Communicable Diseases in the Recreation Community: How Do You Include HIV-Positive Participants in Public Sports?

Article excerpt

A three-year-old cuts himself in your public swimming pool. While the child receives treatment for the injury, his mother tells the lifeguard that the child, who was bleeding in the pool, is HIV-positive.

A fight breaks out on the sidelines of your sporting venue. One of the spectators is bleeding and discloses his HIV status.

During registration for your youth basketball program, a child's mother discloses his HIV status to your staff.

An injured soccer player walks off the field with an open, bleeding wound. No one knows, but this child is HIV-positive.

These real-life scenarios occur in public recreation complexes and programs on a regular basis. If they happened at your facility; or at one of your programs, would your agency be prepared? If not, then you need to develop appropriate policies and procedures that minimize the risk of disease transmission during play.

In developing a policy, a primary concern should be to ensure that the person who is or who is perceived to be infected with the human immunodeficiency virus (HIV) receives equal access to programs and services. This concern, while humanitarian in nature, is also a requirement of the Americans with Disabilities Act. Additionally, the American Academy of Pediatrics, the National Collegiate Athletic Association (NCAA), the National Football League and the World Health Organization, among others, all recommend that athletes with HIV infection should be permitted to participate in competitive sports at all levels.

Not an Isolated Case

The Centers for Disease Control and Prevention (CDC) reports that, by the end of 2001, an estimated 161,976 Americans were living with HIV, and an additional 344,178 were living with AIDS. People with HIV infection can lead productive and active lives for many years following infection, and are likely to continue participating in sport and recreation programs for the health benefits they offer.

Knowing that people with HIV are likely to participate in your recreation programs, and that not all will disclose their status, what policies do you have in place to address issues of education and training, treatment of injuries, and appropriate clean-up and disposal of potentially infectious materials and soiled uniforms?

Let's start with pre-event planning. The NCAA recommends certain pre-event planning before allowing an athlete with HIV into play. These precautions, applicable to all athletes, include medical consultation, proper care for wounds, and proper training, equipment and supplies.

The decision whether to participate in a recreation or sport program is best made on an individual basis by the HIV-positive person in consultation with his or her physician. In the case of a minor, the child's parent or legal guardian would play a key role in the decision-making process.

Wounds, including abrasions, cuts and weeping wounds, may serve as a source for bleeding or as an entry site for germs or pathogens. All such wounds should be covered with an occlusive (air-tight) dressing that will withstand the rigors of play. Additionally, healing wounds and dermatitis should also be securely covered.

Ensuring that all coaches and other persons anticipated to render care have properly equipped first aid kits, in compliance with universal precaution standards, is an important element of recreation programming. Required items include latex or nitrile gloves, bandages, adhesive strips, appropriate biohazard bags for soiled uniforms, supplies and equipment, and appropriate clean-up and disinfection material for spills.

There's a small trend to move away from latex gloves in favor of non-latex nitrile gloves. These gloves provide the same protective barrier as latex gloves but avoid allergic reactions by people coming into contact with latex (either the person administering first aid or the recipient of care).

Training for Coaches

All personnel authorized to render care to an injured athlete should be trained in first aid and CPR as well as in the proper use of protective barriers, including gloves. …