It is generally accepted that participation in sport benefits those who are HIV-positive. Judicious exercise strengthens the immune system and better equips the body to fight HIV, and to delay the onset of Aids.
But can HIV be transmitted during sports participation? The World Health Organisation (WHO) released the following statement in 1989:
"No evidence exists for a risk of transmission of [HIV] when infected persons engaging in sports have no bleeding wounds or other skin lesions. There is no documented instance of HIV infection acquired through participation in sports. However, there is a possible very low risk of HIV transmission when one athlete who is infected has a bleeding wound or a skin lesion and another athlete has a skin lesion or exposed mucous membrane that could possibly serve as a portal of entry for the virus.
"Such circumstances are most likely to take place in the boxing ring. However, a soccer player in Italy reportedly contracted HIV after a bloody collision with an HIV-infected player in 1989. Experts agree that this case is not conclusive because athletic activity could not be established as the source of infection.
"HIV is not transmitted through casual contact such as touching, rubbing, sharing sports equipment or utensils, or using the same locker room or bathroom facilities. The virus has never been identified in sweat and has been found only rarely and in minute concentrations in saliva. Transmission does not occur through mosquitoes or other insects, through swimming pool water, or through the air."
HIV transmission and sports participation
In most countries there is an official policy of non-disclosure of HIV status. Sports participants are not under any obligation to reveal their HIV status, although they are discouraged from participating in sports such as wrestling and boxing. The result of this policy of non-disclosure is that all injuries on the sportsfield are treated as if the injured person could be HIV-positive.
All injured sportsmen and women who have bleeding wounds are sent off the field until they have been treated and the bleeding has stopped.
If sportsmen were to inject anabolic steroids, or any other performance enhancer, using the same needle, they could easily transmit HIV to each other, should one of them be HIV-positive.
So how exactly is HIV transmitted?
For transmission to occur, the virus has to leave the body of the infected person and enter the bloodstream of someone who is not infected. This most often happens through sexual intercourse, or by means of mother-to-child transmission just before or during birth or by means of breast milk, or by needle-sharing between an infected and a non-infected person. These activities do not generally take place on the sportsfield, so how does this happen?
The transmission of HIV can take place when an HIV-infected person is injured, and blood from the infected person enters the bloodstream of the uninfected person through a cut, a lesion or an open wound or mucous membrane such as the eye or the mouth.
Although HIV transmission is technically possible in this manner, experts the world over agree that the chances are extremely remote – up until now there have been no documented cases of HIV being transmitted during participation in sport, so it is reasonable to assume that transmission in this manner is not likely to occur. Nevertheless, there is no point in taking chances.
This explains why all injuries are treated by paramedics who are protected by means of gloves from possible infection.
Sport can be divided into two types: non-contact sport and contact sport.
Non-contact sport includes many different kinds of exercise where there is no direct physical contact between participants during the normal course of the sport. These would include sports such as tennis, aerobic exercise, golf, cycling, running, canoeing, netball, hockey, cricket, softball and volleyball.
Transmission of HIV infection in the normal course of these sports is extremely remote.
These can be divided into low contact and high contact sports. A sport like boxing would classify as a high contact sport and soccer as a low contact sport. In the case of the latter, direct contact is not supposed to take place, but frequently does. Other contact sports would be rugby, wrestling, karate and judo.
Minimising the risk of HIV transmission on the sportsfield
There are many things that can be done on the sportsfield to minimise the risk of HIV transmission while participating in sports, where there may be direct contact or where bleeding could be expected to occur.
The following are principles recommended by the Australian National Council on Aids (ANCA) and the Australian Sports Medicine Federation (ASMF)to help further reduce the low possibility of HIV transmission while participating in sports which involve direct body contact or where bleeding may be expected to occur:
- if a player has a skin lesion, it must immediately be reported to a responsible official and medical attention sought.
- if a skin lesion is observed, it must be immediately cleansed with a suitable antiseptic and securely covered; and
- if a bleeding wound occurs, the individual's participation must be interrupted until the bleeding has been stopped and the wound is both rinsed with plenty of water and, if dirty, washed with soap then covered with a waterproof dressing.
It is important that whoever deals with injuries should wear gloves.
Action to be taken in the event of a blood spill
In an accident where bleeding occurs and if:
- Skin is penetrated - wash the area well with soap and water or an alcohol-based hand rinse foam
- Clothes are blood-stained - they should be changed for clean ones once the wound has been treated. They should be handled with rubber gloves and soaked in a disinfectant before washing in a domestic machine on a hot water cycle.
- Blood gets on the skin - irrespective of whether there are cuts or abrasions, wash well with soap and water.
- Eyes are contaminated - with the eyes open, rinse the area gently but thoroughly with water or normal saline.
- Blood gets in the mouth - spit it out then rinse the mouth with water several times.
- There is an additional concern about infection - Medical advice should be sought from a physician at a teaching hospital or clinic with experience in the management of HIV infection.