Non-Mother-to-Child (horizontal) Transmission

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HIV horizontal Transmission of HIV to children and adolescents through,

• Sexual transmission i.e. Rape Defilement, High-risk survival sex, Married adolescents, (Mentally, psychologically, physically immature).
• Use of contaminated needles
• Other skin-piercing instruments
• Exposure to infected body fluids and transfusion with contaminated blood and blood products.

The disease status of the rapist or defiler i.e. viral load, the presence of STIs is an important factor. Any rapist should be assumed as HIV positive unless proven otherwise.

Management of the sexually assaulted child

• Admit the child where possible
• Take history to establish circumstances leading to the sexual assault
• Examine the child under anaesthesia if possible or sedation to determine the extent of the injury and whether the assault is acute or habitual. Ideally, it should be done by a female health worker.

In the presence of the mother or caregiver

• Collect blood for HIV test, HBV, and syphilis screening and plan to repeat them at 6 weeks, 3 months and 6 months after the assault.
• Collect specimen of genital secretions to be examined for sperm and seminal fluid
• Take swabs for bacterial STI.