The BSTU's Teachers' Handbook on HIV/AIDS

The purpose of this document is to seek to reassure teachers as to the possible risk of being infected by contact with members of the school community who may be carriers of the HIV virus.

The UK Department of Education and Science booklet "Children at School and AIDS" is available for reference. Every teacher should have access to this booklet, which contains a great deal of useful information. Please contact the BSTU if a copy is not available within your school. The BSTU is attempting to build up resource material for its members.

The BSTU has set up a Sub-Committee to advise on all matters relating to AIDS and the Sub-Committee, in conducting its investigations, was able to obtain information from several sources. The Union acknowledges with gratitudethe assistance given by the National Education Association of the USA, the Canadian Teachers Federation adn the National Union of Teachers in Great Britain. Parts of this document have been copied directly from the material made available to the BSTU.

The BSTU should also like to record and acknowledge the assistance given to it by members of the Medical profession here in Barbados.

The BSTU is aware that research into the extent of the spread of AIDS in the Caribbean is being conducted by the Caribbean Epidemiology Centre in Trinidad. The BSTU is also aware of the work being undertaken in Barbados by the National Advisory Committee on AIDS. The BSTU has been able to offer its comments on the draft position paper prepared by that body.

Normally, when a virus enters the blood, certain white blood cells known as T4 Helper Lymphocytes attack and kill the virus. When HIV enters the blood, it can infect and destroy some of these white blood cells. As a result, people infected with the virus are more likely to develop illnesses which the body would normally be able to combat. These illnesses can become serious and may be fatal. The development of clinical AIDS can lead to serious infections in the lungs, digestive system, central nervous system and in the skin. Particular forms of cancer may also develop. At present, there is no known cure for AIDS, although many of the less severe illnesses can be treated.

Infection with HIV does not necessarily lead to the development of clinical AIDS. Most infected people show no symptoms and remain fit and well, at least in the short term, and can therefore be identified only by a test for the presence of virus antibodies in their blood. Latest implications suggest that many carriers of the HIV virus may eventually develop the full disease. IT IS IMPORTANT TO EMPHASISE THAT ALTHOUGH THE MAJORITY OF THOSE INFECTED WITH THE HIV SHOW NO SYMPTOMS, THEY MUST BE REGARDED AS CARRIERS OF THE VIRUS AND MAY THEREFORE BE ABLE TO TRANSMIT IT TO OTHERS.

HIV is a fragile virus which is easily destroyed and much less infectious than, for example, the Hepatitis B virus. It is difficult to pass from person to person and can only happen in certain circumstances, i.e.

• through sexual intercourse with an infected person;

• by entry of infected blood or blood products into the bloodstream;

• from an infected mother to her newborn baby, either during pregnancy or possibly through breast feeding.

Although the virus has been isolated in many body fluids, cases of transmission have been recorded only from blood, semen and, possibly, breast milk. There is no evidence to suggest that the virus is transmissible through saliva or tears. Infection is not spread through the air (for example by coughing, sneezing or spittle). Nor is there evidence of danger from handling objects which has been used by an infected person, from sharing toilets, or sharing eating and drinking utensils. None of the family members of the 12,000 AIDS patients reported to the Centre for Disease Control in the USA have been reported to be infected with the HIV virus except those who are in sexual or perinatal contact with the patients.

CURRENT EVIDENCE INDICATES THAT CHILDREN IDENTIFIED AS HIV CARRIERS DO NOT PRESENT A RISK TO OTHER CHILDREN OR ADULTS IN THE ORDINARY SCHOOL ENVIRONMENT. THE BSTU EXECUTIVE THEREFORE FULLY SUPPORTS THE VIEW THAT CHILDREN IDENTIFIED AS BEING INFECTED SHOULD BE ALLOWED TO ATTEND SCHOOL FREELY AND BE TREATED IN THE SAME WAY AS OTHER PUPILS.

The BSTU executive also supports the view that new practices should be adopted in relation to those school subjects or activities where risks may occur (e.g. an HIV carrier giving blood for science lessons). Certain children's social practices which should be discouraged to prevent the spread of infection include tattooing and ear-piercing. The risk of AIDS presented by these practices is believed at present to be small, but there are a number of other health reasons why discouraging such practices is a sensible precaution.

If any school is not so equipped, the matter should be reported forthwith to the BSTU staff representative at the school. This report and the action taken by the BSTU staff representative should then be relayed without delay to the BSTU.

If, for any reason, a child is identified as an HIV carrier, any information concerning that child must be discreetly managed in order not to emphasise the situation.

Any decision as to the extent of any disclosure within a school will require careful consideration in each case, with the benefit of medical advice, on the discharge of a school's responsibilities for proper care of the child.

We should also hope that the information contained in this booklet will provide reassurance in situations where members of the school community are identified as HIV virus carriers.

1. Disposable gloves
2. Adequate supplies of bleach (e.g. Clorox) and disinfectant (e.g. Milton and Cetavlon or Dettol)
3. Paper towels

The following is the basic hygiene procedure recommended by the BSTU. This procedure should be put into operation in all instances to provide protection against a range of infections to which teachers in schools may be exposed.

1. PERSONAL HYGIENE

   Razors, toothbrushes or other implements which could become contaminated with blood must not be shared.

   Minor cuts, open or weeping skin lesions and abrasions should be covered with waterproof dressings.

