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February 2003




HIV/AIDS and Sport

Lloyd Leach
Department of Sport Recreation, and Exercise Science, UWC

In recent years, the prevalence of the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has received increasing attention because of the growing number of infections, especially amongst popular celebrities and prominent sportspersons, such as Arthur Ashe (tennis) and Earvin "Magic" Johnson (basketball). The disease has reached epidemic proportions in Sub-Saharan Africa, and more especially in South Africa, which currently has the highest infection rates in the world. This clearly represents a major public health problem, with government spending currently standing at R1-billion to address this pandemic.

Given this reality, it is to be expected that more and more sportspersons will present with this infection in future. A comprehensive plan of action, involving meaningful inputs from various sectors of society, including the state, non-governmental organizations, and more appropriately, the sporting fraternity, can go a long way in addressing, if not containing, this threat.

Within sport there exists a risk of injury and subsequent bleeding. Accordingly, there is a possibility, albeit small, of risk of HIV infection during participation in certain physical activities. This is particularly true in the case of high-risk combat sports, such as boxing, wrestling, and the martial arts, where open bleeding wounds tend to occur quite often, especially during competition.

Risk of HIV Infection in Sport and Recreation

According to current scientific evidence, the risk of HIV transmission during participation in the majority of sporting codes is extremely small. However, this position is only true if the precautions taken by all persons, both participants and officials alike are timely, proper and adequate.

The transmission of HIV or other blood-borne pathogens in sport has not been documented substantially, except for one reported incident during a soccer match in which two players collided. The collision caused severe skin wounds of the eyebrows and profuse bleeding in both players. As a consequence thereof, one of the players is alleged to have contracted HIV, arising from traumatic contact with the other HIV seropositive player. Except for this isolated incident, there have been no other reports of HIV transmission in sport. Because of the extremely low probability of HIV transmission, it is recommended that previously active persons be allowed to continue in their sport activities provided that further participation does not compromise their condition. Alternatively, it is equally important to mention that under no circumstances should HIV positive persons be compelled to participate in sport because of one or other commercial endorsement or financial obligation to a club.

Accordingly, all participating sportspersons, coaches, and administrators should be appropriately informed about the inherent risk that sport presents. More importantly, sportspersons with HIV who are actively competing must be carefully managed and encouraged to act responsibly towards fellow competitors. In this regard, when bleeding occurs, the recommended approach should be one that assumes all blood is HIV infected, for which universal safety precautions must be adopted at all times, and the injury treated no differently from any other in sport. In such a way all sportspersons assume some responsibility for their own safety, and it should not be taken for granted that all sportspersons are disease free.


It may be deemed prudent to reconsider the appropriateness of a sport like boxing for youth, especially competitive boxing, in the absence of mandatory HIV testing. Such an instance could pose a significant risk for HIV transmission to sports participants that could otherwise be averted. Under such circumstances, known cases of HIV infected boxers could be encouraged to refrain from further participation or competition in boxing and to adopt an alternative, less robust activity with a lower risk of transmission. By so doing one is acting in the best interests of all persons, if not sport.

Even at the professional level, there is a lack of adequate control in boxing. The country's boxing commission has a policy of testing boxers only once a year when they apply for new licences. Those testing HIV positive are denied new licences and banned from further competition. As a policy, the SA Boxing Commission, like others worldwide, does not publish statistics on the number of boxers infected with HIV, because of a serious controversy created in 1995 after such disclosure. The response throughout the world was very negative, and became a lesson for boxing in particular, and other sports in general. The standard procedure of operating for most boxing commissions is simply to revoke or deny boxing licences to HIV infected boxers. Alternatively, some boxers, after knowing their HIV status, simply refrain from applying for boxing licences subsequently. Even at the professional level, there is a lack of adequate control in boxing.

Because there exists a probable risk of HIV infection in sport, it would be recommended that all sport federations clearly communicate these risks through sports awareness programmes and educational workshops to all sectors of the sporting community, and if appropriate, even the broader community.

HIV transmission is further facilitated when protective sports equipment is not used, such as mouth/gum guards, shin guards, shoulder pads, proper footwear and helmets. Some of these sports aids need to be made mandatory by certain sports bodies as a precautionary measure, and actively enforced by sports coaches, administrators and officials during competitions.

