures

  The principal and staff should develop detailed procedures to support health and safety policies. These should include a timeframe for regular monitoring. A staff member should be delegated responsibility for monitoring the effective implementation of such procedures.

  All personnel should know how to carry out the school's first aid safety procedures. See Appendix A. Guidelines for Infection Control of HIV/AIDS and Other Blood-borne Viruses in Schools.

  Staff who work in areas where there is special equipment or machinery, or who have specific health and safety responsibilities, should be knowledgeable about the risks and safety practices involved. Such staff could be, for example, technicraft, outdoor education teachers and the school nurse.

  School cleaning staff should be trained in the correct procedures for the disposal of contaminated wastes.

  First aid kits should be sited strategically around the school, particularly in areas where an injury is more likely to be sustained. These should contain all necessary materials and equipment. Students should also be trained in the correct safety procedures. Following these procedures will prevent transmission of blood-borne viruses when providing first aid.

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  Developing Teaching and Learning Programmes

  Professional Development

  Boards should provide opportunities for staff to participate in professional development in health and safety areas. This is a key component in the successful management of HIV/AIDS and other blood-borne viruses in the school community.

  Teaching and Learning Programmes

  School health education programmes should develop the knowledge, understandings, skills and attitudes necessary for students to deal confidently with matters surrounding HIV/AIDS and other blood-borne viruses.

  Health education programmes should be based on the Health and Physical Education in New Zealand Curriculum. Important areas to note are:

  • Creating Positive Learning Environments;
  • Mental Health;
  • Sexuality Education; and
  • Body care and Physical Safety.

  Teachers should take into account the differing needs of students from the diverse range of identities and cultures represented in our schools. Sensitive issues in health education should be approached in a way that suits the individual and family situation. For example, the family or whanau may wish to be included in discussions.

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  Legal and contractual obligations

  The board's legal and contractual obligations are set out in the following legislation:

  • Education Act 1989, s3 - A student's entitlement to free education in any state school.
  • Human Rights Act 1993, s21 and 57 (1). It is unlawful for a school to discriminate against an HIV/AIDS student. Section 60 (2) provides the exception where there is an unreasonable risk of harm to the student or to others. However, the exception does not apply if the school can take reasonable measures to reduce the risk of harm to a normal level (see s60 (3).
  • Health Act 1956. Its purpose is to improve, promote and protect public health.
  • Health (infectious and Notifiable Diseases) Regulations 1996 . Sets out legal responsibilities in relation to infectious diseases. The Health (Immunisation) Regulations 1995 require primary schools to maintain an immunisation register showing the immunisation status of children born from January 1995. The immunisation schedule includes protection against Hepatitis B. Having a highly immunised population at school also provides some protection for HIV infected children by reducing their exposure to vaccine preventable diseases.
  • Privacy Act 1993, s6 - Information Privacy Principles. In particular, Principle 3 - Collection of information from subject and 11 - Limits on disclosure of personal information (see Appendix C attached).
  • Health and Safety in Employment Act 1992 Employers shall take all practicable steps to ensure the safety of employees while at work.
  • National Education Guidelines 1993, National Administration Guidelines (1 iv & 5 i, ii). Boards of trustees must develop and implement strategies which address identified learning needs to overcome barriers to students' learning, provide a safe physical and emotional environment for students and comply with any legislation to ensure the safety of students and employees.

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  Where to go for further information

  A useful video resource: Taking Care (1992) This is a 20 minute video you can purchase from the Video Production Unit, Christchurch College of Education, P.O. Box 31-065 Christchurch. Cost $33.75 including GST & postage.

  This video was developed by a school "faced with integrating an HIV positive child into its midst and was determined there would be none of the prejudice and problems that have been apparent elsewhere".

  A useful policy resource written from a medical perspective: Education of children with human immunodeficiency virus infection: guidelines for families, health care and education personnel (1994). Infection and Immunisation Committee of the New Zealand Paediatric Society, NZ Medical Journal 13 April 1994 pp.124-6.

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  Contact Addresses/Phone No/Fax No

  NZ AIDS Foundation
  24 Hour Toll Free AIDS Hotline: 0800 802437 OR (09) 358 0099 (if dialling within Auckland).

  National Office
  1st Floor, 31-35 Hargreaves Street, Ponsonby
  P O Box 6663, Wellesley Street, Auckland
  Tel: (09) 303 3124 Fax: (09) 309 3149
  Email: contact@nzaf.org.nz.

  Librarian
  New Zealand AIDS Foundation
  P O Box 6663, Wellesley Street, Auckland
  Tel: (09) 303 3124 Fax: (09) 309 3149
  Email: Librarian@nzaf.org.nz.

