AIDS in abused kids

IN EARLY June, Associated Press reporter Ron Word chronicled the tragedy of Tashia Shipley, who had just died at 11 of AIDS, eight years after Florida authorities were first told that her mother's boyfriends were molesting her.

In 1989, at age 6, the Jackson ville, Fla. girl was diagnosed with herpes and gonorrhea and Florida's health department finally concluded she was a victim of sexual abuse.


Later, she was found to have syphilis.

She was never tested for HIV, the virus that causes AIDS; the girl developed AIDS in 1992, the same year she was placed in the foster care of Carl and Arlene Shipley.


Nobody wants to hear about this singular, monstrous example of perversion and victimization, you might think. But readers across the country were touched by the tragedy and the tenderness of the foster mother, who assured the dying child, "God will take you to heaven" to alleviate the terrible hurt.

Since the story ran, says Mr. Word, Arlene Shipley has received more than 10,000 letters of sympathy.

Tashia was portrayed as the one and only 11-year-old victim. Why not try to round up similar cases and draw a national portrait?

"There was no attempt to nationalize the story. I could see from talking to the Centers for Disease Control how difficult the data would be to come by," says the reporter.

Not difficult -- impossible. Officially, stretching back to 1983, there are zero cases of AIDS via sexual contact in children under 13. The CDC doesn't even have a code under which health

agencies can file such cases.

Not only that. In the 13-to-19 age group, underreporting of AIDS contracted sexually is evident.

As of last December, the total caseload was 675. Stack that figure and "nobody under 13" up against the accepted count of 200,000 annual confirmed sexual abuse cases in males and females under 18; most of these documented cases are in children under 13.


Stack up CDC's numbers against the known risky sexual and social behavior of innumerable parents and broken families.

"It's generally accepted that 18 to 28 percent of kids growing up are at some point physically assaulted and a large portion of the assaults are sexual," points out Dr. George Gellert, a pioneering investigator.

"When you get down to 11-year-olds, we're talking about absolute nonvolitional sex," says Dr. Gellert, director of medical programs for Project Hope.

"Two-thirds of the victims are girls and the perpetrators include fathers, mothers, uncles, cousins, anyone with access and coercive power."

Mr. Word himself speaks of another shocker in Florida, this one an abused 11-year-old Tampa foster child with AIDS.

Dr. Gellert coauthored a 1992 report providing the only national documentation of AIDS in sexually abused children under 13. Querying 2,147 health and social service professionals, he turned up 28 cases over the previous three years in which sexual abuse and the HIV transmission link were clear-cut.


Family members were the perpetrators in 67 percent of cases. The victims made the disclosure 75 percent of the time. Their mean age: 9.

But the 28 cases Dr. Gellert nailed down are just the tip of the iceberg. For one thing, reportage was voluntary, not mandatory.

Moreover, even in this small sample, a third of victims suffered from one or more sexually transmitted diseases other than AIDS.

This points toward the hundreds of annual cases in which preadoles cents are diagnosed with gonorrhea, chlamydia and syphilis, predisposing them to HIV infection.

In 1988, then Surgeon General Everett Koop issued an advisory to the health establishment: all children should be tested for HIV as soon as feasible after being diagnosed with another sexually transmitted disease.

That didn't prompt Florida authorities to give Tashia Shipley an HIV test, nor has it brought other cases out of the woodwork.


"I'm basically for the Koop approach," says Dr. Gellert. "But there's a debate over universal testing versus selective testing. What's practical? What's cost-effective? What's humanly effective?"

"If you're in a geographic area where you've tested 20,000 kids and they're all seronegative, what's the point?"

There's also a helpless feeling about a positive HIV test. At the Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect in Denver, Dr. Gail Ryan says, "It's not anything you can do anything about. In the context of child

protection, if they've already got AIDS, you can't protect them.

"My experience working with other professionals who are confronted daily with child sexual abuse is that coming on top of all the emotional trauma you see in kids, the prospect that they might also have something that's going to ultimately take their lives is just too overwhelming."

"But still," says Dr. Michael Durfee, a Los Angeles County (Calif.) abuse prevention expert, "somebody should be trying to collect the data." Dr. Durfee coauthored the child sexual abuse report with Dr. Gellert.


"Along with all the complexities that hamper testing, there's a leadership problem in mounting aggressive surveillance. It's bureaucratic inertia combined with classical fears and denial," observes Dr. Gellert.

"The easiest and most comfortable thing for authorities to do is attribute all the cases in kids to perinatal transmission," says Marsha Herman-Giddens, former director of the child protection

team at Duke University.

She has a point. Since 1983, 4,637 cases of AIDS in such children have been reported to the CDC, 610 of them in 5- to 12-year-olds. Many preadolescent cases could be dumped in this bin.

All newborns' HIV status is determined, but hospitals don't tell the mother out of respect for privacy and because the odds are 3-to-1 that the "positive" baby will not get AIDS.

But for children who become HIV positive outside the womb, there's no chance that they won't get AIDS.


For preadolescents, like everybody else, the latency period before developing AIDS may be eight or 10 years. But they're doomed. They're bound to show up at a hospital for treatment by their early 20s.

If you create a category of 13- to 21-year-olds, you find about 4,000 cases last year, up from the 20 cases in 1983.

Think about it. There could be 20 kids carrying the virus for every one who has AIDS. Something like 80,000 cases could be shaping up in America's most prized possession, our kids.

"Add up the whole sex abuse issue -- spousal, child, adolescent, dependent and elder -- and it says to you that families are not innately noble. Families can do this," says Dr. Durfee.

Let's end the self-deception and start seriously toting up the cases of AIDS in pre-adolescents.

Bill Ingram is the former editor of the Medical Tribune newspaper for physicians. He was awarded the 1993 William Hammond Award of the American Medical Writers Association for excellence in medical journalism.