Analysis Sexual Health

Arkansas School Tells Students They Can’t Return Until They Prove They Don’t Have HIV

Martha Kempner

Though many thought this issue was settled in the 1980s, a school system in Arkansas has demanded to know the HIV status of three siblings, saying their behavior poses a risk to students and staff.

Three siblings in the Pea Ridge School District in Arkansas were sent home from school last week and told they could not return until they provided administrators with documentation of their HIV status. Disability advocates are calling the school’s actions “unlawful and immoral,” but school officials have suggested that aspects of the students’ behavior put other students and staff at risk.

According to the Disability Rights Center of Arkansas (DRC), the issue began on September 9, when school officials called a meeting with the siblings’ case worker. In that meeting, the school officials said the three kids could not return to school until they received documentation that the children are not HIV-positive. Administrators had reportedly learned over the summer that one of the four siblings in the family (only three of them are of school age) and their birth mom are HIV-positive. They then demanded information on the others.

The siblings have been in and out of foster care over the years, and their current foster parents refused the request on the advice of experts who said the kids could not be denied education because of their HIV status. When they returned to school the next day without any paperwork, administrators reportedly kept them apart from the other kids and demanded that the foster parents come get them. The superintendent then informed the foster parents that upon advice from school counsel, the students were not to return to school without documentation. One of the siblings missed his first football game because of this disagreement.

The DRC is investigating the incident. The organization’s executive director, Tom Masseau, said in a statement, “The fact that the foster families have to provide documentation that the children are HIV negative before entering the school is unlawful and immoral. Further, the fact the school’s attorney authorized this unlawful act is at best appalling. It stigmatizes individuals with disabilities or their ‘perceived’ disabilities as there is no indication these individuals have HIV.”

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The school’s actions do appear to violate the Americans With Disabilities Act (ADA), which says that public schools cannot prohibit young people from attending because of their HIV status. Many of us remember when this issue first made headlines in 1984, with the case of Ryan White. White, who had hemophilia, was 13 at the time and had contracted HIV through blood transfusions. The Kokomo, Indiana, school district would not allow him to attend classes for fear he would spread HIV to other students. Instead, they insisted he “dial in” to his seventh-grade courses from home. White took the district to court and won. Still, he faced so much discrimination at school that his family relocated to another community about 20 miles away.

Ryan White’s fight was at the beginning of the U.S. AIDS epidemic, when people did not understand how HIV was and was not transmitted. People feared that a playground accident or nose bleed could expose numerous children to HIV. There was also fear that the virus could be transmitted through casual contact such as sharing drinks, utensils, or toilets.

Today we understand that HIV can only be contracted through direct contact with blood, semen, vaginal fluids, or breast milk. Though HIV is present in saliva, it is not in high enough concentrations to transmit the virus. Moreover, there is widespread understanding that schools should protect staff and students by taking universal precautions—which essentially means assuming that anyone might be infected, and handling all bodily fluids with care (for example, using latex gloves when helping a student who is bleeding or when cleaning up blood, vomit, or other fluids). If such precautions are applied to all students, the HIV status of an individual student becomes irrelevant.

In this case, however, the school argues that the behavior of these siblings may mean they pose an increased risk to staff and students. After days of not responding to media requests for information, the school district put out a press release last week, which said in part:

The Pea Ridge School District is dedicated to providing a safe environment for our students, teachers and staff.

As reported in the media, the district has recently required some students to provide test results regarding their HIV status in order to formulate a safe and appropriate education plan for those children. This rare requirement is due to certain actions and behaviors that place students and staff at risk.

Though the school district did not provide any additional information, the DRC reports that two of the siblings have sensory processing issues and become overwhelmed easily. When these students do become overwhelmed, they often lash out and hit, scratch, or bite themselves or others. While hitting and scratching cannot transmit HIV, human bites do pose a risk of transmission.

According to the Centers for Disease Control and Prevention (CDC):

It is very rare, but in specific circumstances HIV can be transmitted by a human bite. In 1997, CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other rare reports in the medical literature in which HIV appeared to have been transmitted by a human bite. Biting is not a common way of transmitting HIV, in fact, there are numerous reports of bites that did not result in HIV infection. Severe trauma with extensive tissue damage and the presence of blood were reported in each of the instances where transmission was documented or suspected. Bites that do not involve broken skin have no risk for HIV transmission, as intact skin acts as a barrier to HIV transmission.

Despite this very small risk, experts agree that the school has no scientific reason to know the siblings’ status. Jeffrey Levi, executive director of Trust for America’s Health, told Rewire, “This is an old and settled question—testing is not required, knowledge of students’ serostatus is not required.” He added that in all the years of the epidemic there has never been transmission of HIV in a school setting, and said that the biting did not add to the risk. “Any exposure to blood should be treated with universal precautions,” he added.

The last time the American Academy of Pediatrics (AAP) addressed this issue was 1999. The organization explained:

Discussions about children with HIV infection attending schools have disclosed that discrimination has occurred and that erroneous information, ie, HIV is likely to be transmitted in the school setting, has been given. These situations create unnecessary hardships for children and their families and illustrate the continuing need for community educational programs about HIV transmission.

The AAP concluded, “Knowledge of a child’s HIV status is unnecessary for school entry. Disclosure of a child’s HIV status to the school should not be required.”