  Burnett Centre
  Unit 1/3 Poynton Tce, Newton, Auckland
  Tel: (09) 309 5560 - Fax: (09) 302 2338
  Email: contact.burnett@nzaf.org.nz.

  Te Puawaitanga o Te Ora - NZAF Midland
  11 Ohaupo Road, PO Box 41, Hamilton
  Tel: (07) 838 3557 - Fax: (07) 838 3514
  Email: contact.hamilton@nzaf.org.nz.

  Awhina Centre
  Level 3, 27 Dixon Street, Wellington
  PO Box 9247, Marion Square, Wellington
  Tel: (04) 381 6640 - Fax: (04) 381 6641
  Email: contact.awhina@nzaf.org.nz.

  NZAF South - Te Toka
  269 Hereford Street
  PO Box 13618, Armagh, Christchurch
  Tel: (03) 379 1953 - Fax: (03) 365 2477
  Email: contact.tetoka.@nzaf.org.nz.

  Sexual Health Clinics are an appropriate place to get information and testing for blood borne viruses. Look in your phone book under "Hospitals and other health service providers" for local phone numbers.

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  Public Health Services

  The nearest hospital and health service:

  Public Health Manager Primary and Community Health Services Northland Health PO Box 742 WHANGAREI Phone: (09) 430 4100 Fax: (09) 430 4124	Public Health Protection Manager Public Health Protection Service Auckland Healthcare Private Bag 92 605 Symonds Street AUCKLAND Phone: (09) 262 1855 Fax: (09) 630 7431	Public Health Manager Public Health Unit Health Waikato PO Box 505 HAMILTON Phone: (07) 838 2569 Fax: (07) 838 2382
  Regional Public Health Manager Toi Te Ora - Public Health Pacific Health PO Box 241 WHAKATANE Phone: (07) 307 8720 Fax: (07) 307 8992	Public Health Manager Public Health Unit Tairawhiti Health Private Bag 119 GISBORNE Phone: (06) 867 9119 Fax: (06) 867 8414	Public Health Manager Health Protection Unit Taranaki Healthcare Private Bag 2016 NEW PLYMOUTH Phone: (06) 753 7798 Fax: (06) 753 7788
  Public Health Manager Public Health Unit Health Care Hawkes Bay PO Box 447 NAPIER Phone: (06)834 1815 Fax: (06) 835 4813	Public Health Manager Public Health Unit MidCentral Health Private Box 1942 PALMERSTON NORTH Phone: (06) 358 1055 Fax: (06) 350 1106	Manager Regional Public Health Service Hutt Valley Health LOWER HUTT Phone: (04) 570 0044 Fax: (04) 570 4401
  Public Health Manager Public Health Unit Nelson Marlborough Health Private Box 647 NELSON Phone: (03) 546 1537 Fax: (03) 546 1542	Chief Executive Crown Public Health PO Box 1475 CHRISTCHURCH Phone: (03) 379 9480 Fax: (03) 379 6125	Public Health Manager Public Health Service Healthcare Otago PO Box 5144 Moray Place DUNEDIN Phone: (03) 474 1700 Fax: (03) 474 0221
  Public Health Manager Southern Public Health Service PO Box 1364 INVERCARGILL Phone: (03) 214 2375	Ministry of Health National Office P O Box 5013 WELLINGTON Phone: (04) 496200 Fax: (04) 496 234

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  Human Rights Commission
  P O Box 6751, Wellesley St, Auckland
  Toll Free Phone No 0800 496 877
  Email: hrc@hrc.co.nz

  P.O. Box 5045, Lambton Quay, Wellington
  Tel: (04) 473 9981

  P.O. Box 1578, Christchurch
  Tel: (03) 379 2051

  The Office of the Commissioner Privacy Commissioner for Children
  P O Box 12537, Thorndon, Wellington
  Tel: (04) 471 1410 - Fax: (04) 471 1418

  P O Box 466, Auckland
  Tel: (09) 302 8680 - Fax: (09) 302 2305
  Toll Free 08000 803 909
  Email: privacy@iprolink.co.nz

  New Zealand School Trustees Association (NZSTA)
  Te Whakaroputanga Kaitiaki Kura O Aotearoa
  P O Box 5123, Wellington, New Zealand Tel: +64 4 473 4955
  Fax: +64 4 473 4706
  Email: admin@nzsta.org.nz

  Websites

  Human Rights Commission:
  http://www.hrc.co.nz/

  New Zealand School Trustees Association:
  http://www.nzsta.org.nz/

  Ministry of Health:
  www.moh.govt.nz

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  Acknowledgements

  The Ministry of Education would like to acknowledge the contribution of the Ministry of Health, New Zealand AIDS Foundation, New Zealand School Trustees Association, The Office of the Commissioner for Children, The Privacy Commissioner and The Human Rights Commission.

