Your Student Athlete

27 08 2013

Kids are back in school and signing up for sports.

Some parents wonder about their infected children playing sports and possibly infecting others in the process.  Parents also wonder how concerned they should be about their children becoming infected from other players living with undiagnosed or undisclosed infections.

Playing sports can be risky in many ways and part of that risk is the potential to become infected with all sorts of germs.

Parents of children living with diagnosed infectious diseases worry that they may be responsible for infecting another child.  They wonder if they should inform the coach or the school.  They worry that the adults in charge don’t really follow standard precautions, thereby increasing the risk of infections.  They want their kids to enjoy life and they want to do the right thing.

The American Academy of Pediatrics issued a policy statement on this dilemma in December, 1999: HIV and Other Blood-Borne 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.”

The AAP’s Redbook still supports this policy.

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

There is no reason to exclude any student from sports if they’re infected with HIV, HBV or HCV.  Nor is there a reason to disclose the infection.  There are many people living with undiagnosed infections, so it is more prudent to ensure everyone is practicing standard precautions rather than simply excluding those with known infections and not properly protecting all athletes from undiagnosed infections.

Dr. Steven J. 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.

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

Dr. Anderson does feel that 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, and the person is no longer contagious.

An article that ran in 2004 in the British Journal of Sports Medicine talked about possible methods of transmission in sports and reported incidents of transmission:

Bleeding or oozing injuries could, in theory, transmit the virus through the mucous membrane or injured skin of other athletes.  This risk is considered extremely low.  However, contact and collision sports like wrestling or boxing increase that risk.  The risk goes down a bit for those playing basketball or soccer, and those playing sports with little physical contact, such as tennis or baseball, are at the lowest risk.

It has been suggested that bloodborne infections may be transmitted through sharing a water container, because bleeding around the mouth is common in contact sport.  Therefore it is recommended that water containers should be available individually for each player in contact sports. Athletes should use squeeze water bottles which they do not put in their mouth.

Bloodborne infections can be transmitted through blood doping. There is also a risk from sharing needles which may be associated with drug abuse in sport. Injectable drugs used in sports include steroids, hormones, and vitamins.

Three separate cases of HIV infection associated with sharing needles among bodybuilders have been reported, two in the United States and one in France.  It has also been reported that three soccer players from one amateur club were infected with HCV as a result of sharing a syringe to inject intravenous vitamin complexes. Syringes have often been shared by athletes who inject vitamins minutes before a game.

A 1993 study estimated that, in the United States, there were one million people who were either current or past users of anabolic androgenic steroids. Of these, 50% were intramuscular drug users, and about 25% had shared needles. Therefore it seems that the risk of transmission in this way may be considerable among athletes, especially bodybuilders.

So, if your family is getting involved in sports, it would be worth your time to:

  • Get caught up on all vaccinations
  • Practice standard precautions
  • Wash your hands a lot or, if hands aren’t visibly soiled, use alcohol handrubs
  • Don’t share needles with anyone for any purpose




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





Sports and Infectious Disease – Part 1 of 3

6 04 2013

exeterIf you coach a little league team, parent an active athlete or are an avid sportsperson yourself, it is important to know what health risks may be present during athletic events other than shin splints and bruised egos.

Close physical contact and a heightened chance of bleeding present a chance for disease transmission unless appropriate precautions are taken.

Athletes, trainers, coaches, parents, and teachers alike must know how to prevent the transmission of bloodborne viruses such as HIV and hepatitis B or C, or even skin-to-skin infections.

These infectious diseases, and others, pose complex problems for athletes of all ages and everyone involved in sports activities.  But following standard precautions to prevent bloodborne, skin-to-skin, and respiratory infections simplifies and safeguards sports events and ensures that everyone can participate safely.

Sports and Standard Precautions

Universal use of standard precautions is critical because many children, adolescents, and adults who are infected with viruses, such as HIV and hepatitis B or C, may not even know they have these viruses.  Estimates vary, but some predict that more than half of those infected with these viruses do not know they’re infected.

Standard precautions protect everyone, from those whose diseases have been identified, to those that have not yet been diagnosed, to those not infected.  When everyone follows standard precautions, no one who has an infection needs to be treated differently.  Essentially, standard precautions are the great equalizer; when followed, they allow everyone to fully and safely participate in sporting events.

