During the past several years a number of children testing positive for the AIDS virus have been identified within Maryland's public school population. In most cases, these children have been exposed to the AIDS virus as a result of blood transfusions that occurred before mandatory blood screening became effective.
Faced with a complex civil rights, public health and public relations issue, the state's local school superintendents, school boards and other school officials have successfully avoided the two greatest threats posed by AIDS to the public schools: hysteria and demagogy. They have accomplished this through five strategies:
1. School systems have developed and maintained an atmosphere of trust between school officials and parents. In order for school officials to implement any policy with regard to the treatment of children who test HIV-positive, parents must come forward with an honest report of their child's condition. Parents afraid their child will be expelled or face other punitive acts by school officials may keep their child's test results secret. This renders it impossible for school officials to take reasonable precautions to protect the health of all the children and adults within the school community. Moreover, parental permission to release information concerning the child's condition may be needed as part of subsequent steps in the overall strategy.
2. School systems have built working relationships with local health officials. Early in this century the Supreme Court gave approval to the power of a state to "quarantine" an individual whose medical condition poses a substantial threat to the health and safety of others. Subsequent cases have made clear that the power to quarantine may be applied only in very limited circumstances and only by those officers of the state charged by state law with the responsibility for public health and safety.
Understanding that the real power lawfully to exclude a child from school does not lie with school boards or school officials, Maryland school boards properly have refused to take upon themselves the responsibility of making such decisions. This unwillingness to usurp another agency's role has helped to prevent the politicization of what may only properly be regarded as a medical determination.
Local health officials have proven most effective where they have been willing to respond to concerned parents with patience and an understanding that fears may be real even where the actual danger is not. While the U.S. Department of Education has chosen not to be helpful to school officials, the Public Health Service and the Centers for Disease Control (both part of the Department of Health and Human Services) have provided practical policy assistance to local health officials faced with a quarantine decision.
The surgeon general and the Centers for Disease Control have issued reports that strongly discredit any notion that the AIDS virus can be transmitted from a child to another child or adult through any type of casual contact. To date, in fact, there have been no verified cases of child-to-child transmission of the disease. The absence of serious risk of transmission (except through extraordinary situations, such as biting) has led both the surgeon general and the Centers for Disease Control to issue guidelines recommending the continued (or initial) enrollment of children testing HIV-positive in the public schools, with no need for special precautions to prevent transmission.
3. The success of AIDS-related policy implementation has turned on both the attitudes and the skills of school principals and teachers who have been provided with information and in-service training. Such individuals have created a positive educational environment for the AIDS-exposed child and communicated to the parents of other children that there was no reason for alarm. In some Maryland school districts, PTA meetings have been called by school officials to provide basic information and to elicit community support.
4. Experience has shown that open cooperation between school and health officials and the press, both in the reporting of background information and in the coverage of PTA meetings, can be invaluable in permitting informed public support for nonpunitive responses by school officials.
5. School systems, wherever possible, have developed written policies in advance of public reaction to a decision to enroll or continue to enroll a child who has tested HIV-positive. The existence of such a written policy allows for development of effective interagency relationships, internal training programs and media coordination and conveys to parents wondering whether to inform school officials of positive test results the sense of trust vital to the success of the entire approach.
In Maryland, state and local school officials and their health department colleagues have provided the kind of quiet, consistent leadership that comforts and supports families experiencing the tragedy of a seriously ill child and reassures other parents about the health and safety of their children. This blend of technical skill, compassion, sensitivity and leadership can provide a positive blueprint for other states. -- Martin Gerry and David Hornbeck are, respectively, special counselto the Wednesday Group of the U.S. House of Representatives and Maryland's state superintendent of schools.