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aikishrine 07-30-2007 05:15 AM

training with HIV
 
this may be a rough topic, but i was thinking about this the other day after watching a show about HIV, and its misconceptions
what i was wondering is has anyone found themselves in this situation, were they trained with someone with HIV and is it something that you would feel comfortable trining with someone with HIV or is it possible to train with HIV?

dbotari 07-30-2007 07:05 AM

Re: training with HIV
 
Brian,

There was a thread on e-budo not too long ago dealing with this very subject. You may want to check it out. I don't have the link but go to e-budo and use the search function. you should have no problem finding the thread it was a quite active one.

Dan

jennifer paige smith 07-30-2007 08:23 AM

Re: training with HIV
 
I am vey comfortable training with people who have AIDS, so long as any person is respectful and maintains personal hygiene and responsibility ( like not training wih open sores or any open wound) than that person is welcome to train with me.
In my heart I see that In Aikido we are a healing community. We benefit from diversity in training and education and we have all the tools to do away with fear of others.

As a last thought, Magic Johnson comes to mind.

dragonteeth 07-30-2007 09:19 AM

Re: training with HIV
 
Great question! Please forgive the long post - I'm responsible for the bloodborne pathogen training for our healthcare facility...so I might get a little longwinded. :)

First off - I think you can safely assume that at some point in your aikido training (unless you're just starting), you have already been on the mats with someone that has either HIV, hepatitis C, or something equally as nasty. We hear about risk factors for these diseases, but the reality is that there are a significant number of people who don't have visible risk factors that are infected with a bloodborne pathogen. For example, a member of my family was discovered to have HepC much to everyone's astonishment, including his physician. He had no risk factors - no drug use, monogamous relationship for over 20 years, deacon in the church, father to 5 kids, middle age middle class normal sort of guy. They only found the HepC when his liver started to fail, and they had ruled everything else out. Apparently he had picked it up in VietNam when he was the third person to be sewn up with the same suture line and needle. Fortunately, his particular variant was the kind that responds well to treatment, and he's alive and well today. If he had walked onto your mats, he would have been the last person you would have thought to have a potentially deadly disease.

Second, you would probably be more of a risk to the HIV infected person than they would be to you. We all sweat profusely, and that sweat carries a ton of bacteria. Those bacteria might never do anything to a non-infected person, but might be deadly to someone with a low cell count.

Third, there are a lot of other things out there you should also be thinking about when you consider what you would do if a blood exposure happens on the mat. Hep C is scarier to me than HIV because certain strains of it kill you much faster. Methicillin resistant staph aureus (MRSA) can get into an open cut and cause an infection that is really freakin hard to eliminate. Tuberculosis is on the rise again, and some cases are resistant to every drug we have.

The answer to this is to have a good universal precautions plan in your dojo, and to follow common sense. You should at the very least have nitrile gloves available for treating cuts and cleaning blood spills, as well as an anti-viral mat-friendly cleaning agent. I say nitrile because there are a number of people who are latex allergic, and many viruses can penetrate vinyl, given enough time. You should never walk onto a mat with an unprotected open cut or sore, preferably not only covered with a band-aid but also taped over. If you have a fever or unexplained cough, you shouldn't come to the dojo at all (nor should anyone with the same be allowed to train). Cuts on the mats should be treated immediately by cleansing and covering, as much for self-protection as for preventing exposure to others.

I agree with Jennifer that aikido can be a great place of healing. With care and common sense, both the diseased and healthy can be kept safe with minimal effort.

Ron Tisdale 07-30-2007 09:33 AM

Re: training with HIV
 
Nice post Lori, good information.

Thanks,
Ron

jonreading 07-30-2007 10:45 AM

Re: training with HIV
 
There's defintely a legal side and a ethical side to this question. The legal side is easy: state laws and medical guidelines outline blood-pathogen rules of disclosure, waivers, and precautions. From a legal standpoint, you need to make sure you comply with the various laws surrounding this issue.

From an ethical standpoint, things get complicated. I will not argue right or wrong on this topic. My dojo is more physcial and students come into contact with each other's fluids (blood, sweat, etc.) regularly. For that reason, I avoid taking students who have severe illnesses such as HIV/HepC/TB; in Georgia, a person has no obligation to tell me if he is infected, but I usual ask that if he is infected with a communicable disease to consider the possibility of transmitting that disease to others. It is not my place to put my students into contact with a potential deadly disease. I would feel terrible if I ever was a vechicle through which my of my students contracted one of these [potentially] deadly diseases while training.

Life is not fair, and I feel sympathy for those who contract these diseases. For those who train with these diseases, I only hope you use caution as not to transmit the disease to others.

lbb 07-30-2007 01:08 PM

Re: training with HIV
 
Quote:

Jon Reading wrote: (Post 184904)
There's defintely a legal side and a ethical side to this question. The legal side is easy: state laws and medical guidelines outline blood-pathogen rules of disclosure, waivers, and precautions. From a legal standpoint, you need to make sure you comply with the various laws surrounding this issue.