Voluntary HIV Testing

Based on current medical and scientific evidence, compulsory HIV testing of sportspersons in general is neither recommended nor prudent. In addition to creating numerous ethical dilemmas, such testing also has legal implications that ultimately could affect the livelihood of sportspersons, sports clubs, federations and related organizations and institutions. Voluntary HIV testing should rather be encouraged amongst all persons engaging in sport and recreation, where individuals are fully informed about the purpose and nature of testing, and their voluntary consent is secured as a prerequisite before proceeding with any testing. Under no circumstances should cooperation be coerced or mandated from participants. In addition, individuals must be informed that opting not to be tested or withdrawing at any stage from testing will not in any way count against them or result in any unfair or discriminatory practice taken against them.

Prevention of HIV/AIDS Transmission in Sport and Recreation

The risk of HIV transmission during participation can be substantially reduced if universal precautions are introduced and observed in sport and recreation. The following guidelines can prove helpful, namely:

That all blood and body fluids should be considered infected regardless of the circumstances.
That all sportspersons be encouraged to view the prompt reporting of injuries, particularly bleeding, as being in the best interests of all concerned.
That all injuries, especially bleeding wounds, receive proper and adequate first aid.

General HIV education and awareness about this disease is one of the most important vehicles of decreasing the spread of the disease, especially in sport and recreation. More specifically, the implementation of general safety guidelines and ensuring good medical practices directly addresses the issue of HIV transmission. In a sense, such interventions help reduce injury in sport, and minimize the likelihood of complications arising from such injury through timely and appropriate wound management.

Exercise Training and HIV

Regular moderate physical activity is not only feasible but strongly recommended for most individuals infected with HIV and who are moderately to severely immunocompromised. It can have significant beneficial effects, both psychologically and immunologically. Presumably, increased levels of physical fitness can also translate into enhanced vitality and vigour, and allow for alternative recreational pursuits by HIV infected persons. Such efforts can allow the HIV infected individual to experience not only a better quality of life but also a vibrant mental constitution, and may even prolong the individual's sports career for a number of seasons.

Moderate aerobic exercise, prescribed in accordance with the recommendations of the American College of Sports Medicine, i.e., between 50 and 70 percent of maximum heart rate performed continuously for 20 to 30 minutes at least thrice weekly, is recommended because of its beneficial effects on the body's immune system. Additional improvements, reflected objectively, were: maximal oxygen consumption (aerobic power), minute ventilation, oxygen pulse, rate pressure product, as well as lower heart rates at rest and during submaximal training workloads; and subjectively: lower rating of perceived exertion (RPE) for a given exercise load, and an increased willingness to engage in vigorous physical activity.

Similarly, progressive resistance training (circuit weight training) can also help to develop skeletal muscle mass, lean body mass (LBM), body composition and muscle strength, as well as play a key role in the maintenance of bone (skeletal) mass. In addition, the use of supplemental androgenic agents (steroids) to improve the benefits of resistance training is apparently an acceptable intervention for certain individuals with AIDS wasting syndrome (AWS).

In human exercise studies using gross serologic markers of immune status in asymptomatic HIV-infected individuals with moderate to severe immunocompromisation, exercise training reflected stable or improved CD4+ counts (statistically nonsignificant). Under these conditions, the relative immunostimulatory effect of exercise could be viewed as grounds for encouraging continued participation by HIV infected individuals. Similarly, in certain instances where exercise did not result in significant gains in CD4+ count, it helped to stabilize or slow down the rate of decline.

Other clinical studies have shown evidence of transitory immunosuppression following acute, exhaustive exercise, but this trend was less pronounced in trained subjects. The clinical significance of this change, particularly for the HIV infected individual, is yet to be determined, and will need to be investigated in future studies. Nevertheless, HIV infected sportspersons with immunosuppression, as reflected in decreased CD4+/CD8+ cell ratios, should preferably not undertake acute strenuous physical exercise to exhaustion, especially if the exercise is combined with the stress of sport competition.

Unquestionably, moderate, regular physical exercise appears to have definite therapeutic benefits for the HIV positive individual, and if sensibly applied can provide an alternative, effective means of intervention in the ongoing management of this disease.





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