Sports and Infectious Diseases – Part 2 of 3

10 04 2013

bloodborneWhat risk does an athlete with a bloodborne pathogen pose?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other Bloodborne Viral Pathogens in the Athletic Setting.  In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.  The Academy tackled each infectious disease individually:

HIV: The risk of HIV infection via skin or mucous membrane exposure to blood or other infectious bodily fluids during sports participation is very low . . . such transmission appears to require, in addition to a portal of entry, prolonged exposure to large quantities of blood.  Transmission through intact skin has not been documented: no HIV infections occurred after 2,712 such exposures in 1 large prospective study.  Transmission of HIV in sports has not been documented.  One unsubstantiated report describes possible transmission during a collision between professional soccer players.

Hepatitis B: HBV [hepatitis B virus] is more easily transmitted via exposure to infected blood than is HIV . . . the risk of infection [is] greater if the blood [is] positive for HBV e antigen . . . transmission of infection by contamination of mucous membranes or broken skin with infected blood has been documented, but the magnitude of risk has not been quantified.

Although transmission of HBV is apparently rare in sports, 2 reports document such transmission.  An asymptomatic high school sumo wrestler who had a chronic infection transmitted HBV to other members of his team.  An epidemic of HBV infection occurred through unknown means among Swedish athletes participating in track finding (orienteering).  The epidemiologists concluded that the most likely route of infection was the use of water contaminated with infected blood to clean wounds caused by branches and thorns.

An effective way of preventing HBV transmission in the athletic setting is through immunization of athletes.  The American Academy of Pediatrics (AAP) recommends that all children and adolescents be immunized.  Clinicians and the staff of athletic programs should aggressively promote immunization.

Hepatitis C: Although the transmission risks of HCV infection are not completely understood, the risk of infection from percutaneous [through the skin] exposure to infected blood is estimated to be 10 times greater than that of HIV but lower than that of HBV.  Transmission via contamination of mucous membranes or broken skin also probably has a risk intermediate between that for blood infected with HIV and HBV.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests students should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson.  Strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status.  Coaches and teachers must have a plan in place to handle blood spills, said Dr. Anderson, including latex [or non-permeable] gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials.

The following is an excerpt of a sample school policy, used by numerous public school districts and in compliance with ADA that addresses HIV infection:

“The privilege of participating in physical education classes, programs, competitive sports and recess is not conditional on a person’s HIV status.  School authorities will make reasonable accommodations to allow students living with HIV infection to participate in school-sponsored physical activities.

“All employees must consistently adhere to infection control guidelines in locker rooms and all play and athletic settings.  Rulebooks will reflect these guidelines.  First aid kits and standard precautions equipment must be on hand at every athletic event.

“All physical education teachers and athletic program staff will complete an approved first aid and injury prevention course that includes implementation of infection control guidelines.  Student orientation about safety on the playing field will include guidelines for avoiding HIV infection.”

In addition to the Academy, several sports and other health organizations have also weighed in on this issue.  According to the NCAA, National Football League (NFL) and World Health Organization, athletes with HIV should be permitted to participate in all competitive sports at all levels.

These organizations all endorse immunization against hepatitis B for all athletes.

The National Athletic Trainers’ Association (NATA) echoes Dr. Anderson’s suggestion that coaches, trainers, athletic directors, school officials and others take the lead in educating themselves, their teams, parents and their communities about the importance of effective disease prevention.

Trainers and coaches, they suggest, should provide the following information in age-appropriate terms to all participants before or during any competition :

  • The risk of transmission or infection during competition.
  • The risk of transmission or infection generally.
  • The availability of HIV testing (for teens and adults).
  • The availability of hepatitis B vaccination and testing (for parents, teens and adults).

“Athletic trainers who have educational program responsibility should extend educational efforts to include those, such as the athletes’ families and communities, who are directly or indirectly affected by the presence of bloodborne pathogens in athletic competitions,” the NATA stated in a position paper.

