6.3 Counselling

A child with suspected HIV generally means a family with suspected HIV. Counselling therefore has to take into consideration the mother and, if possible, the father. See Chapter 5 for the issues for discussion with adults with suspected HIV.

Pre-test counselling

It is important to counsel the mother and obtain her consent before testing her blood (if the child is under 18 months) or the child’s blood (if the child is over 18 months) for HIV. If her child tests HIV positive, then it is extremely likely that she is the source of infection and is HIV positive.

Consider the bad news for the mother when she hears that her child may have HIV infection:

· her child may have an incurable and fatal disease;
· she herself may have HIV;
· her husband may have HIV;
· any future children may have HIV.

Her decision to have a test or not is difficult. She will need time and support while she considers the advantages and disadvantages of a test. If she knows she is HIV-positive, the main advantage is that she can plan for the future. The main disadvantage is the fear that her husband may beat her or leave her if she tells him that she is HIV-positive.

Post-test counselling

Consider a mother whose child has TB and suspected or known HIV infection. See Chapter 5 for the issues for discussion relevant to anyone who tests HIV-positive. There are other issues specific to a mother who tests HIV-positive. These include the poor outlook for the child and the risk for future babies of HIV infection. About one third of children born to HIV-positive women are also HIV-infected.

When counselling women who are breast-feeding or who have delivered recently it is important to discuss breast-feeding. There may be o small risk of HIV transmission by breast-feeding. However, in many low-income countries, breast-feeding is still a safer alternative to bottle-feeding. For example, consider a child whose mother is HIV-positive and who lives in an environment where there is no clean water. The child is probably at higher risk of dying from diarrhoea if bottle-fed than from AIDS if breast-fed.

SUGGESTIONS FOR FURTHER READING

Chintu C, Bhat G, Luo C, et al. Seroprevalence of human immunodeficiency virus type 1 in Zambian children with tuberculosis. Pedr Infect Dis J 1993; 12:499-504.

Sassan-Morokro M, De Cock KM, Ackah A, et al. Tuberculosis and HIV infection in children in Abidjan, Cote d’Ivoire. Trans Royal Soc Tr Med and Hygiene 1994; 88: 178-181.

WHO. Global Programme on AIDS. Source Book for HIV/AIDS Counselling Training. Geneva, 1994.

WHO Global Programme on AIDS. Counselling for HIV/AIDS: a key to caring. Geneva, 1995.