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Nov 29, 1995 The Honorable Frank S.

Turner Maryland House of Delegates 6284 Light Point Place Columbia, Maryland 21045 Dear Mr. Turner: This letter is in response to your inquiry to Robert Silverstein, Minority Staff Director for the United States Senate, Committee on Labor and Human Resources, Subcommittee of Disability Policy. Mr. Silverstein forwarded to this office your letter regarding questions raised by the Howard County Family Care Association concerning the Federal and State role in protecting children living with AIDS or HIV and also protecting non-disabled children. Please excuse our delay in responding. As you note, many child care and early education providers are concerned about the possible risk of HIV transmission in child care settings, such as when children collide while playing. Specifically, you first ask whether the ADA provides legal protection to caretakers who enroll children living with AIDS or HIV in their programs, if another child becomes infected due to routine contact with a child with AIDS or HIV. Secondly, you ask what States can do to protect children from obtaining HIV while in school. The Centers for Disease Control and Prevention (CDC) reports that while some people fear that HIV might be transmitted through casual contact, scientific evidence proves otherwise. For your reference, we have enclosed a copy of the CDC's "Facts About The Human Immunodeficiency Virus and Its Transmission," published in May 1994. As reported in this article, HIV can be spread through sexual contact with an infected person, by sharing needles and/or syringes with someone who is infected, or, less commonly, through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before of during

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01-04085 -2birth, or through breast-feeding after birth. There is a single incidence in which HIV was transmitted from a dentist infected by HIV to his patients. There are no other reported instances in which HIV has been spread in commercial settings. In fact, only in very rare instances has HIV been transmitted between family members in a household setting. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. There are no reported cases in which a child has acquired HIV or AIDS through exposure to the disease at a child care facility or school. In all settings, including child care facilities and educational institutions, the CDC recommends that certain universal precautions should be taken to prevent exposure to the blood of persons who are living with HIV or whose infection and risk status are unknown. These precautions may also be effective in preventing transmission of other diseases, such as hepatitis. For example, gloves should be worn during contact with blood or other bodily fluids that could possibly contain blood, such as urine, feces, or vomit. Cuts, sores, or breaks on both the caregiver's and children's exposed skin should be covered with bandages. Hands and other parts of the body should be washed immediately after contact with blood or other body fluids, and surfaces soiled with blood should be disinfected appropriately. Practices that increase the likelihood of blood contact, such as sharing toothbrushes, should be avoided. To the extent that needles and other sharp instruments are used for medical procedures, they should be used according to the manufacturer's instructions and disposed of in puncture-proof containers that are kept out of the reach of children and visitors. The Americans with Disabilities Act of 1990 (ADA) prohibits State and local governments, as well as the owners and operators

of child care facilities and other places of public accommodation, from imposing eligibility criteria that screen out or tend to screen out persons with disabilities, unless necessary to prevent a direct threat to the health or safety of others. A direct threat is a significant risk to others that cannot be eliminated or reduced to an acceptable level by reasonable modifications to the public accommodation's policies, practices, or procedures or by the provision of appropriate auxiliary aids or services. The determination that someone poses a direct threat should be based on the best available objective evidence rather than generalizations or stereotypes. Based on the CDC's findings as articulated above, private and public child care and educational institutions cannot exclude from their programs children who are living with HIV or AIDS, because abundant scientific evidence suggests that there is almost no risk that the disease will be transmitted through the types of contact that occur in these settings. 01-04086 -3For more information regarding AIDS or HIV, you may call the CDC National AIDS Hotline, 1-800-342-2437, 1-800-344-7432 (Spanish), or 1-800-243-7889 (TDD). You may also wish to contact the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, Maryland 20849-6003. The Clearinghouse can provide you with technical assistance materials such as "The AIDS Prevention Guide: The Facts About HIV Infection and AIDS," or "Facts About Adolescents and HIV/AIDS," or posters such as "You Won't Get AIDS from Hide 'N Seek," or "You Won't Get AIDS From A Public Pool." Each of these costs 10 cents per copy or is free. I hope this information will be helpful to you in responding to the Howard County Family Child Care Association and other constituents. Sincerely, Deval L. Patrick Assistant Attorney General Civil Rights Division Enclosure


(301) 596-7619 Mr. Bobby Silverstein, Staff Director Sub-Committee on Disabilities 113 Hart Senate Office Building Washington, D.C. 20510 Dear Mr. Silverstein: The Howard County Family Child Care Association requested that I contact you concerning the Federal and State role in protecting children with aids or who have tested HIV positive. In addition, these providers are also concerned with protecting children who do not have aids related Since aids is protected by the Disabilities Act, many providers are concerned about the possible risk of blood exchange if two children collide while playing. What legal protection would a provider and the children have under the Disabilities Act and second, what can a state like Maryland do to protect its children from a related incident in school? Thank you very much for your help in addressing these concerns. I look forward to your reply. Very truly yours, Frank S. Turner Delegate, District 13A FST:cld cc: Wafa Sturdivant, President Howard County Family Child Care Association