Jeffrey Crowley, program director of the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law, agreed that this was a settled issue. He noted a similar case last year in which an HIV-positive teen was initially denied admission to a boarding school. He told Rewire, “It’s fascinating that we’re making so much progress in handling HIV in this country, but in some ways we are going back to the beginning of the epidemic.”

The question here, Crowley said, is not only whether there is risk, but who gets to make that call: “We as a society decided we didn’t want these decisions to rest with individual superintendents across the country, which is why Congress passed the Americans With Disabilities Act. It’s comprehensive and it’s the law of the land.” As mentioned earlier, the ADA is very specific when it comes to HIV in schools, and though it does make exceptions for a direct threat, a child with HIV, even one who bites, is not a danger to the school community. In an ADA fact sheet, the Department of Justice explains that “[p]ersons with HIV or AIDS will rarely, if ever, pose a direct threat in the public accommodations context.”

Not only is the risk of transmission through biting incredibly small, but the steps school officials would take in handling a bite would not change if they knew that the “biter” was HIV-positive. As Crowley noted, “If you’re trying to protect children, this actually does a lot of harm through stigmatization.”

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.

Roundups Sexual Health

This Week In Sex: Middle Schoolers Get Condoms, Some University Students Don’t Use Them

Martha Kempner

This week in sex, the San Francisco School Board voted unanimously to approve condom availability for middle school students, agencies provide new advice on Zika virus, and a survey of University of Minnesota students found fewer of them are using condoms these days.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

San Francisco School Board Votes to Make Condoms Available in Middle School

The San Francisco school board voted unanimously to make condoms available to middle school students despite opposition from some parents. The proposal was put forth by the district’s superintendent after a survey found that while 5 percent of middle school students are sexually active, fewer than 40 percent of those students are using condoms. Board Member Rachel Norton told the San Francisco Chronicle“This is not a giveaway program. They are going to be in a private, controlled space with an educator. This policy really is about the handful of students that really need it.”

Some parents and community members, however, argued that this would encourage sexual activity in other young people. Victor Seeto, issues chairman of the Chinese American Democratic Club, said, “The program’s message says sex is normal, is acceptable, but disease is bad. Let us strengthen the family and not weaken it.”

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Nikkie Ho, a parent in the district, told local media, “We’re talking about between 11 and 14 years old. And they are not ready for it, so I don’t think this is appropriate.”

Others were supportive of the plan. One mother pointed out, “It’s latex; it’s an inanimate object. It’s not going to tell my kid what to do. I don’t see what the problem is.”

District officials believe this is an opportunity to engage students in discussions about their reproductive health. They are so committed to making condoms available that parents are not allowed to opt out of the program.

Research shows that allowing students access to condoms does not increase sexual behavior but does increase condom use. The American Academy of Pediatrics believes that schools are an important place to make condoms available.

Advice Differs on Zika Virus Found in Sperm and Breast Milk 

Zika virus is mainly spread by mosquitos but, as with other viruses, it has been found in both sperm and breast milk of infected people. As of now, however, only sperm is considered a possible route of transmission and breastfeeding women in affected areas are being told to continue.

The Centers for Disease Control and Prevention (CDC) is investigating 14 cases in which the Zika virus appears to have been sexually transmitted. All of these cases involve possible infections in female partners of men who recently traveled to areas with Zika outbreaks. Several of the women are pregnant.

Zika virus is usually mild with symptoms that last about a week, such as fever, joint aches, and a rash. The virus, however, may be linked to a condition known as Guillain-Barré syndrome, an auto-immune disorder that can cause temporary paralysis. In addition, researchers are trying to determine what link, if any, Zika has to an alarming number of babies born in Brazil with microcephaly, a birth defect in which the head is much too small.

The CDC is advising that men who have traveled to regions affected by Zika either abstain from sex or use condoms during sex with pregnant partners.

In contrast, the World Health Organization urges women in infected regions to continue breastfeeding despite evidence of the virus in the breast milk of at least two mothers. The WHO said that scientists still don’t know how much of the virus is present in breast milk and for how long it might remain there. Researchers also question whether mothers who have had Zika can pass along protective antibodies through their breast milk.

Despite these unknowns, the WHO says that for babies exposed to Zika after birth, there have been no reported cases of brain damage or neurological problems. Therefore, the agency believes that the benefits of breastfeeding outweigh the risks and is encouraging women in Zika-affected areas to continue.

Condom Use at All-Time Low for University of Minnesota Students

The University of Minnesota wants its students to use condoms to protect themselves from unintended pregnancy and sexually transmitted infections (STIs). Like many schools, it makes condoms available free of charge at various places around campus. But a survey says that condom use among students is down and, not surprisingly, STIs are up.

The survey was done with about 2,000 students, none of whom were married or in long-term committed relationships. It found that only 52 percent used a condom the last time they had sex. This is down from 60 percent just five years ago. The number of students reporting an STI diagnosis is, in contrast, up from 6 percent in 2013 to 9 percent this year.

On-campus health center officials do not know for sure what has prompted the drop in condoms use, but speculate that increased access to other forms of birth control (such as the IUD) and a decreased sense of urgency about HIV may be part of the cause.