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  Appendix A

  Guidelines for infection control of HIV/AIDS and other blood-borne viruses in schools

  1. Before treating a child who is bleeding, make sure you cover any cuts or abrasions with a water-proof dressing.
  2. Wear gloves for all procedures.
  3. Don't delay treatment of a child who is bleeding, under any circumstances because gloves are not immediately available. Use an absorbent barrier such as a towel, paper towel, handkerchief etc. for an actively bleeding child.
  4. Dispose of used gloves, soiled dressings, sanitary towels, tissues, etc, in a place where they will not be handled, e.g. in bags which are burnt or buried.
  5. Wipe clean and then sterilise all surfaces and instruments contaminated with blood. Make sure you use an effective disinfectant, e.g. (one volume of household bleach to nine volumes of cold water).
  6. Soak surfaces for 20 minutes and then wipe dry. Prepare a fresh solution immediately before you want to use it.
  7. Wash hands thoroughly when you have finished. Hand washing is usually adequate for non-blood secretions, but the above precautions (i.e. gloves, etc) can also be used.
  8. Make sure that first-aid kits include disposable gloves, disposable wipes or towels, plastic bags for contaminated waste, a skin disinfectant and a bleach solution (or hypochlorite solution/or granules) with instructions for use.

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  Appendix B

  Some useful information about HIV/AIDS and Hepatitis B and C

  Definitions

  Human Immunodeficiency Virus (HIV): This is a virus which attacks the immune system. It is both immune suppressing and opportunistic, not only depleting the immune system but replicating within the body as the immune system becomes more damaged. People with HIV become increasingly likely to develop certain infections, or some forms of cancer, which the body would normally be able to resist easily.

  Acquired Immune Deficiency Syndrome (AIDS): This is the most severe clinical expression of infection with HIV. AIDS is diagnosed according to clinical criteria established by the Ministry of Health. These criteria include the diagnoses of one of several opportunistic infections, including Kaposi's sarcoma, lymphoma, and a rare form of pneumonia.

  Hepatitis B: This is a vaccine preventable viral infection of the liver that causes nausea, loss of appetite, vomiting and jaundice (yellow skin).

  Hepatitis C: This is a blood-borne viral disease that affects the liver and can cause serious long-term liver problems.

  "Notifiable" diseases

  The Health Act (1956) determines that there is a list of diseases specified as infectious and a list of diseases that are notifiable. Examples of notifiable diseases include, AIDS, new cases of Hepatitis C, Hepatitis B and meningococcal disease.

  A medical doctor is legally required to notify the Medical Officer of Health that a person has AIDS. Boards of trustees, principals and parents are NOT required to carry out the notification.

  Although AIDS is a notifiable disease, the doctor does not use the patient's name when he/she is making the notification. Thus this information remains confidential between the doctor and the patient.

  The reason for notification is to monitor the number of cases occurring in New Zealand and not to take specific action with any particular case.

  HIV is not on the Ministry of Health's list of infectious or notifiable diseases. There is no legal requirement for this infection to be notified to health authorities.

  How these viruses are transmitted

  HIV can only be transmitted through sexual intercourse/activity involving the exchange of body fluids (semen & vaginal fluids); the exchange of blood by sharing needles and syringes, by injecting drug users. It can also be transmitted from mother to baby during pregnancy, delivery and breastfeeding.

  HIV positive children represent a minimal risk to others. It has not been conclusively demonstrated that HIV (and hepatitis B) infected children who bite others transmit the virus. Any child who is bleeding from an injury should be removed for the protection and safety of all other participants in whatever sport they are playing. The injury should be treated following the safety procedures set out in these guidelines. (Appendix A)

  HIV is not transmitted by casual contact, such as sneezing, handshaking, and the sharing of eating and toilet facilities.

  Hepatitis B is transmitted through close contact with blood or other body fluids of an infected person. This can happen in a number of ways:

  • by close physical contact;
  • by sexual intercourse;
  • from mother to baby when the baby is born;
  • by injecting drug users sharing non-sterilised needles; and
  • by tatooists using non-sterilised needles.

  Hepatitis C is transmitted through contact with infected blood. It occurs through sharing contaminated injecting equipment and contaminated skin piercing such as tatooing and body piercing.