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of Lolie Smith





Infected Kids and Sports

23 07 2012

While soccer, softball and gymnastics are a joyful rite of passage for many young children, athletic events carry a risk for all children, given the increased chance for mishaps, accidents and blood spills.

For parents of children with viral infectious diseases, including hepatitis B, hepatitis C and HIV/AIDS, these games often present a number of stressful issues.

  • What if my child is hurt and another child is exposed to his or her blood?
  • Should I tell the coach about my child’s infectious disease if it will spur him or her to practice standard (universal) precautions?
  • What if the coach or athletic director doesn’t know or practice standard precautions?
  • Should I attend every game in case there is an accident?
  • Should my child even be playing this sport?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other BloodBorne Viral Pathogens in the Athletic Setting. (This policy was reaffirmed in 2008.) In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.

The Academy tackled each infectious disease individually.

HIV/AIDS: The risk of HIV infection through skin or mucous membrane exposure to infected blood or other infectious bodily fluids during sports events is very low. The Academy found the risk from damaged skin or mucous membrane exposure was one in 1,007 exposures or 0.1 percent.

Hepatitis B: While hepatitis B is more easily transmitted through exposure to infected blood than HIV, the Academy found only two documented sports transmission. A high school sumo wrestler with chronic hepatitis B was found to have transmitted the infection to a team member. Wrestling is the only sport that raised concern because herpes, impetigo and measles have been transmitted through skin-to-skin contact. However, there is no risk of bloodborne pathogens being contracted through wrestling, the Academy found.

An outbreak of hepatitis B occurred within an outdoor orienteering team in Sweden. Doctors believe the team members used a common cup of warm water to clean wounds caused by branches and thorns.

Hepatitis C: The risk of transmission is greater than for HIV but less than with hepatitis B. The Academy reported no documented cases of transmission in sports.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests children should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

Pediatricians can avoid reporting a student’s infection, the Academy noted, by making it clear on any participation forms that they support the Academy’s position that all students can participate in all sports and that pediatricians must respect an athlete’s right to confidentiality.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson, “that includes their own physicians! While that may seem wrong, it is felt that if standard precautions are used for blood contact or contamination, the risk of contagion is adequately reduced.”

But strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status. “As a parent, I would make sure that there is a plan in place to handle blood spills,” said Dr. Anderson, “including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and event a printed protocol for coaches, athletes and officials.

“If standard precautions are not followed, I would recommend that the coaches or instructors are queried as to their familiarity with the precautions,” he added. “If they are not familiar with or following procedures, a higher up source needs to be consulted, such as a league office or school administrator.”

Parents should also contact the school or athletic league’s physician so he or she can also act as an advocate to ensure the coaches comply with the department or organization’s safety procedures.

But the Academy’s policy may not lessen the stress some parents feel when their very young children approach a soccer field for the first time. “When children are young, parents should educate their children about the dangers of blood contact,” said Dr. Anderson. “Despite the trauma that can accompany free play, I don’t hear of too many cases where two or more bleeding children mix their blood. I would also hope that an adult would be present when children are playing and would be consulted if there were an injury.”

Dr. Anderson feels it is not necessary to disclose a child’s infectious status to a coach. “Given the low risk of infecting other children, and the high risk of being shunned or ostracized. However, I think a responsible parent would be adamant about standard precautions being in place and followed. I supposed an astute coach might make inferences if a particular parent was a zealot about blood contamination. I would read that as a message that their child was infected and that they wanted their child to participate without creating a risk for others.”

Even when a child has an HIV infection, disclosure is not a requirement, explained Dr. Anderson, stating his personal opinion. “However, if a coach is educated about the risks, the necessary precautions and can be trusted to maintain confidentiality, disclosure may be appropriate. Unfortunately, most youth sports coaches are parent volunteers, non-professionals and are unlikely to have a long-term relationship with the athlete. In such cases, I recommend that standard precautions be followed.”

