Most school-age children and school employees with AIDS would be allowed to remain in the San Diego school system, with their illness kept confidential, under a proposed policy to be considered by Board of Education today.
The proposal is based on medical findings and federal recommendations, and would bar only preschool children and others who might bite or be incontinent. But the district would consider each child and staff member individually.
“There has been no evidence of person-to-person transmission through the air or by casual contact . . . ,” reads the policy document to be discussed. “There has been no case of infection by being in the same room with an AIDS patient, sharing a meal or a bathroom, being sneezed on, or even hugging and social kissing.”
AIDS, or Acquired Immune Deficiency Syndrome, is a fatal disease that destroys its victims’ ability to fight off infection. Transmitted through sexual contact and blood products, it has mostly affected homosexual and bisexual men, and recipients of blood transfusions.
About 200 cases, or less than 2% of those reported in the United States, have been children. Among them, younger children have received the infection by being born to a mother with AIDS or through transfusions of contaminated blood.
The question of whether to allow AIDS patients in public schools has provoked an emotional response. In New York City, as many as 18,000 children were kept out of school earlier this month after an unidentified second-grader with AIDS was allowed to attend.
There have been two reported cases of AIDS in children in San Diego County, officials say. One of the children died, and the other is too young for school. So neither has involved a child in the school system. All AIDS cases must be reported to the county health department.
Under the proposed policy to be discussed by the San Diego Unified School District’s Board of Education this afternoon, most school-age children and employees with AIDS would be allowed in the district without restrictions.
Children “whose oral behavior and incontinence would increase the theoretical risk of transmission” would be educated at home. The superintendent would decide each case individually, in consultation with doctors and district officials.
The policy, prepared by epidemiologists working closely with school administrators, is modeled on guidelines compiled by experts in the field of pediatric AIDS and issued late last month by the federal Centers for Disease Control.
District administrators and the CDC point out that there have been no documented cases of AIDS transmission through household contact. The only health-care worker reported to have been infected was a nurse who was stuck with an infected needle.
The district also notes that although the virus has been detected in semen, blood, urine, saliva and tears, documented cases of transmission have only occurred through blood and semen. In addition, it notes that the virus is fragile.
“It does not survive outside the human body,” reads literature distributed Monday to the trustees. “It does not linger on doorknobs, clothing, food, dishes, glasses, utensils or toilet seats. It is quickly killed by simple disinfectants like rubbing alcohol or bleach solutions.”
A series of questions and answers drawn up by the state of Connecticut and distributed to the trustees states that no unusual precautions, beyond cleaning up bodily fluids after an accident or injury, need be taken if a child with AIDS is in school.
In response to the question of whether a parent has the right to know if someone in the school has AIDS, the paper states, “Schools must protect each child’s right to privacy whether he/she has herpes, leukemia or AIDS.”
As for the possibility of blood pacts between children, the paper states, “This practice presents a risk of transmission of AIDS, hepatitis B, etc., and should certainly be discouraged! Even if this practice occurred, the risk of transmission would be very low.”
District administrators and trustees say they have received few calls from parents or other members of the public on how they ought to handle AIDS cases. Neither the local nor the state Parent Teacher Assn. has taken a position on the question.
But Superintendent Tom Payzant predicted Monday that the proposed policy would “generate a lot of discussion.” He suggested the absence of controversy in San Diego has reflected the lack of a forum to vent it. “This will provide it,” he said.
“I think it’s important to have the policy discussions and get some guidelines when implementation is not imminent in terms of a known case, rather than waiting until we have a case and then scurrying around to react,” he said.
“I think you can have a more rational discussion and attempt to deal with the concerns people have when you’re not forced with an immediate decision about an individual child.”
But others pointed out that the real controversy may arise only with a real case.
“To reach conclusions in the absence of a real case is one thing,” said Michele Ginsberg, an epidemiologist with the county Department of Health Services.
“To adhere to the program that you’ve designed if you are challenged by a real case is another thing.”