suggests that their celebrity status may lead to higher
risks (Johnston, 1994).PREVENTION
- Education for all athletes: Physicians should educate
athletes about risky behaviors and to consider HIV
testing on a voluntary basis. Education should include
discussions on abstinence, safe sex, and use of shared
needles or personal items such as razors, clippers, and
earrings that may be contaminated with blood. - Universal precautions: Coaches and athletic trainers
should receive training in universal precautions and
prevention of HIV transmission. Additionally,
Occupational Safety and Health Administration
(OSHA) has standards concerning the reduction of
occupational exposure to blood-born pathogens,
which may be applicable to the athletic training room.
To reduce transmission of HIV and other infectious
agents, the following universal precautions should be
taken:- Athletes with skin wounds and potentially infec-
tious skin lesions should be securely covered
with bandages and wraps before competition. - Athletes participating in sports with extensive
skin-to-skin contact (i.e., wrestling) should be
excluded from matches or practice when skin
wounds or lesions are contagious or cannot be
securely covered. - Ambu bags and oral airways should be available
for use for cardiopulmonary resuscitation(CPR). - Athletic trainers and health care personnel should
use disposable, preferably sterile, examination
gloves when treating athletes who are bleeding.
Hands should be washed after gloves removal. - When a sports participant sustains a laceration or
wound with substantial bleeding, the injury
should be treated promptly. Blood should be
washed off thoroughly with soap and water.
Emergency care should not be delayed if gloves
are not available. A bulky towel may be used to
cover the wound until an off-the-field location is
reached and gloves can be used for definitive
treatment. The athlete should be allowed to return
only after the wound has been securely covered
or wrapped. - Small amounts of dried blood on uniforms or
equipment do not constitute a risk for transmis-
sion and do not warrant changing; however, if
uniforms or equipment appear wet with blood or
if blood has penetrated both sides of the uniform
fabric it should be changed at the next stoppage
of play.
7. After each practice or game, any uniforms or
equipment soiled with blood should be laundered
using standard laundry cycles.
8. Disposable toweling or absorbent cleaning mate-
rial should be used to clean environmental sur-
faces if more than a few drops of blood are
present. Clean with soap and water or a germicide
registered with the Environmental Protection
agency, or a 1/100 dilution of bleach in tap water
(one cup bleach to 4 gallons water).
9. Receptacles should be available for uniforms
soiled with bodily fluids. Sharps containers
should be used for needles or scalpel blades.
- Athletes with skin wounds and potentially infec-
- Rules forbidding activities such as biting, scratch-
ing, fighting, or other unsportsmanlike behaviors
that may lead to bloody contact should be strictly
enforced (AAP, 1999; NCAA Guideline 2h, 2000;
Dorman, 2000; Mast et al, 1995).
- Recommendations and restrictions for the HIV posi-
tive athlete: The most widely used recommendations
regarding restriction of the HIV positive athlete from
competition come from the American Academy of
Pediatrics (AAP) and the NCAA. - AAP recommendations: Athletes infected with HIV
should be allowed to participate in all competitive
sports. Physicians should respect the right to confi-
dentiality including not disclosing infection status to
participants or to staff of athletic programs.
Physicians should counsel the known HIV-infected
athlete of the theoretical risk of contaminating others
during sports involving blood exposure especially
wrestling and boxing. Physicians should strongly
encourage the HIV-positive athlete to consider
another sport (AAP, 1999).
•A 1993 survey of NCAA institutions concerning
HIV/AIDS policies showed that 3% of respondents
either restricted or intended to restrict participation of
HIV-positive athletes; 15 institutions’ policies
restricted participation in some form: six barred the
HIV-positive athlete from any sport, and nine barred
the HIV positive athlete from selected sports includ-
ing hockey and wrestling (McGrew et al, 1993).
•However, as of the year 2000, NCAA recommenda-
tions clearly state that HIV-positive student-athletes
should be allowed to participate in intercollegiate
athletics based on the individual’s health status. The
student-athlete should be allowed to play if asympto-
matic and there is no evidence of immune function
deficiency; however, the intensity of training and
stress of competition should be taken into account to
prevent the deterioration of the student-athlete’s
health status (NCAA Guideline 2h, 2000). - Mandatory testing: The AAP, NCAA, American
College of Sports Medicine, Canadian Academy of
606 SECTION 7 • SPECIAL POPULATIONS