Dr. Anderson contends active contact sports, such as football, are also not off limits to athletes with infectious viral hepatitis. “However, students with infectious hepatitis A (spread through close physical contact with contaminated food, water or skin) or with liver or spleen enlargement should be restricted from contact or collision sports until the liver or spleen has returned to normal size,” he added, “and the person is no longer contagious.”

One mother whose son has hepatitis B commented, “I used to worry about my son infecting other children, but eventually I decided to make sports decisions based on what my kids risked catching from others.”

This post originates from PKIDs’ website.

Image courtesy of Rugby Pioneers





Hepatitis A, B, C, D, and E

10 05 2012

The month of May is well-used. Mother’s Day is in here. May Day too, of course, along with graduations galore and, not insignificant for us, a date with the IRS that nonprofits shouldn’t miss.

It’s also Hepatitis Awareness month, although World Hepatitis Day is in July. We can’t explain why.

The important part is that we can use this month to remind moms and dads that hepatitis is around and some of it can be prevented by vaccination.

Hepatitis C is a bloodborne virus that attacks the liver. It is not vaccine-preventable. If babies are infected it’s usually from their hepatitis C+ mothers or, and this is unlikely these days, from a blood transfusion. It’s unlikely because the screening process of donated blood is pretty darn thorough. But, germs have slipped through that screening process.

Teens and young adults may become infected, primarily through sharing of needles, sex with an HCV+ person, or sharing personal items such as razors or toothbrushes that may be contaminated with HCV.

There are effective treatments that work on a good portion of hepatitis C-infected children. But not on all infected children. Work is ongoing in this area.

Hepatitis C is frequently a chronic infection, meaning that if treatment is not effective, you will be infected for your lifetime.

Hepatitis A is vaccine-preventable. Normally, it’s passed person-to-person through the fecal-oral route, which is when something you eat or drink has been contaminated with hepatitis A+ poop. If you haven’t been vaccinated, chances are you will become infected.

This virus makes you feel lousy and can, rarely, do serious damage to the body. It does not become a chronic infection. It infects you and then goes away, like a cold virus.

Hepatitis B is vaccine-preventable. It’s transmitted in a lot of ways—mom to newborn, sharing needles or personal items, sex with an infected person, even household (nonsexual) contact. If a mom is aware of her infection prior to giving birth, shots can be given to the baby within 12 hours of birth that are effective at stopping tranmission of the virus from mom to baby. However, when babies are infected, almost half of them in the US will become chronically infected. In developing countries, that figure shoots up to 90 percent.

Today, despite the vaccine, approximately 1,000 babies become chronically infected with hepatitis B each year in the US. Many of the moms-to-be who are infected are unaware of their infection. Every pregnant woman should be tested for hepatitis B so that action can be taken at birth to prevent infection of the newborn.

Hepatitis D is an odd virus. You have to be infected with hepatitis B before you can get hepatitis D. It’s vaccine-preventable in that, if you get immunized against hepatitis B, you won’t be able to get hepatitis D.

Hepatitis E is similar to hepatitis A in the way it is transmitted—the fecal-oral route. It’s rarely a chronic infection. For most people, they get it, get sick, and get over it. It can however be dangerous for pregnant women, with a 10% – 30% fatality rate for this group. It’s not often found in the US but can be easily picked up in some other parts of the world.

That’s about it for hepatitis in the US. To prevent a hepatitis infection (and lots of other infections), wash your hands throughout the day, put barriers between yourself and another person’s blood or body fluid, and use the available vaccines. The trick is to do these things with everyone. It’s impossible to tell who is infected with what, most of the time, so the safest course of action is to assume everyone is infected with something and then act accordingly.

Got any tips? Hope you share them will us in the comments.

