Possible ways of transmission HIV in sport

Athletes are at risk of blood borne infections through bleeding injuries or injection of drugs with contaminated syringes. Prevention should focus on reducing non-sport associated risky behavior, as well as dealing appropriately with bleeding injuries. The risk of transmission of hepatitis B virus is particularly high in athletes in contact and collision sports, those who live in or travel to endemic regions, injecting drug abusers, and those who practice first aid when there is no healthcare practitioner available. It is recommended that such athletes and also adolescent athletes, should be vaccinated against the virus as a routine. Blood borne infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV are all major health problems. According to the World Health Organization (WHO), there are 34–46 million people with HIV world wide, about 5million of them newly infected. Approximately 3 million people died of AIDS in 2003. Who also reported that “Hepatitis B is one of the major diseases of mankind and is a serious global public health problem”. There are more than 350 million people who have chronic, lifelong, infections of HBV world wide. These carriers are at high risk of serious diseases such as liver cirrhosis and primary liver cancer which kill more than one million of them a year. The American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine have suggested that these infections are increasing among athletes, and they create important and complex problems for sports medicine practitioners. News of infected athletes with HIV, especially well known athletes, causes concern among other athletes.

HIV is transmitted through sexual contact, parenteral exposure to blood and blood components, contamination of open wounds or mucous membranes by infected blood, and perinatal from an infected mother to fetus or infant. Hepatitis B and C are spread through the same routes as HIV. There is a theoretical risk of blood borne infections being transmitted during sporting activities, from bleeding wounds or exudate skin injury of an infected athlete to the injured skin or mucous membrane of other athletes. It is generally reported that this risk is extremely low.

This risk may be higher in contact and collision sports, especially wrestling, boxing and tae know do, because of the higher risk of bleeding injuries and prolonged close body contact. Athletes taking part in these sports should be aware of these small theoretical risks. Players of basketball, field hockey, ice hockey, judo, soccer, and team handball are at a moderate risk, and those who participate in sports that require little physical contact such as baseball, gymnastics and tennis are at the lowest risk.

According to researchers in the Center for Disease Control and Prevention (USA), the risk of transmission of HIV during sports, except boxing, is small—less than one potential transmission in one million games. This risk is calculated by other researchers to be one transmission in 43 (range 1–85) million games, based on the following factors: (a) the estimated prevalence of HIV among athletes the risk of per cutaneous HIV transmission in health care, the risk of a bleeding injury in American football. However, this calculated risk may still be an overestimate because it has been back calculated from the risk through needle stick injuries, and this is probably much greater than the risk resulting from skin injury in sports.

There are no confirmed reports of HIV transmission during sport. Torre et al reported one case of seroconversion of HIV as a result of a bleeding injury during a football match in Italy. However, it was later suggested that this report was not sufficiently well documented to confirm that the transmission occurred during sports activity. Transmission in a non-sports setting for this man, who worked in a drug dependency rehabilitation center, could not be ruled out.

Transmission of HIV during bloody street fights has been reported in the literature. Generally, street fist fights can be considered similar to contact sports. However, the manner of physical contact—for example, repeated banging of the forehead of one fighter against the face and forehead of the other in a vigorous street fight—is less likely in typical sports settings. HIV cannot be transmitted through normal body contact such as touching and sharing sports equipment or using facilities such as locker rooms or bathrooms or contact with contaminated surfaces such as wrestling mats or toilet seats.