The more serious bloodborne viruses that athletes need to be aware of are: HIV (the virus that causes AIDS), hepatitis B, and hepatitis C.  There is no recommendation that people infected with these viruses not be allowed to participate in most sports.

Although HIV and hepatitis C are not vaccine-preventable, there is a safe and effective vaccine that prevents hepatitis B infection.

Skin-to-Skin Infections

According to the NCAA Injury Surveillance System, “skin infections accounted for almost one-third of the practice time loss events” in wrestling during the 2001-2002 season.  As a result, the NCAA recommends that coaches, teachers and other sports officials be able to identify symptoms of skin infections.  Symptoms may include:

  • Crusting
  • Scaliness
  • Oozing lesions

Skin infections may include:

  • Bacterial skin infections including impetigo, erysipelas, carbuncle, staphylococcal disease, folliculitis and hidradenitis suppurativa.
  • Parasitic skin infections including pediculosis and scabies.
  • Viral skin infections including herpes simplex, chickenpox and molluscum contagiosum.
  • Fungal skin infections including ringworm.

In some cases, such as fungal infections, the skin conditions can be covered with a securely attached bandage or non-permeable patch to allow participation in the sporting event.

In addition to identification and treatment of individuals with skin infections, prevention can occur through proper routine cleaning of all equipment, including mats and shared common areas, such as locker rooms.

Respiratory Illnesses

Anyone with an infectious respiratory illness, such as flu, or whooping cough, or perhaps tuberculosis, should be prohibited from playing to prevent the spread of infections that are transmitted through respiratory routes.

Check back over the next couple of weeks for Parts 2 and 3 in this sports series. Part 2 gets into specifics on bloodborne pathogens, and Part 3 provides guidelines for sports teams to follow before, during, and after each event.

 

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of University of Exeter





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





HIV + NTDs – the Relationship

16 07 2012

In early April, we wrote a blog post about the END7 Campaign’s work to raise awareness and donations in order to eliminate seven neglected tropical disease (NTDs) by 2020.

We are dedicated to fighting these devastating diseases because they infect more than one billion people around the world. That’s one out of every six people who is likely to suffer from blindness, malnutrition or disfigurement due to these totally preventable diseases.

But in addition to minimizing suffering from these effects, controlling NTDs is also important for success in fighting other diseases notably HIV/AIDS. In many parts of the world, there is quite a bit of geographic overlap between NTDs and HIV/AIDS. In fact, research demonstrates that there are increased odds of having HIV when an individual is co-infected with an NTD. For instance, women with female genital schistosomiasis (FGS) have a three-fold increased risk of contracting HIV/AIDS compared to those not burdened by the disease. Moreover, soil-transmitted helminths (or intestinal worms) can actually worsen the progression of HIV toward AIDS by increasing viral loads.

These high rates of co-infection mean there are a number of opportunities for the NTD and HIV/AIDS communities to join forces to coordinate and collaborate on further research and treatment programs for these diseases.

We’re hosting a workshop at AIDS 2012: XIX International AIDS Conference to begin these discussions. If you’re attending, we hope you’ll join us!

To learn more about NTDs and the links between these diseases and HIV/AIDS, visit END7 on Facebook and tell your friends and family to do the same.

Heena Patel
Communications Department
Sabin Vaccine Institute 
hpatel@sabin.org

Image courtesy of Esther Havens





Safer Sex (We Hope)

19 01 2012

Warning: This article contains explicit sexual information. It has been adapted from a piece written for PKIDs’ Pediatric Hepatitis Report. We encourage young people to talk with their parents and healthcare providers about safer sex and abstinence before becoming sexually active. The methods of disease prevention described in this post are not guaranteed to work. You may practice safer sex and still acquire an STD.

Anyone can become infected with a sexually transmitted disease (STD). CDC estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24.

Many people are unaware they have an infection. Some diseases that can be transmitted sexually may also be transmitted during the birthing process, or through a blood transfusion. You may be living with hepatitis B or herpes or human papilloma virus (HPV) and not know it.

For maximum prevention, teens and adults should either abstain from sex or always practice “safer sex,” although abstinence is the more sure method of STD prevention.

What Is Safer Sex?

Safer sex means taking action to make sure no one gets their partner’s blood, semen or vaginal fluids in their body. Similarly, safer sex means you make sure your own body fluids don’t enter your partner.