By Trish Parnell

Image courtesy of Johns Hopkins





HCV and Menstruation

12 12 2011

When girls first start menstruating, one of the less-talked about side effects is the messiness. A practical mom of an HCV+ teenage girl contacted us to find out just how to deal with potential blood and body fluid exposures in the home and in public areas.

We thought the answers to her questions might serve many families, so we’re posting them here, with thanks to several infection preventionists who pitched in to provide answers!

In no particular order, here are the questions and answers.

Q: What cleaning products can we use to kill the hepatitis C virus?

Hepatitis C is not an easy bug to kill. Store-bought products (such as Lysol®, Clorox® Clean-up® Cleaner with Bleach, or Mr. Clean®) are not effective.

Bleach is questionable with regard to killing HCV. The proper dilution and the state of the HCV will vary the efficacy. If HCV is in a dried state, it is harder to kill than if it’s in a liquid state.  With all blood or infected body fluids, the area needs to be physically cleaned first and then disinfected with 1:10 dilution of bleach (one part bleach, 10 parts water), although studies (see references below) are varied on efficacy.

Ethanol in studies does not show efficacy. Hand Hygiene Alcohol MSDS sheets do not list HCV as a bug that is killed by an alcohol hand rinse.

Moving to hospital grade disinfectants—quaternary ammonium chloride such as Coverage® Spray HB Plus Ready-To-Use One Step Disinfectant kills HCV. Lysol® Brand I.C. Quaternary Disinfectant Cleaner (concentrate), soon to be available on Amazon.com, kills HCV.

Super Sani-Cloth Wipes to be used on environment, a quaternary in a cloth/wipe form, kills HCV. Although I would like to emphasize that cleaning the environment must occur before any of these products are effective. Clorox® Germicidal Wipes, bleach wipes for the environment, kills HCV.

For any product, the label must be read. If the label states that it kills HCV, then follow the manufacturer’s guidelines with regard to kill time.

For skin that is contaminated with blood, the hands or skin can be cleaned with soap and water. Wet the skin, suds and use friction on  the area with soap for 20 seconds or more, and thoroughly rinse the skin with warm water. This is not to kill the virus but an action to rinse the virus off the skin.

Answering these questions was a very useful refresher on bloodborne pathogens. Breaking the chain of infection is key in preventing transmission to others. Each link must be present and in sequential order for an infection to occur. The links are: infectious agent, reservoir, portal of exit from the reservoir, mode of transmission, and portal of entry into a susceptible host.

References:

  • Resistance of Surface-dried virus to common disinfection procedures, FG Terpstra, Elsevier Ltd, June 29th 2007
  • The Effect of Blood on the antiviral activity of sodium hypochlorite, a phenolics and Quaternary compound, Weber and Rutala, ICHE, 1999 20: 821-827
  • Recommendation or Prevention and Control of Hepatitis C virus, MMWR, October 16,1998
  • Guidelines on prevention of transmission of Hept C virus infection in the workplace: do they work in practice; Oxford University Press on behalf of Society of Occupational Medicine 2007
  • Efficacy of Sodium Hypochlorite in Eradication Hep C from peritoneal effluent of PD patients , peritoneal Dialysis International, 2010, volume 30, pp 644-659
  • How Stable is Hep C? Environmental Stability of HCV and its Susceptibility to Chemical Biocides, JID, 2010:201 June 15th
  • Lysol Brand IC Quaternary Disinfectant Cleaner (concentrate – MSDS)
  • Coverage Spray HB ready to use One – Step disinfectant – MSDS
  • Professional Lysol Brand Disinfectant Foam Cleaner for Multiple Surfaces MSDS
  • Clorox Germicidal Wipes, Label

Cathy Doern Stone, BSMT,CIC, ASCP Infection Prevention  Coordinator Good Samaritan Regional Medical Center, Corvallis, Or 97330

Q: How does one handle and dispose of soiled sanitary pads, underwear, or tampon applicators? What about the mess that soiled hands leave behind?