Your ability to do so is greatly hindered by the fact that very few people have any idea what their "blood-borne pathogen" status is. How many of you have been actualy tested for HIV or one of the heps, instead of assuming that only naughy nasty bad people get those diseases?

Quote:

From an ethical standpoint, things get complicated. I will not argue right or wrong on this topic. My dojo is more physcial and students come into contact with each other's fluids (blood, sweat, etc.) regularly. For that reason, I avoid taking students who have severe illnesses such as HIV/HepC/TB; in Georgia, a person has no obligation to tell me if he is infected, but I usual ask that if he is infected with a communicable disease to consider the possibility of transmitting that disease to others. It is not my place to put my students into contact with a potential deadly disease. I would feel terrible if I ever was a vechicle through which my of my students contracted one of these [potentially] deadly diseases while training.
But that's not purely an ethical call; there are legal issues as well. If you decide to deny a public accomodation to someone, better make sure you have a legal leg to stand on.

I guess from my perspective, it might not make a whole lot of sense to ban the person who knows his/her status and discloses it to you (indicating to me that there's a good chance that this person has some skills and awareness re: managing his/her condition), and wave through the hundreds whose status is unknown.

Life is not fair, and I feel sympathy for those who contract these diseases. For those who train with these diseases, I only hope you use caution as not to transmit the disease to others.[/quote]

Ron Tisdale 07-30-2007 01:32 PM

Re: training with HIV
 
Quote:

How many of you have been actualy tested for HIV or one of the heps, instead of assuming that only naughy nasty bad people get those diseases?
I have. I got tested before each one of my major relationships. To me seems like SOP...today anyway. Especially since I spent a year living in Africa in the mid eighties. Nothing else seemed responsible.

And I personally have no problem stating it.

Best,
Ron

MM 07-30-2007 03:18 PM

Re: training with HIV
 
Quote:

Ron Tisdale wrote: (Post 184927)
I have. I got tested before each one of my major relationships. To me seems like SOP...today anyway. Especially since I spent a year living in Africa in the mid eighties. Nothing else seemed responsible.

And I personally have no problem stating it.

Best,
Ron

Uh, to echo Ron, I have. Colonoscopy two years ago. Good to go.

Had a physical last year. Had bloodwork, too, for normal stuff. EKG, too. All good to go.

Was tested this year for HIV and a few others. Clear on all tests. Cholesterol was just slightly high. Blood pressure normal (although it does run the high "normal"). Added a Stress Test later. All turned out good.

It's called a pre-emptive approach. IF (i say if) you have the insurance to handle it, why not take advantage of it? While mine doesn't cover all costs, it's good enough to go through the testing. And better to catch things before they get out of hand.

Mark

Janet Rosen 07-30-2007 03:21 PM

Re: training with HIV
 
"Universal precautions" assumes that all bodily secretions are potentially carrying fatal diseases, and all dojos and people training in them should be be equipped to handle this (gloves and disinfectants for mats/other surfaces that need cleaning, gloves and gauze and bandaids in case ANYbody gets bloodied).
Beyond that...I have no concerns and I do not think the hiv or hep status of those I train w/ is any of my business.

Luc X Saroufim 07-30-2007 03:56 PM

Re: training with HIV
 
i wouldn't deny someone with HIV the possibility of studying Aikido.

tarik 07-30-2007 06:12 PM

Re: training with HIV
 
Quote:

Mary Malmros wrote: (Post 184924)
How many of you have been actualy tested for HIV or one of the heps, instead of assuming that only naughy nasty bad people get those diseases?

Add another to the list of those who get tested.

Quote:

But that's not purely an ethical call; there are legal issues as well. If you decide to deny a public accomodation to someone, better make sure you have a legal leg to stand on.
I reserve the right to teach who I want to teach although it actually has nothing to do with blood-borne pathogen status, religion, race, gender, sexual orientation or any other typical reason for discriminating. But yes, I do discriminate.

I think many people operate in this way, although I also know many people who are open to 'all-comers'.

Basically, as Lori has already mentioned, I have no concerns about transmission of fatal illnesses from training... the protocols are straightforward to follow. The problem really is for those who are positive, as their health is much more fragile and they are more likely to catch the actual illness that will kill them than we are to get the illness that will destroy our immune system.

Regards,

aikishrine 07-31-2007 01:48 PM

Re: training with HIV
 
good feedback, well thought out thank you all

Bronson 07-31-2007 01:52 PM

Re: training with HIV
 
According to these, and similar, on line sources there is a possiblity that hep-B and hep-C may be transimitted through contact with sweat.

http://www.medpagetoday.com/Infectio...atitis/tb/5166

http://forum.myredbook.com/cgi-bin/d...h&viewmode=all

So at what point are we going to start seeing people required by public health code to have a full complement of immunizations, including hep-B, before being allowed to participate in any activity that may involve physical contact?

Bronson

lbb 08-02-2007 06:41 AM

Re: training with HIV
 
Quote:

Tarik Ghbeish wrote: (Post 184950)
Add another to the list of those who get tested.

