Three siblings in the Pea Ridge School District in Arkansas were sent home from school last week and told they could not return until they provided administrators with documentation of their HIV status. Disability advocates are calling the school’s actions “unlawful and immoral,” but school officials have suggested that aspects of the students’ behavior put other students and staff at risk.
According to the Disability Rights Center of Arkansas (DRC), the issue began on September 9, when school officials called a meeting with the siblings’ case worker. In that meeting, the school officials said the three kids could not return to school until they received documentation that the children are not HIV-positive. Administrators had reportedly learned over the summer that one of the four siblings in the family (only three of them are of school age) and their birth mom are HIV-positive. They then demanded information on the others.
The siblings have been in and out of foster care over the years, and their current foster parents refused the request on the advice of experts who said the kids could not be denied education because of their HIV status. When they returned to school the next day without any paperwork, administrators reportedly kept them apart from the other kids and demanded that the foster parents come get them. The superintendent then informed the foster parents that upon advice from school counsel, the students were not to return to school without documentation. One of the siblings missed his first football game because of this disagreement.
The DRC is investigating the incident. The organization’s executive director, Tom Masseau, said in a statement, ”The fact that the foster families have to provide documentation that the children are HIV negative before entering the school is unlawful and immoral. Further, the fact the school’s attorney authorized this unlawful act is at best appalling. It stigmatizes individuals with disabilities or their ‘perceived’ disabilities as there is no indication these individuals have HIV.”
The school’s actions do appear to violate the Americans With Disabilities Act (ADA), which says that public schools cannot prohibit young people from attending because of their HIV status. Many of us remember when this issue first made headlines in 1984, with the case of Ryan White. White, who had hemophilia, was 13 at the time and had contracted HIV through blood transfusions. The Kokomo, Indiana, school district would not allow him to attend classes for fear he would spread HIV to other students. Instead, they insisted he “dial in” to his seventh-grade courses from home. White took the district to court and won. Still, he faced so much discrimination at school that his family relocated to another community about 20 miles away.
Ryan White’s fight was at the beginning of the U.S. AIDS epidemic, when people did not understand how HIV was and was not transmitted. People feared that a playground accident or nose bleed could expose numerous children to HIV. There was also fear that the virus could be transmitted through casual contact such as sharing drinks, utensils, or toilets.
Today we understand that HIV can only be contracted through direct contact with blood, semen, vaginal fluids, or breast milk. Though HIV is present in saliva, it is not in high enough concentrations to transmit the virus. Moreover, there is widespread understanding that schools should protect staff and students by taking universal precautions—which essentially means assuming that anyone might be infected, and handling all bodily fluids with care (for example, using latex gloves when helping a student who is bleeding or when cleaning up blood, vomit, or other fluids). If such precautions are applied to all students, the HIV status of an individual student becomes irrelevant.
In this case, however, the school argues that the behavior of these siblings may mean they pose an increased risk to staff and students. After days of not responding to media requests for information, the school district put out a press release last week, which said in part:
The Pea Ridge School District is dedicated to providing a safe environment for our students, teachers and staff.
As reported in the media, the district has recently required some students to provide test results regarding their HIV status in order to formulate a safe and appropriate education plan for those children. This rare requirement is due to certain actions and behaviors that place students and staff at risk.
Though the school district did not provide any additional information, the DRC reports that two of the siblings have sensory processing issues and become overwhelmed easily. When these students do become overwhelmed, they often lash out and hit, scratch, or bite themselves or others. While hitting and scratching cannot transmit HIV, human bites do pose a risk of transmission.
According to the Centers for Disease Control and Prevention (CDC):
It is very rare, but in specific circumstances HIV can be transmitted by a human bite. In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other rare reports in the medical literature in which HIV appeared to have been transmitted by a human bite. Biting is not a common way of transmitting HIV, in fact, there are numerous reports of bites that did not result in HIV infection. Severe trauma with extensive tissue damage and the presence of blood were reported in each of the instances where transmission was documented or suspected. Bites that do not involve broken skin have no risk for HIV transmission, as intact skin acts as a barrier to HIV transmission.
Despite this very small risk, experts agree that the school has no scientific reason to know the siblings’ status. Jeffrey Levi, executive director of Trust for America’s Health, told RH Reality Check, “This is an old and settled question—testing is not required, knowledge of students’ serostatus is not required.” He added that in all the years of the epidemic there has never been transmission of HIV in a school setting, and said that the biting did not add to the risk. “Any exposure to blood should be treated with universal precautions,” he added.
The last time the American Academy of Pediatrics (AAP) addressed this issue was 1999. The organization explained:
Discussions about children with HIV infection attending schools have disclosed that discrimination has occurred and that erroneous information, ie, HIV is likely to be transmitted in the school setting, has been given. These situations create unnecessary hardships for children and their families and illustrate the continuing need for community educational programs about HIV transmission.
The AAP concluded, “Knowledge of a child’s HIV status is unnecessary for school entry. Disclosure of a child’s HIV status to the school should not be required.”
Jeffrey Crowley, program director of the National HIV/
The question here, Crowley said, is not only whether there is risk, but who gets to make that call: “We as a society decided we didn’t want these decisions to rest with individual superintendents across the country, which is why Congress passed the Americans With Disabilities Act. It’s comprehensive and it’s the law of the land.” As mentioned earlier, the ADA is very specific when it comes to HIV in schools, and though it does make exceptions for a direct threat, a child with HIV, even one who bites, is not a danger to the school community. In an ADA fact sheet, the Department of Justice explains that “[p]ersons with HIV or AIDS will rarely, if ever, pose a direct threat in the public accommodations context.”
Not only is the risk of transmission through biting incredibly small, but the steps school officials would take in handling a bite would not change if they knew that the “biter” was HIV-positive. As Crowley noted, “If you’re trying to protect children, this actually does a lot of harm through stigmatization.”