There are a variety of products on the market for the disposal of tampons and sanitary napkins (search the internet “products for tampon/sanitary napkin disposal”).  The products may have some advantages over a plastic baggie that can be difficult to seal with potentially soiled hands in a restroom stall.

There are towelettes that can kill HCV, but they are not meant for cleaning of skin, just cleaning of surfaces (it takes 3-4 minutes for HCV to be killed on a surface with these products).

Towelettes for hand sanitizing can be used to clean hands prior to leaving the stall— they are available in small packets that can be kept in a purse.  Hand washing with soap and water is important before leaving the bathroom, even if towelettes are used to wipe the visible blood off of your fingers, because the towelettes won’t kill HCV, they will just wipe off some of the blood.

When an HCV+ woman is having her menstrual period, she needs to be prepared to dispose of her sanitary napkin/tampon in a way that decreases exposure of her blood to the environment.

When entering a public restroom, she needs to practice procedure that flows from dirty to clean. This means that prior to entering the restroom stall, she needs to have the items to complete this process—napkin/tampon, disposal bag, disinfectant wipes, and hand cleaning wipes.

She should then get the items out of her purse if there is a place/shelf to put them. If there is not a place, then she should at least put them at the top of her purse, so she is not digging around for them when she needs to use them. Next step is to open the items she needs, such as disposal bag.

Remember, if she is in a public restroom with the designated metal disposal box with leak proof bag she does not have to put her napkin/tampon in a separate bag unless it is very soiled and leaky (that is to reduce contamination of the metal box as it is placed in it). The rationale for this is that the special metal containers are meant for everyone’s napkin/tampon, and all items should be treated as potentially infectious, not just one individual’s napkin/tampon.

The restroom cleaning person’s job description to empty and clean that container falls under the OSHA mandate to receive education and training for bloodborne pathogens. They should know how to properly handle this by using proper personal protective equipment.

While she is removing her napkin/tampon, it might be best to use her less dominant hand so she will have her dominant hand with better control to reach for the disposal bag on top of her purse.

If she has any soiled underwear, she should replace it at this time using a separate disposal bag since she will bring it home to wash. After removing and replacing the napkin/tampon, she needs to clean the environment of any visible blood with the disinfectant wipes. Put the used disinfectant wipes in either the special metal box, if available, or the disposal bag that contains her used napkin/tampon.

If she has visible blood on her hands, she should use the hand cleaning wipes. Also, put the used hand wipes in either the special metal box, if available, or the disposal bag that contains her used napkin/tampon.

Once she leaves the stall, she needs to do hand hygiene at the sink with soap and water. Research has shown that we need to pay attention to cleaning our thumbs, between fingers, around our wrist, and our dominant hand. Also, once she is finished with water, soap, and drying her hands, she should use a paper towel to turn off the faucet and to open the bathroom door, since so many people open the door without doing hand hygiene.

As for her soiled clothes, if she is away from home she should remove them and place them in a plastic bag with the intent of removing the items as soon as she gets home. If it will be awhile before she will return home, she might want to add some water to the bag to keep it moist.

Once she is home, she should place the soiled item in a designated bucket to soak. If someone else is handling her soiled clothes, they should wear gloves. Also, remember to not hold the soiled items next to your clothes. If there is excessive blood or blood clots, they should be mechanical removed either with gloved hands or brush. Next step is to spray some stain remover on the area. OxiClean® is one product that works on red stains. Remember to follow the manufacturer’s instructions. For OxiClean®, spray it on the stain until it’s saturated, rub in, and let stand for up to 10 minutes. Do not let OxiClean® dry on fabric.

Erin Coke, Infection Preventionist/Employee Health, Ashland Community Hospital, Ashland, OR 97520

(Another infection preventionist contributed quite a bit to this answer, but due to her workplace, she asked that we not share her name.)

Q: What precautions should be taken around the house?