With safer sex, no body fluids enter a vagina, anus or mouth (during vaginal, anal or oral intercourse) or come into contact with mucous membranes, such as around the eyes, gums, or nostrils.

The best way to prevent body fluids from reaching someone during intercourse is to use a condom. A condom is a sheath that fits over the penis. It can be made of latex (the safest condom available), plastic or animal tissue. It is also called a rubber, safe or jimmy.

Today, nearly as many women as men buy and carry condoms. It catches a man’s semen before, during and after he ejaculates. Some condoms have a nipple-shaped tip to hold the semen so it does not spill out.

Experts consistently recommend latex because some animal tissue, such as lambskin, has pores small enough for sexually transmitted viruses or bacteria to pass through. Polyurethane condoms break more often than latex.

A study cited by Planned Parenthood observed heterosexual couples where one partner was HIV-infected and the other was not for an average of 20 months. It found:

  • None of the uninfected partners among the 124 couples who used condoms consistently and correctly for vaginal or anal intercourse became infected with HIV.
  • About 10 percent of the uninfected partners (12 of 121) became infected when condoms were used inconsistently for vaginal or anal intercourse.
  • Of the 121 couples that used condoms inconsistently, 61 used condoms for at least half of their sexual contacts and 60 rarely or never used condoms. The rate of infection was 10.3 percent for the couples using condoms inconsistently and 15 percent for couples not using condoms.

In short, nothing guards against STDs like a latex condom and other safer sex practices. Spermicidal foams and jellies, diaphragms, implants and other devices do not block body fluids and may not kill all of the harmful bacteria and viruses in your partner’s secretions.

The female condom fits inside the vagina like the diaphragm and also covers the vulva. It is a pouch with flexible rings that is inserted into the vagina. It has the advantage of not requiring a man to maintain an erection during use. Although it is not as effective as the male condom, the female condom is an option for women who want some protection against viral hepatitis, STDs and unintended pregnancies.

The birth control pill, IUDs, vasectomies, tubal sterilizations and other methods of birth control offer great protection against pregnancy, but no protection against STDs. Many people use latex condoms along with these birth control methods for the best protection against both pregnancy and sexually transmitted infections.

Even Oral Sex Requires a Condom

Oral sex may not get one pregnant, but it can still transmit disease.

It is safer to put a condom on the penis before beginning oral sex to guard against secretions that may carry infection. It is important not to get secretions or semen in the mouth. A sore throat or small cuts on the gums may serve as entryways for viruses.

Vaginal secretions can also carry viruses, especially if a woman is having her period. Latex condoms can be cut with a scissors up the middle for oral sex on the vulva or anus. Latex dams or squares, which are thicker than plastic wrap and more likely to resist tearing, may be used. Latex gloves also provide STD protection.

Proper Use of Condoms

A condom just might save a life, and should be treated like the valuable tool it is. Store condoms in a cool, dry place. Long exposure to air, heat or light makes them more breakable. Do not store them continually in a back pocket, wallet, purse or glove compartment.

Check the expiration date to make sure the condom is fresh and safe. Throw away condoms that have expired, been exposed to heat, carried around in a wallet, or washed in the washer or dried in the dryer. If they appear dry, stiff or sticky, toss them. If there are any doubts about a condom, buy a new one.

Condoms usually come rolled into a ring shape. They are individually sealed in aluminum foil or plastic. When opening the condom package, do it carefully to avoid tearing the condom.

To minimize mistakes, both partners should know how to put on and use a condom. Planned Parenthood Federation recommends learning in a safe place free of pressure or frustration. Practice on one’s own penis or on a penis-shaped object like a ketchup bottle, banana or cucumber.

To ensure maximum protection, never use a condom twice and always put a new condom on an erect penis before there’s any genital, anal or oral contact.

If intercourse has already begun, pulling out and putting on a condom right before ejaculation may be too late for protection against STDs and pregnancy.

The male should put on a condom as early as possible at the very beginning of sex play rather than waiting until his partner is ready for penetration. It’s also a good idea to have extra, new condoms around in case a condom is put on too soon or if he loses his erection.

A condom is like a sock, with a right and wrong side. First, unroll it about half an inch to see in which direction it is unrolling. Then put it on. If a male has not been circumcised, pull the foreskin back first. It should unroll easily down the penis. If it starts off on the wrong side, try again with a new condom. Don’t be afraid to practice ahead of time.

