23: Laura

Laura is seven years old and was diagnosed with HIV infection at three years of age with a medical history of failure to thrive and recurrent ear infections.

Laura was born in Sub-Saharan Africa but moved to the United Kingdom. Laura lives with her Mother Denise and her younger brother Clinton. Clinton is HIV negative due to the appropriate management of his mother’s HIV care during pregnancy. Laura’s father died soon after Clinton’s birth from a HIV related illness.

Between the ages of three and seven years, Laura’s CD4 count began to fall and viral load increased. She was not growing and had recurrent chest infections. There were numerous conversations between Denise and the children’s team about starting Laura on treatment but Denise had been resistant to this.

Laura was at the stage where she needed to start on antiretroviral medication to reduce the viral load in her blood and enable some immune system recovery. Unfortunately, Laura failed to attend her next four clinic appointments. Several attempts were made to carry out a home visit but Denise persistently refused.

A referral was made to children’s social care due to concerns of neglect. The allocated social worker carried out an assessment and worked alongside Laura, Denise and the hospital staff to help Laura re-engage in services. After two months of intensive support and health education, Laura started on antiretroviral medication. Six months later Laura is 100% adherent to her medication and now has an undetectable viral load and improving CD4 count.

Paul Archer

Safeguarding Children Lead (Named Nurse)

South London and Maudsley NHS Foundation Trust

  • What are the priorities in this case?

› Suggested answers

Despite intense efforts from the clinical team in the discussed case study Laura was at significant risk of harm and an appropriate referral was made to children’s services. The needs of the child must always be paramount. It is important to explain referrals and the likely process to families unless sharing this information is likely to increase harm. A referral to services that names a child’s HIV status must be managed strictly confidentially and followed up with advice and support from a specialist team. The risk of unnecessary disclosure of a HIV diagnosis can have detrimental effects because of stigma and misunderstanding in the general population.