Standard precautions (acting under the assumption that all blood and body fluids are potentially infectious) can and should be followed at home, especially for people living with HCV, in order to prevent the transmission of the virus to others.

Casual contact, such as sharing household items (dishes, cups, and glasses) is not a risk. But blood, body fluids, and items that come in contact with blood are possibly infectious.

Cleaning up blood spills and not sharing household grooming equipment (such as razors, nail clippers, and toothbrushes) will keep people and their families safe from HCV and other infections.

LAUNDRY:

  • Clothes may be washed together with regular detergents
  • Use gloves when handling any clothes stained with blood, semen, or vaginal fluids
  • Wash blood-stained items in hot soapy water using one cup of bleach per load
  • If items cannot go into the wash, wipe them dry and take them to the dry cleaners

Per HIV Edmonton, 9702 111 Ave. NW Edmonton, AB  T5G 0B1 (877)-388-5742, (780) 488-5742, Fax (780) 488-3735, contact@hivedmonton.com

Wash contaminated items with hot water and detergent for at least 25 minutes. Presoaking may be required for heavily soiled clothing. The most important factor in laundering clothing contaminated is elimination of potentially infectious agents by soap and hot water.

Per VA Department of Health

PRECAUTIONS FOR BLOOD SPILL CLEAN-UP

When cleaning up blood spills, the following steps are important for preventing the spread of bloodborne infections like HCV:

  • Wear gloves—torn gloves will not protect the hands from coming into contact with the blood.
  • Carefully remove any sharp pieces, such as broken glass, and put them in a sturdy plastic container like one used for detergents.
  • Wipe up the blood using paper towels or disposable rags and cloths.
  • Disinfect the area with a solution of at 1 part bleach to 9 parts water. [note the difference in solution compared to Cathy’s in the first Q/A – perhaps take your pick?]
  • Wipe up the bleach solution using paper towels or disposable rags and cloths.
  • Dispose of the gloves, paper towel, rags and cloths into a durable bag.
  • Wash hands thoroughly

Wendy Griffin, RN, BSN, MSPH, Infection Preventionist, Oregon Health and Science University, Portland, Oregon.





Life On a Blog

24 03 2011

image by inju

Blogging is therapeutic. For those living with or affected by infectious diseases, it can be a way to connect with those whose lives mirror their own.

Brooke Davidoff, diagnosed HIV positive in January 2010, blogs about her life as a newlywed and a first-time mom. Brooke’s life turned upside down during her pregnancy, when she had a routine blood test for HIV and discovered she was positive. “If there was no baby, I’d still have no idea,” she blogged. 

Brooke started blogging “. . . to express myself, I don’t know how not to. When I was diagnosed, I searched for stuff written by other HIV positive females to relate to, and I had a very hard time finding what I was looking for. So I began to write it for other women like me who needed to know they are not alone.”

Sabina is a 15-year-old girl who loves volleyball and dancing. She’s slogging through a year of treatment for hepatitis C and blogs about it “. . .  to share my experience of HCV treatment for children or adults who are starting or already started their treatment. I know that treatment can be difficult and painful, I would just like to give another perspective. I just want to help out and be there for other kids or adults.”

Elizabeth Boskey, PhD, MPH, calls on her education and research experience each time she blogs about STDs. Ever the teacher, Elizabeth says, “There is a lot of secrecy and stigma surrounding STDs. I blog about STDs not only to address the misconceptions about them, but to make them a topic of discussion.

“Some people think that having an STD means that they’re dirty or ruined, that infection marks them as a slut or somehow undesirable—all of which is ridiculous. Still, these feelings are common in people who have had bad experiences disclosing an STD to a partner, or who have simply internalized the stigma that is widely present in American society.

“People make jokes, and not kind ones, about STD infection, but the truth is that STDs are just diseases like any other. Yes, they are often preventable, and people should do their best to prevent them, but acquiring an STD doesn’t make you a bad person.”

