Foster children and HIV testing in San Francisco County: 1987--2001 (California)

Approximately 500,000 children are in foster care in the United States. California estimates 100,000 children are in some type of foster care placement. Children entering foster care from 0–4 years is twice the number of children aged 5–17. In San Francisco County 80% of the children entering foster care have a parent with a history of substance abuse and over 90% of infants are prenatally drug exposed. The rate of HIV infection has increased among child-bearing women infected with seroprevalence of HIV infection 1.7 per 1000 pregnant women nationwide. AIDS Clinical Trial Group Protocol 076 (ACTG 076) and Adoption and Safe Families Act of 1997 (ASFA) represent intersection of child health and child welfare practice and policy changes affecting foster children. In 1994, ACTG 076 showed that AZT therapy reduced the risk of perinatal of HIV infection by 2/3. ASFA's goal was to double adoptions and other permanent placements by 2002. The present study attempted to determine the rate of HIV infection in those tested before and after 1995 and to determine the rate of referrals for HIV testing before and after the Adoption and Safe Families Act was implemented. This was a 14-year period prevalence, retrospective chart review of all infants and children aged 0–18 years referred for HIV screening and testing from 1987 to 2001 in San Francisco foster care system. The results of the study revealed that 2857 children were referred for HIV testing with 1437 (50.3%) tested. Nearly 30% of children were referred for HIV testing. Testing occurred approximately 6 months after referral for 80% of the children and over 70% were 18 months and younger. The most common reasons for HIV testing were drug use in family and HIV in family. There were 1423 children with negative results and 14 children (8 boys and 6 girls) with positive results. Seroprevalence rates for S.F. foster care children over 14 year period was between 1.49 to 5.58 per 1000 with an average of 1.64 per 1000 pregnant women.