I reserve the right to teach who I want to teach although it actually has nothing to do with blood-borne pathogen status, religion, race, gender, sexual orientation or any other typical reason for discriminating. But yes, I do discriminate.

The discussion wasn't about whether you (or anyone else) pick and choose your students, but whether you'd allow a HIV+ person to train. Picking and choosing is all well and good, but picking and choosing who shall be admitted to a public accomodation (which is basically what you have if you've hung out a shingle and are publically advertising for students) based on a protected category is illegal in the United States. People with HIV have successfully brought suit under the Americans with Disabilities Act, not sure how such a suit would work in the case of martial arts training, but seems to me the burden of proof would be on you to demonstrate that the hazard justified exclusion.

tarik 08-02-2007 01:27 PM

Re: training with HIV
 
Quote:

Mary Malmros wrote: (Post 185290)
The discussion wasn't about whether you (or anyone else) pick and choose your students, but whether you'd allow a HIV+ person to train.

And as already stated, perhaps not clearly for you, I would.

Quote:

Picking and choosing is all well and good, but picking and choosing who shall be admitted to a public accomodation (which is basically what you have if you've hung out a shingle and are publically advertising for students) based on a protected category is illegal in the United States.
You're making some interesting assumptions. I know of a number of dojo that are most certainly not public accommodations.

Quote:

People with HIV have successfully brought suit under the Americans with Disabilities Act, not sure how such a suit would work in the case of martial arts training, but seems to me the burden of proof would be on you to demonstrate that the hazard justified exclusion.
Actually, the burden would be upon them to demonstrate that I discriminated for that reason and to do so they would have to establish a pattern of such discrimination. I may have just not liked their attitude or approach to training and I am absolutely allowed to discriminate on that basis.

You do bring up an interesting point that could also be tested in court, that there might actually be legitimate business interest (such as protection of other members of the dojo since there certainly is a risk of blood borne contact, however small) in not allowing HIV+ people on the mat. Normal protections can legitimately be overridden in some cases.

In this specific issue, as previously mentioned, I personally believe that the risk is quite manageable and that it is not a good reason to disallow training, so it's not something I'd ever need to test.

Regards,

dragonteeth 08-02-2007 02:45 PM

Re: training with HIV
 
Just to clarify - yes, HIV status is protected under the ADA to a point. However, there is legal precedent for barring an HIV positive student from a martial arts class if there is a significant risk of blood exposure to the other participants. (see http://www.fitnessmanagement.com/FM/...otes0599.html). A child who was HIV positive was barred from a Virginia karate school, which was upheld in court. Keep in mind, this was a karate school that was full contact and competition oriented. It might be harder to prove that aikido presents the same risk for blood exposure as full contact competition karate, so you should not assume that the precedent would hold.

It is worth considering the inclusion of a statement about possible exposure to bloodborne pathogens in your dojo's permission form/injury waiver. Should the unthinkable happen and and something be transmitted between students on the mat, you will want to have some sort of legal protection for your school. I recently saw a great example of such a statement on the registration form for a Frank Doran seminar (http://www.aikido-nova.org/doran2007.pdf). Dojo owners may want to contact their attorneys or liability insurance carriers for state-specific language.

That said, I do feel that aikido poses a minimal risk if any for transmission of HIV if universal precautions and common sense are used in good measure by all parties involved. The hepatitis viruses present a little more significant risk, but are still within reason. More virulent critters like tuberculosis, however, present enough hazard to warrant a vacation from the mats. If you find yourself facing any other disease about which you don't have enough information, your local health department or infectious disease specialist should be able to provide adequate guidance.

jennifer paige smith 08-04-2007 10:56 AM

Re: training with HIV
 
Quote:

Tarik Ghbeish wrote: (Post 184950)
Add another to the list of those who get tested.

I reserve the right to teach who I want to teach although it actually has nothing to do with blood-borne pathogen status, religion, race, gender, sexual orientation or any other typical reason for discriminating. But yes, I do discriminate.

I think many people operate in this way, although I also know many people who are open to 'all-comers'.

Basically, as Lori has already mentioned, I have no concerns about transmission of fatal illnesses from training... the protocols are straightforward to follow. The problem really is for those who are positive, as their health is much more fragile and they are more likely to catch the actual illness that will kill them than we are to get the illness that will destroy our immune system.

Regards,

Hi Tarik (are you there?),

It's been a while since we talked last. Where are you teaching these days?

Regards,
Jen

tarik 08-06-2007 09:49 AM

Re: training with HIV
 
Hi Jen,

Quote:

Jennifer Smith wrote: (Post 185503)
Hi Tarik (are you there?),

It's been a while since we talked last. Where are you teaching these days?

I'm actually not teaching at the moment; just focused on my own training and efforts to eliminate some of my specific bad habits.

Regards,

jennifer paige smith 08-08-2007 07:55 AM

Re: training with HIV
 
Are we all done with this thread for now? Did the OP get the info they were after? Just wondering.


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