Are you ready to blog?
It’s easy to get started. There’s no cost, other than your time, and, if you’re speaking from personal experience, what it costs you to speak from your heart.

Brooke blogs to share with women like herself, and to let her friends and family know that she’s OK. “I think I’m helping other people feel more normal…the stigma hopefully will diminish in time.”

Blogging can be a positive experience, but there are emotional risks.

“I think that if more people blogged about STDs it might help reduce some of the stigma associated with them,” says Elizabeth. “However, I think it’s important to acknowledge that doing so is not without risks. Publicly acknowledging an STD infection may change the way that people around you treat you. It may even affect your employment—although it shouldn’t.”

Boundaries
It’s OK to not share every single thing in your life. Write honestly, but don’t fret about keeping some details private. It is your life, so you define the boundaries beyond which you’re not comfortable sharing.

Readers
If you write about it, they will come, but be prepared for the readers’ thoughts that may cascade upon you. Some comments you’ll treasure and some, well, let’s just say they’ll raise the eyebrows.

“I check daily for new comments and emails,” says Brooke. “The ones that touch me the most are people who found out the same way I did, or the ones who decided to have a baby after reading my story.”

There’s a yin yang to blogging, as there is elsewhere in life. Be prepared for the nasties you’ll find in the comments section of your blog.

“Although blogging can be a wonderful way to gather personal support, it may also have less positive results,” explains Elizabeth. “Comments can be negative, or even cruel and vindictive. It may be worth blogging anonymously if you are concerned about your privacy and the ramifications for exposure in your daily life; however, it is very difficult to ‘guarantee’ that your identity will not become known. This is particularly true if you are discussing sensitive issues such as those involving your sexuality.”

Last words
Bloggers always get the last word, and that’s no less true for our guests today.

Brooke on HIV: I live a normal life other than taking pills every day. I’m waiting to see what the disease does to me. I think all of us sit and wonder when it’s going to kick in, and what it’s going to do.
If you’re having unprotected sex, get tested. You never know. There are really no symptoms that would lead you to get the test, it’s better to know and get on meds now than find out when it’s too late and you’re really sick.

Sabina on HCV: [I want people to know] that we’re not harmful to others as long as we don’t share blood transferring items, such as razors, and toothbrushes. And that having HCV [hepatitis C virus] doesn’t set you apart from others even though it’s a serious virus.

Elizabeth on STDs: I don’t think you have to blog about STDs to help destigmatize them. Make a point of having open and honest discussions of sexuality with your partners and your family. Don’t allow people to get away with making cruel comments about infectious diseases or even “cute” jokes. And, finally, remember that a lot of the stigma surrounding STDs has to do with ignorance. Educate yourself—about how common STDs are, about testing, and about prevention—so that you can educate the people around you.





Ryan is Hepatitis C+

14 03 2011

(Guest post from Nora, Ryan’s mom.)

courtesy sugar daze

As a little girl, I dreamed of being a wife and mother with a home filled with children. 

When I realized that “prince charming” wasn’t showing, I knew I could still be a mom.  When I set out on the journey alone, I thought it would take forever, however I was a lucky one.  I signed with an adoption agency in June of 2002, and my son was born in August 2002. 

When the agency told me they had a birthmother looking for a single mom, I questioned why? In speaking to the birthmom she said “she had grown up in a household where her parents fought a lot, so her thought was if there was one parent she was ok with that.”  Anyway, it worked out great for me. 

 The agency told me the mother was a drug user and had hepatitis B and C.  I thought “OK so what does that mean?”

I was able to get the birthmom’s medical records as well as my son’s records, once he was born, and have then reviewed.  At birth, my son’s blood was non-reactive to hepatitis C and of course he was given the vaccine for hepatitis B.  OK, non-reactive that’s good right?  Well it really doesn’t mean anything except that the virus is not active as of right now, and we would have to wait until he was 15 months old to run further blood work. 