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  Appendix C

  Privacy Act 1993

  Information privacy principles

  There are 12 information privacy principles. Principles 3 and 11 are as follows:

  PRINCIPLE 3 Collection of information from subject

  (1) Where an agency collects personal information directly from the individual concerned, the agency shall take such steps (if any) as are, in the circumstances, reasonable to ensure that the individual concerned is aware of---

  1. The fact that the information is being collected; and
  2. The purpose for which the information is being collected; and
  3. The intended recipients of the information; and
  4. The name and address of--- (i) The agency that is collecting the information; and (ii) The agency that will hold the information; and
  5. If the collection of the information is authorised or required by or under law,--- (i) The particular law by or under which the collection of the information is so authorised or required; and (ii) Whether or not the supply of the information by that individual is voluntary or mandatory; and
  6. The consequences (if any) for that individual if all or any part of the requested information is not provided; and
  7. The rights of access to, and correction of, personal information provided by these principles.

  (2) The steps referred to in subclause (1) of this principle shall be taken before the information is collected or, if that is not practicable, as soon as practicable after the information is collected.

  (3) An agency is not required to take the steps referred to in subclause (1) of this principle in relation to the collection of information from an individual if that agency has taken those steps in relation to the collection, from that individual, of the same information or information of the same kind, on a recent previous occasion.

  (4) It is not necessary for an agency to comply with subclause (1) of this principle if the agency believes, on reasonable grounds,---

  1. That non-compliance is authorised by the individual concerned; or
  2. That non-compliance would not prejudice the interests of the individual concerned; or
  3. That non-compliance is necessary---
     1. To avoid prejudice to the maintenance of the law by any public sector agency, including the prevention, detection, investigation, prosecution, and punishment of offences; or
     2. For the enforcement of a law imposing a pecuniary penalty; or
     3. For the protection of the public revenue; or
     4. For the conduct of proceedings before any court or Tribunal (being proceedings that have been commenced or are reasonably in contemplation); or
  4. That compliance would prejudice the purposes of the collection; or
  5. That compliance is not reasonably practicable in the circumstances of the particular case; or
  6. That the information---
     1. Will not be used in a form in which the individual concerned is identified; or
     2. Will be used for statistical or research purposes and will not be published in a form that could reasonably be expected to identify the individual concerned.

  PRINCIPLE 11 Limits on disclosure of personal information

  An agency that holds personal information shall not disclose the information to a person or body or agency unless the agency believes, on reasonable grounds,---

  1. That the disclosure of the information is one of the purposes in connection with which the information was obtained or is directly related to the purposes in connection with which the information was obtained; or
  2. That the source of the information is a publicly available publication; or
  3. That the disclosure is to the individual concerned; or
  4. That the disclosure is authorised by the individual concerned; or
  5. That non-compliance is necessary---
     1. To avoid prejudice to the maintenance of the law by any public sector agency, including the prevention, detection, investigation, prosecution, and punishment of offences; or
     2. For the enforcement of a law imposing a pecuniary penalty; or
     3. For the protection of the public revenue; or
     4. For the conduct of proceedings before any court or Tribunal (being proceedings that have been commenced or are reasonably in contemplation); or
  6. That the disclosure of the information is necessary to prevent or lessen a serious and imminent threat to---
     1. Public health or public safety; or
     2. The life or health of the individual concerned or another individual; or
  7. That the disclosure of the information is necessary to facilitate the sale or other disposition of a business as a going concern; or
  8. That the information---
     1. Is to be used in a form in which the individual concerned is not identified; or
     2. Is to be used for statistical or research purposes and will not be published in a form that could reasonably be expected to identify the individual concerned; or
  1. That the disclosure of the information is in accordance with an authority granted under section 54 of this Act.

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  Bibliography

  Department of Health Te Tari Ora HIV/AIDS - Information for Health Professionals.

  Ministry of Education (1999) Health and Physical Education in the New Zealand Curriculum.

  Neil Orr, (July 1994) National Forum on AIDS and Children, HIV and Children, Highlight No 129.

  New Zealand Medical Journal (April 1994). Education of children with human immunodeficiency virus infection: guidelines for families, health care and education personnel.

  NZSTA (July 1995). The Guidelines to the Privacy Act 1993.

  Office of the Commissioner for Children. The United Nations Convention on the Rights of the Child.

  Wellington Community Law Centre (March 1999). Schools and the right to discipline - A guide for parents.

  World Health Organisation (1991). AIDS prevention through health promotion - Facing sensitive issues.

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  Issued by

  Kathy Phillips
  Senior Manager, National Operations National Office
  45 - 47 Pipitea Street, Thorndon
  P O Box 1666, Wellington, New Zealand
  Phone: 0-4-463 8000
  Fax: 0-4-463 8001

• When developing a new, or changing an existing HIV/AIDS or other blood-borne viruses policy, care should be taken to involve parents of children already enrolled in the school.
• Schools should not inform the parent body of a child's HIV Hepatitis B or other blood-borne virus. The consequences of a breach of confidentiality can be extremely serious for families, leading to social isolation or even harassment.