Question: My child, age five years, has recently started attending a local play school. I have heard so much about HIV and AIDS, the latest being that more and more children are being infected. What are the chances of my child contracting HIV/AIDS at play school?

Answer: Often HIV/AIDS is associated with and thought of as an adult concern and issue. Over the past decade, children have however received attention with regard to HIV/AIDS, not only however as those seen as affected but also as those who at risk of infection.

To allay your fears, it is necessary to state that the highest risk of transmission of HIV in children is through vertical infection. This means that during her pregnancy or during the childbirth process, an HIV positive mother does stand the chance of passing the virus on to her baby. Some studies indicate that babies are also at risk of infection when breastfed by an HIV positive mother. Other sources of HIV infection in children are through child sexual abuse and caring for those infected (this is usually the case in older children).

Increased research in the area of HIV/AIDS and children show that children who have been infected vertically often live to puberty and that these children have become more visible in certain settings.
What you could possibly have come across regarding the increase in the number of infected children is what is referred to as long-term progressors. These are children who have been vertically infected, and have lived with the virus for many years before becoming ill and succumbing to the disease.
These are children infected with HIV who remain relatively healthy and who manage to live through childhood. They therefore are able to do most things that "normal" children do, for example, going to school, having friends, playing games/sport, etc.

There are also those referred to as short-term progressors. These are HIV positive children who also through vertical transmission have become infected, but because of severely compromised immune systems, become ill soon after birth. Within the first year they have usually experienced many illnesses and often only live until approximately age 5. During these few years, because of compromised health and functioning, they often require much more attention, and are often not as able to develop with the same freedom as other children of similar age. Often it is unlikely that "slow-progressors" would be going to play school.
This said, it is important to state that while children engage in rough-and -tumble games sometimes, the likelihood of being infected at play school is very minimal.

HIV is transmitted via bodily fluids, mainly blood. HIV can be passed on through:

• Unprotected sexual intercourse
• Intravenous drug use, using infected needles
• Vertical transmission (as discussed previously)

The main factor however is exposure to blood, as this bodily fluid is the most "concentrated" with HIV.
Children, while curious, might be concerned about their friend or someone who has hurt themselves and are bleeding, but are not that curious to handle blood. The sight of blood is enough for children naturally to be cautious.

However, like we teach our children other important things, like their address, telephone numbers, how to cross the street, so as to be safe, we should also teach our children how to protect themselves in terms of HIV. Of course, this like all complex things we teach our children needs to be age-specific.
It would therefore at "play school" age be useful to teach children what to do when there is exposure to blood. What is useful and in many schools this is what is being taught, is the following:

• Do not touch the blood
• Call a teacher or another adult immediately
• Try to remain calm and not to crowd the injured person

It is ironic however that it is the infected child, rather than the uninfected child who is more at risk of becoming ill from shared contact. Playschools are often places where there are numerous bugs afloat. The infected child's compromised immunity places him/her in a vulnerable position to become very ill from picking up a bug that the uninfected child's immune system would be able to fight with relative ease.