Human immunodificiency virus (HIV) in a residential care center for persons with intellectual disability in Israel: A needle in a haystack investigation

In Israel, the Office of the Medical Director (OMD) of the Division for Mental Retardation (DMR) at the Ministry of Social Affairs (MSA) provides medical services for persons with intellectual disability (ID) in residential care centers in Israel. The OMD sets the standard of care, and a medical/allied professional health team carries out inspections and supervision to staffat the local institutional level. This chapter will discuss the first two cases of HIV/AIDS in a residential care center in Israel for children and adolescents with intellectual disability. The task force (OMD, Ministry of Health and police) established to investigate the two cases diagnosed with HIV/AIDS encountered several obstacles: 1) where should we look for a possible form of transmission? 2) as we suspected sexual abuse, where should we look and find ?the needle in the haystack?? 3) parental opposition (the parents of the other children) to receive back the two cases to the center after they had started highly active antiretroviral therapy (HAART or cocktail) and 4) how to deal with a terrified staffat the center. We have learned several lessons from this case. First of all as physicians you also sometime have to play detective and in this case we were lucky that our investigation found the cause and the perpetrator. Second it is very important to have staffand parents informed along the way, even in very sensitive cases like this and to use all resources and collaborations available and create a task force as early as possible.