 When I was asked if I still wanted to adopt him, I thought they were crazy, well of course.  He was my son, it was meant for me to be his mom and my blessing from above.  We plugged along with him over the first year having some issues, having to be withdrawn from the drugs he was born addicted to, having a bout of meningitis, bladder infections, a lot of virus issues etc.  Then the dreaded 15 month time frame was here. 

Ok we went and had the blood work and I just knew in my heart that since I had been told that there was less than a 1% chance that he would have hepatitis C that we would be doing this just to get the all clear.  I remember it was right before Thanksgiving and I was going into the mall to shop when my cell phone rang.  It was Ryan’s pediatrician who was a friend that I had worked with over the years.  I couldn’t believe what I was hearing, his blood work was positive for hepatitis C.  What, say that again?  You have to be wrong, right? 

No, he wasn’t wrong.  He told me to enjoy the holiday and he would see me right after.  Enjoy the holiday, are you kidding me, how would I ever enjoy anything again? 

You see for me the first 15 months of my son’s life was spent dealing with the other issues, and not ever really thinking that we would have to deal with HCV.  I didn’t really know a lot about it and my first thought was “Oh my God, I am going to have to watch my child suffer.” 

Well over the next week I began researching and reading everything I could on hepatitis.  By the time Ryan got in to see the GI specialist, I knew we had to run a genotype screening and viral load blood work.  I was in an attack mode and wanted my baby fixed.  Well I wish it was that easy.  The GI physician here at our local Childrens’ Hospital told me that there was not much info on children dealing with this disease and he would follow Ryan with blood work and ultrasounds every six months, and at age 3 we would treat him. 

WHAT, I wanted something done now.  Of course I realized in my mind that that was not the protocol and that I had to trust the doctors.  That was hard for me, I wanted to be in control over what happened with my son, not this horrible disease that could be eating away at his liver.  How would I allow it to go on for another 2 years before we did anything?  Of course, now I realize the harshness of the treatment, but at that time I just wanted it not to be true.  I prayed that I would be strong for my son and be able to gain as much knowledge as I could about this monster living within his blood and liver.  

(Ryan is finally in treatment.)





HCV+ Teen Tells It

24 02 2011

My name is Sabina, I live in San Diego, and I’m 15 years old. I have had hepatitis C (HCV) for about 13 years now and I have just recently decided to get rid of it and started treatment.

On MLK day I’m happy to say that I celebrated my first full week of being on the treatment. And let me tell you it wasn’t as bad as I thought it would be.

I started the treatment on January 10, 2011, and now I take two drugs. Every Monday I have to give myself a shot at night. When I was about to get my first shot, I was so nervous and scared. I thought the needle was going to be inches big but it wasn’t. The needle was an inch if not half an inch big. And it didn’t hurt one bit. But still I’m scared for every Monday to come.

Every morning I take pills after breakfast, and in the evening I take another dose after dinner. And so far I haven’t gotten any serious symptoms. Though everyday I get headaches in the evening that really hurt, but as I was doing some research I found out that it’s better that you don’t take medicine to try to make it better. Instead you should eat and drink lots of water, and it really does help.

From talking to people that have gone through the process before, some tips I learned were carrying a water bottle around with you is smart so you can always have water to drink, to not overreact if something happens because its happens to everyone, and to make sure you tell your parents everything from itchiness to headaches to how you’re feeling.

Something that I’m always concerned about is forgetting to take my pills every morning and evening. But you don’t need to worry about that. You should know that if you forget to take your pills in the morning you should never take 4 that night at once. All of that medicine at once can put a dent into your body.

Another thing that I’m worried about is my sports. But I was told from the doctor that after a few months I should be ready to go back to my everyday activities and sports. I’m a volleyball player and club season is coming up, and the doctor says I should be healthy enough to play. Great news, huh? So if you are a sports person don’t stress about not playing.








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