4 Elementary School–Aged Children 101and learn to care for their own health. Additionally, medication can minimize
the mother’s viral load and diminish the chance of transmission to her babies.
Although some transmission still occurs among women who receive little or
no prenatal care due to struggles with addictions, mental health issues, reli-
gious beliefs, IPV, poverty and/or other psychosocial issues, the majority of
women receive enough care that they are able to give birth to children who do
not go on to have HIV infection.
Clinics like ours originally developed to follow children who were peri-
natally HIV-infected and continue to follow families from the earlier era. Fewer
neonates are born with the virus now. We have, however, seen an increase in
HIV-positive children who have been born outside the United States and then
adopted. Our clinic works with children to help them receive the medical care
they need, and also helps the families teach their children about their condi-
tion as they grow using developmentally appropriate teaching methods.
Children who are infected must take their HAART medications consis-
tently, and yet very young children do not understand why they must swallow
the foul-tasting liquid, and later learn to swallow pills. This is an ongoing pro-
cess and one that changes depending on each individual child’s developmental
stage. When children with HIV are very young, most of the work of the social
worker is with the family. Many families with perinatally transmitted HIV are
affected by poverty, drug use, minimal family supports, inadequate education
systems, and/or untreated mental illness. Often, the early work involves getting
families connected to health insurance, cash benefits, stable housing, legal sup-
ports, and other concrete resources while building trusting relationships. These
relationships allow us to help families be consistent with medical care and pro-
vide the emotional and medical support necessary to help the family explain the
diagnosis and treatment of HIV to their children as they grow. Disclosing the
diagnosis to children has been fraught over the years. Traditionally, children have
been viewed as needing to be protected from such information, but Bluebond-
Langner’s pivotal book in the late 1970s challenged this notion (Heeren, 2011).
Heeren also notes that the stigma associated with HIV infection is very strong in
the United States, yet even stronger in many other countries. Families fear that
if they tell their children their medical diagnosis, they will disclose their status
to others, resulting in the children and family being ostracized.
We suggest that children learn about their diagnosis and its meaning
between the ages of 9 and 11, but we work with them before that time to help
them understand how to keep their bodies healthy. Until about first or second
grade, most children will go along with what their caregiver tells them to do.
We may need to help them learn how to swallow pills at this age, but on the
whole, our social work role is to support the family and help the caregivers
stay healthy so that they can help the child thrive. As children become aware
of their specific needs, we focus on how their visits to the clinic help them to
stay healthy and strong. This is the beginning of the disclosure process. In
later years, most children will start to notice that their need to take medica-
tion and have frequent medical appointments differs from their siblings and
peers. A child may begin to ask questions about why they need to take medi-
cation. We often start by comparing their medication to something preventive
that they already understand. For instance, one boy had a dog that took heart-
worm preventive medicine every day and we compared his medicine to his