Medical specialist Kevin Rebe said the Parktown Boys High’s policy was “probably outdated and not based on the latest evidence”.
A top school that discourages learners who disclose that they are HIV positive from participating in contact sports has been warned that its policy is potentially discriminatory.
Parktown Boys’ High School’s code of conduct includes a section on HIV which says that the policy is for the benefit of learners, teachers, school employees and parents.
“Fundamental to all of this policy is the presumption that everyone involved with the school is a potential HIV-infected person.”
It states that those who disclose that they are HIV positive should “carry protective equipment with them at all times. Any cuts or abrasions, even if not considered serious, must be covered up immediately. All learners are encouraged to carry their own plasters, band aids at all times.”
The policy was drawn up after consultation with the student council and learners, the governing body and parents, the school executive and teaching and administrative staff.
Gauteng education MEC Panyaza Lesufi said he would speak to the school because, on the face of it, the policy appeared to be inconsistent with the Bill of Rights and the Constitution.
“They might want to argue that they want to protect other learners and they might say that contact sport has its own limitations. My view is that anything inconsistent with the Bill of Rights or the Constitution is unacceptable. That’s my non-negotiable stance on school policy.”
According to the US government’s Centers for Diseases Control’s website, HIV-infected blood contains the virus. For transmission to occur, blood would have to come “in contact with a mucous membrane or damaged tissue [such as open wound] or be directly injected into the bloodstream from a needle or syringe”.
HIV does not survive long outside the human body and it cannot reproduce outside a human host.
Kevin Rebe, an infectious diseases specialist working for the Anova Health Institute, said the risk of infection becomes close to zero when an HIV-infected person is on antiretroviral treatment, and uses the treatment correctly, because ARVs suppress the reproduction of HIV in someone’s body to a level where the person’s blood contains such small amounts of HIV that infection is highly unlikely to occur.
According to the department of health, about half of the country’s seven million HIV-infected people are on antiretroviral treatment.
Rebe said the Parktown Boys High’s policy was “probably outdated and not based on the latest evidence”.
“I do not think that it’s fair to regard HIV-positive kids as necessarily infectious to others anymore because the clinical data shows us that once somebody is on treatment and their viral load is depressed, they are basically not infectious to others.”
Said Rebe: “It would be entirely irrational to single them out as being a risk to other kids. I do think that the policy could lead to undue discrimination. It is not necessarily supported by HIV transmission evidence.”
He said that about 10 or 15 years ago when there was a limited knowledge about the dynamics of transmission, “that might have been an acceptable precautionary line but I don’t think it is valid anymore”.
“HIV kids who are on treatment are entirely healthy. They are going to want to play sport and to disallow them to do that based on the fact that they are HIV-positive is discriminatory without a doubt.”
Rebe said schools should rather have a policy stating that all body fluids should be considered as potentially infectious.
“Blood spills should be immediately dealt with. People who bleed on the sports ground should have their wounds treated and dressed. That’s the kind of thing you do. If you are bleeding you don’t go on to the sports field, regardless of whether you are HIV positive or not.”
Tim Gordon, national chief executive of the Governing Body Foundation, said he found the clause in the policy to be an acceptable inclusion.
He said there was some danger of possible infection in instances where a person bled “fairly profusely”.
“If they are aware of the fact that they are HIV positive and their participation in certain activities may conceivably be dangerous to their peers, it would not be unreasonable to bring that to their attention and say: ‘Why don’t you play tennis or swimming or netball?’ ” rather than a contact sport such as rugby.
The Human Sciences Research Council’s most recent household HIV survey shows that less than one in three South African teens between the ages of 15 and 19 years know their HIV status.
The study found that about 5% of young people under the age of 24 were living with HIV.
Gordon said schools should ensure there was no stigma attached to disclosing one’s HIV status before including a clause on HIV learners being discouraged from participating in contact sport.
“This type of clause would be most acceptable in a school that has gone a long way towards destigmatising Aids.”
Derek Bradley, Parktown Boys’ High School’s principal, said the school had hired Rape Wise, a professional advisory company, to review its code of conduct.
“The points you have made are noted and these will certainly be altered or reviewed if necessary to ensure that there is absolutely no prejudice. All our policies are in line with the South African Schools Act.”
Bradley said he had no doubt that their updated and reviewed code of conduct would reflect their stance on HIV. “As a leading school, we strive to provide a top quality education to our learners in an environment free from any form of prejudice.”
Asked whether HIV-positive learners would be reluctant to disclose their status for fear of being banned from sport, Bradley said: “This will be addressed as a consequence of the reviewed document.”
A random check of other schools’ HIV policies revealed that at Cape Town’s Rustenburg High School for Girls, learners who are HIV-positive are not “prevented from being involved with school activities” while Bishops, also in Cape Town, bans learners from playing contact sports if they have an “open wound, sore, break in the skin, graze or open skin lesion”.
Bishops said that coaches were aware of the dangers of blood and would not allow boys to play with open wounds.
“With grazes there is probably a judgement call on the stage of the graze. A fresh wet graze would need to be covered. An old one is probably safe.”
The school said it had never had a case reported to it where an HIV positive learner was discouraged from participating in sport. “We would seek medical advice from a range of medical professionals if this situation arose,” it said.
SA Rugby said there were a number of standard protocols in place concerning open wounds. It referred the Mail & Guardian to the rules, regulations and policies of World Rugby of which they were a member.
World Rugby rules and regulations
World Rugby does not have any policy that prevents HIV-positive players from playing the game.
“Transmission of HIV is estimated to be 1:43-million games, based on the estimated prevalence of HIV infection among athletes, the risk of percutaneous HIV transmission in health care and the risk of bleeding injury in American football.
Individuals and sports medicine physicians should be aware of the principles of post-exposure prophylaxis [the use of ARVs within 72 hours of HIV exposure to prevent HIV infection] for HIV infection.”
Kevin Rebe, an infectious diseases specialist working for the Anova Health Institute, said the transmission rate was likely to be much higher in South Africa because there is more likely to be bleeding in rugby than in American football.
“It will be high here simply because the prevalence is higher and more players are likely to be positive.”
Rebe said that once a person was on treatment there was a 96% less risk of transmission.
World Rugby emphasises strong preventative measures for the spread of blood-borne diseases:
- Law 3.11(a) requires that players with open or bleeding wounds must leave the field to have the bleeding controlled and the wound covered.
- Law 4.4(a) prohibits players from wearing any item that is contaminated by blood.
- World Rugby Regulations 15.2.1(c) and 15.3.1 set out the match doctor’s role in relation to monitoring blood injuries in international matches. In brief, the match doctor’s role is to supervise the appropriate treatment of any blood injury and to ensure that the bleeding is stemmed, the wound is covered and all blood-stained apparel removed prior to the player returning to the field.
World Rugby recommends that, where possible, this best practice is also implemented at noninternational matches.