2. ACCIDENTS INVOLVING EXTERNAL BLEEDING

   Normal First Aid procedures should be followed which include the use of disposable gloves.

   Wash wounds immmediately and copiously with a product such as Cetavlon or Dettol and water. Apply a suitable dressing and pressure pad if needed.

   As soon as possible, seek medical advice.

   If there are splashes of blood from one person to another:

       - splashes of blood on the skin should be washed off immediately with soap or disinfectant and water;

       - splashes of blood into the eyes or mouth should be washed out immediately with copious amounts of water.

   After accidents resulting in bleeding, contaminated surfaces (e.g. floors, tables or furniture) should be cleaned liberally with household bleach, freshly diluted 1:10 in water. Such solutions must not come in contact with the skin.

   N.B.Bleach can corrode metal and burn holes in fabric if used for too long or in the wrong concentration.

3. GENERAL HYGIENE

   Normal cleaning methods should be used; no special disinfectants are necessary for either bath or toilet; use disposable cloths; use separate cloths for kitchen, bathroom and toilet facilities.

   Spillages of blood and vomit should be cleaned up as quickly as possible. Ordinary household bleach freshly diluted 1:10 in water should be gently poured over the spill and covered with paper towels (see warning in paragraph 2).

   Mops and mop buckets used for normal cleaning purposes should NOT be used to clean up spillages of blood and vomit.

   If practical, the diluted bleach should be left for 30 minutes before being wiped up with disposable paper towels (see warning in paragraph 2). Disposable gloves should be worn.

   Individual paper towels may be discarded down the toilet. However, if many are used, it is preferable to treat them as infected waste. Gloves and aprons should be discarded as infected waste (see paragraph 5).

   Clothes and linen that are stained with blood or semen should be soaked in bleach or disinfectant and then washed.

   Crockery and cutlery can be cleaned by handwashing with hot soapy water or in a dishwasher or dish steriliser.

4. STAFF PRECAUTIONS

   As a general policy, if those members of staff who give medical care to infected children themselves have cuts and abrasions, then disposable gloves should be worn.

5. WASTE DISPOSAL

   Urine and faeces should be eliminated or discarded into the toilet in the normal manner. Potties should be washed and dried with paper towels after use. Disinfectant is not necessary.

   Soiled or infected waste - i.e. sanitary napkins, diapers and pads - should be burnt. If this cannot be done in the school, the rubbish - including protective disposable gloves or aprons - should be double-bagged and effectively secured. Arrangments should be made for this waste to be burnt.

   Non-infected waste should be treated like ordinary garbage and placed in sealed garbage bags. These should be collected and disposed of in the usual mannerby the Sanitation Service Authority.

   WHEN WORK IS COMPLETED, WASH AND DRY YOUR HANDS.

  Preamble

Acquired Immune Deficiency Syndrome (AIDS) is caused by a virus which attacks the immune system. In the fully developed stage of the disease, the body's immune system is totally destroyed, thereby allowing diseases which do not normally cause illness to invade the body. It is these diseases, called opportunistic infections, which kill the individual with AIDS. The virus known as the Human Immunodeficiency Virus (HIV) cannot be detected by a simple test at this time. At the moment, the only test available is the antibody test, which is evidence of infection from the virus.

Unfortunately, a significant number of people with HIV infection go on to develop the disease which is known as clinical AIDS and which is a fatal disease as there is no cure at present.

It should be noted that a person who is infected with the virus may not develop any symptoms for some time. However, any infected person may transmit the virus:

• through sexual activity;
• by contaminated needles such as those shared by intravenous drug users or as a result of contamination of transfused blood or blood products;
• by a mother infecting her child either during pregnancy or during delivery, and very rarely by breast-feeding.

1. STUDENTS WITH HIV INFECTION

   1.1  Students infected with HIV should have the right to attend their regular classes.

   1.2  The identity of a student with HIV infection should be protected.

2. ALTERNATIVE INSTRUCTION FOR STUDENTS WITH HIV INFECTION

   2.1  Where the physical condition or behaviour of a student infected with HIV poses a health risk, alternative instruction should be provided by the Government.

   2.2  Decisions regarding alternative instruction should be made on a case-by-case basis on medical grounds.

   2.3  Alternative instruction for students infected with HIV should be provided by teachers who fully understand the situation of a student who has developed AIDS-related illnesses and agree to provide their services and for whom specially negotiated contracts with Government shall apply.

3. TEACHERS WITH HIV INFECTION

   3.1  The identity of a teacher with HIV infection should be protected.

   3.2  A teacher infected with HIV should have the right to continue his/her employment.

   3.3  Where a teacher with an AIDS-related illness (as with any other chronic or terminal illness) becomes too weak to work, then that person shall have full access to his/her entitlement under the relevant regulations.

4. CURRICULUM

   4.1  Information on AIDS should be provided as part of a compulsory curriculum and appropriate funding for teaching materials should be provided.

   4.2  The Erdiston Teachers' Training College and the University of the West Indies In-Service Diploma and Certificate in Education, and Certificate in Educational Administration courses should include information on AIDS and other communicable diseases.

   4.3  Special courses should be provided by the Government to ensure that all teachers have relevant information on AIDS and other communicable diseases.

5. GENERAL

   5.1  The BSTU should be consulted prior to the formulation and/or implementation of any policy decisions by the Government in respect of AIDS and HIV infection which may affect schools.