Hold the tip of the condom gently between the fingers as it rolls down. This keeps out air bubbles or pockets that can increase the chance of a condom breaking. It also leaves space at the end for the semen. Roll the condom down as far as it will go.

Anal intercourse increases the chance of STDs tremendously, because there can be small tears or bruises in the anus during sex, which makes one tremendously vulnerable to bloodborne infections like viral hepatitis and HIV.

For anal intercourse, lots of lubrication is helpful. Using a water-based lubricant is also helpful for vaginal intercourse. The lubricant goes on after the condom is put on, not before, or else it could allow the condom to slip off easily. Add more lubrication often. Dry condoms break more easily than properly-lubricated ones.

Using lubricant will make things go smoother and give added protection. Lubrication is especially helpful for women when they have intercourse for the first time, or if there is a tendency for soreness.

Always use a water-based lubricant (such as KY Jelly, Astroglide, Aqua Lube, Wet, Foreplay, or Probe) because oil breaks latex. Don’t use vaseline, hand creams or lotions as a lubricant. Also, treatments for yeast infections may contain oil and may break latex.

After ejaculation, hold the condom at the bottom of the penis so it doesn’t slip off. Try to pull out while still erect or hard. The condom comes off only after the penis is completely out of the partner.

Use a condom only once.

Never use the same condom for vaginal and anal intercourse.

Talk Contraception Before the Heat of the Moment

It may be embarrassing to talk to a partner about contraception and condoms, but it’s essential, and should be done before a sexual situation begins. Don’t wait until the heat of passion takes over. It can overwhelm good intentions.

Be honest about feelings and needs. Silence is not a virtue in this situation. Talking about condoms will make it easier for both partners. It can help create a relaxed mood and make sex even more enjoyable and safe.

Embarrassment should not become a health risk and increase chances of infection. It’s important for partners to be open and share health concerns and sexual health history.

By PKIDs staff





Everyone Should Get Tested For HIV

23 06 2011

June 27, 2011, is the 17th annual National HIV Testing Day. It follows on the passing of the 30th anniversary of the day the Centers for Disease Control and Prevention announced a deadly new syndrome, acquired immune deficiency syndrome, or AIDS. Three decades later, many things have changed about infection with HIV, including life expectancy, groups that it infects the most, and ever-evolving treatment successes.

Why get tested? Because the earlier you get treated, the better it is for you and for people at risk of acquiring infection from you. People who are under treatment are less likely to pass HIV to others than people who are going untreated. Without getting tested, you can’t know if you’re infected. Without getting treatment, you can’t keep yourself healthy or avoid endangering others.

You may be thinking that you’re someone who doesn’t need to get tested. Think again. The CDC says that everyone between the ages of 13 and 64 should be tested at least once. If you’re sexually active or engaged in recreational drugs, you need to be tested. There are, of course, groups at higher risk for infection. According to the National Association of People with AIDS, these groups include:

  • younger sexually active teens
  • poor women of color
  • men who have sex with men
  • people who inject or snort drugs with others
  • sex workers or people who barter in sex for life necessities
  • people who live in HIV “hot spots,” places where infection rates are so high that anyone who is sexually active is at risk. These hotspots can sometimes encompass only a few city blocks.

How can you get tested? Depends on how you want to do it. It’s possible to test at home, sending in blood from a finger prick to a lab for analysis. You can buy such kits at drugstores, but doing it on your own means that you won’t receive appropriate counseling if the result comes back positive. In some places, people can get tested anonymously and still receive counseling. But for National HIV Testing Day, testing events are happening all over the United States. If you’re interested in finding a testing site near you, check this interactive map.

Each of the two types of tests available—one tests for antibodies the body makes if the virus is present, the other tests for the virus itself—requires only a blood draw or even just an oral swab for antibody testing. If you think you’ve recently been exposed to HIV, the viral load testing is the test you need. You can’t rely on the antibody test results if 3 to 6 months haven’t elapsed since exposure, as it takes that long for the antibodies to register.

An HIV test doesn’t take much investment in terms of money or blood or even time. But even in this age of improved therapies and life expectancies with infection, the results can literally mean life or death, not only for you but maybe for someone you love. If you haven’t been tested, isn’t that reason enough to make June 27, 2011, your day to get it done?

By Emily Willingham





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.





Lessons Learned from Botswana’s AIDS Fight

16 07 2010

In the early to mid-’90s, life expectancy in Botswana was 65 years. Ten years later, it was below 40 years of age due to the impact of AIDS. The children of Botswana were also affected by the pandemic. To date, nearly 100,000 children have lost at least one parent to AIDS

Faced with such losses in a country with a population under 2 million, and determined to save its people, the government took action and the Botswana-Harvard AIDS Institute Partnership (BHP), was founded.

The Institute provides training and research, and acts as point of contact for the efforts to reduce HIV/AIDS in Botswana. In 2001, simultaneous to the opening of a state-of-the-art lab funded by the Institute, the government launched the Masa (or “new dawn”) treatment program, buying antiretrovirals and making them widely available at no cost to infected citizens. The research capabilities of the BHP, along with Botswana’s HIV/ AIDS education, prevention, and treatment efforts, are unparalleled and show impressive results.

Key factors in Botswana’s fight against HIV/AIDS include:

  • International and national funding and research partnerships (represented by the Botswana-Harvard AIDS Institute)
  • Coordination of education efforts at the national level, and targeted to specific populations including school-age children, pregnant and new mothers, and high risk adult populations
  • Education outreach including targeted mobile outreach (involving peer-to-peer education and counseling)
  • Focus on enrolling mothers in the program to prevent mother-child transmission of the disease.

Stemming the tide of mother-to-child transmission of HIV is crucial in halting the spread of disease. In Botswana, peer-to-peer enrollment in the government-sponsored prevention and treatment program slowly increased maternal participation from under 10% to just over 33%.

Both the Masa and the Botswana-Harvard Institute aren’t easily replicated in countries without a similarly high level of financial and governmental support, but the lessons learned can still be applied.

Although it’s unlikely that most developing countries have the resources to accomplish what wealthy Botswana has done, it is a bit of bright news in the otherwise depressing struggle that is HIV/AIDS in Africa.





Access to ART? Good Luck.

4 06 2010

We know how to control HIV—we do it with antiretroviral therapy (ART). We’re so successful, an HIV infection is now a chronic condition rather than a death sentence . . . for some. For those with access to ART.

Before and after ART

But what about those without access? What about everybody else? As of the end of 2008, just 42 percent of those in lower- and middle-income countries were able to get these drugs.

Why is it so hard to provide this lifeline to those in need? A report put out in May 2010 by Médecins Sans Frontières (a.k.a. Doctors Without Borders), says it’s about the lack of infrastructure, particularly human resources, for the administration of treatment and care, including:

  • Inadequate salaries and poor working conditions, which lead to ‘brain drain,’ attrition, and an inability to attract new health workers
  • National policy barriers that block the possibility to shift tasks to lower level health staff
  • Lack of adequate national and international resources committed to address the health care worker crisis
  • Lack of donor funding for recurrent human resource costs, particularly salaries, due to concerns about “sustainability” and other constraints
  • Limits on spending from ministries of finance and international finance institutions, which can hinder governments’ ability to invest adequately in the health workforce

In addition to infrastructure, the AIDS charity AVERT suggests that barriers to universal access to treatment include:

  • A safe and sufficient supply chain of drugs
  • A life-long commitment on the part of patients to antiretroviral drugs (ARVs) and the ability of healthcare workers to help patients stick to the regimen
  • An awareness of the need for testing and treatment

This group goes on to explain that, “Focusing too heavily on treatment can also be problematic if it detracts too much from efforts to prevent new HIV infections, a scenario which would only add to the eventual treatment burden. Furthermore, unless treatment programmes focus on the vital tasks of monitoring and patient retention, many patients will eventually die from treatment failure.”

The real risk of reducing the work being done in prevention by focusing so much on treatment adds a troubling layer to the discussion.

So, there we are—the usual mountain of reasons why we can’t do what needs to be done. But, what’s a mountain? There are steps we as individuals can take to support universal access to ART:

  1. Press our politicians to stop backing off their commitment to help fund HIV/AIDS services in poorer countries.
  2. Find a reputable charity already in place and doing the work, then do a little fundraising of our own and give it to the charities doing the most good.
  3. Keep talking about these challenges, and if we haven’t been doing so, then start talking.  Silence isn’t an option, given the potential outcomes

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