Should those who are HIV positive be able to play contact sports such as football?

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Should those who are HIV positive be able to play contact sports such as football?

Echo Issue Outline 1999 / 14: copyright © Echo Education Services
First published in The Echo news digest and newspaper sources index.

Issue outline by J M McInerney

What they said ...
`The issue could threaten the future of amateur sports. It has the potential to wreck our competition'
Mr Phil Stevens, the head of the Victorian Amateur Football Association (VAFA)

I have no problem with it. Once more people are educated about it more people will be apt to accept it'
AFL footballer, Wayne Carey

On April 23, 1999, the Victorian Civil and Administrative Tribunal ruled that an amateur football player could be registered to play despite the fact that he had previously been banned by the Victorian Amateur Football Association(VAFA).
The player had been banned because his application for registration contained the statement that he was HIV positive.
The debate surrounding HIV positive players and contact sport has been rekindled by the situation of this footballer and be the decision of the Victorian Civil and Administrative Tribunal.

Background
The situation of Mr Matthew Hall, amateur footballer in question did not become public knowledge until July, 1998. At this point his application for registration had been formally denied after having been significantly delayed while the VAFA considered the implications of his HIV status.
Mr Hall decided to refer the matter to the Equal Opportunity Commission.
The hearing of Mr Hall's appeal began at the end of August, 1998. The decision in his favour was reached by the end of April the following year.

There is a large number of Internet sites offering useful information on contact sports and HIV positive players, as well as sites with information on the issue of whether Mr Hall should be able to play within the VAFA.

In 1994 the Australian National Council on AIDS and the Australian Sports Medicine Federation produced a pamphlet titled, HIV and Sports. The pamphlet has since been put on the Internet by the National Occupational Health and Safety Commission. It can be found at http://www.worksafe.gov.au/worksafe/pamphlet/h/003709.htm
The pamphlet explains the different modes of transmitting HIV. It surveys the risks associated with sports participation and the advantages and disadvantages of sports participation for the HIV positive person. It also makes a series of recommendations as to how to minimise the risk of infection and what procedures should be followed in the event of a blood spill.
It notes that it is illegal to reveal that another person is HIV positive and thus states that the HIV status of all sports participants must be kept confidential unless they choose to make it known.

The Warthog Society is an international association of doctors practising sports medicine. (All were originally fellowship trained at the Cleveland Clinic Medical Foundation.) The Cleveland Clinic Foundation website publishes papers written by these doctors.
In November 1996 it published an article titled, AIDS and the athlete. The article is written by John Zisko. It can be found at http://www.hypermedic.com/warthog/rounds/aidsan~1.htm
This seven page article repays careful reading. It gives statistics on the incidence of AIDS and HIV world-wide and detailed United States statistics on modes of transmission.
The article also describes the various stages and symptoms a person infected with HIV passes through. It lists the known modes of transmission and the current state of research on transmission through contact with body fluids such as sweat and saliva.
The article also details the effect of various levels of exercise on those with HIV/AIDS and the risk of infection faced by other sports competitors and trainers. It also surveys the policy positions of a range of bodies, sporting and otherwise. It gives a summary of the United Nations World Health Organisation's 1989 Consensus Statement on HIV and sport.

The University of Western Ontario's Medical Journal has published a valuable article titled HIV/AIDS in the sports setting.
The article gives a listing of known instances of HIV positive sportspeople competing in a range of codes.
It reviews the attitudes of different sporting bodies, especially in the United States and Canada, toward such participation.
It details the Universal Precautions measures recommended by the United Nation's World Health Organisation and Centre for Disease Control. These are a set of steps which it is believed should further reduce the risk of transmission between sports competitors of blood-borne diseases including HIV and Hepatitis B. These measures form the basis of most codes regulations re the management of bleeding players.
The article can be found at http://publish.uwo.ca/~ahpandya/HIV19.html

The Matthew Hall case first appeared in the media in July, 1998.
The Age published a report titled, HIV footballer to fight league's ban, on July 23, 1998.
The article can be found at http://www.theage.com.au/daily/980723/news/news12.html
The report indicates that Mr Hall's registration had been delayed while the VAFA considered his health status. At this point Mr Hall had already taken his case to the Equal Opportunity Commission.
The article deliberately did not name Mr Hall and the case only became public because the general manager of the AFL had raised it at a national conference on football injuries.

On July 25, 1998, The Age published an editorial titled, Playing football may mean dealing with risk.
The editorial is sympathetic toward HIV positive sports men and women who want to continuing playing contact sports. However, it also considers the risks involved and raises questions as to how sports administrators might respond.
The editorial was reproduced on the Internet by OUT!, New Zealand's National Gay Magazine. It can be found at http://nz.com/NZ/Queer/OUT/news_199807/19980725b.html

OUT!, New Zealand's National Gay Magazine has also reproduced a Herald Sun report originally published on August 5, 1998. The report, titled, HIV player booted out of football, covers the decision taken by the full executive of the VAFA to refuse Mr Hall permission to play within the Association.
It can be found at http://nz.com/NZ/Queer/OUT/news_199808/19980805f.html

The Age published a report on August 4, 1998, which outlined the VAFA's reason's for refusing Mr Hall permission to play and looked at some of the concerns about the decision held by the civil liberties organisation, Liberty Victoria.
The report is titled Concern at ban on HIV player and can be found at http://www.theage.com.au/daily/980804/news/news8.html

On August 5, 1998, The Age published a report titled, HIV-positive player's tribunal date set.
It can be found at http://www.theage.com.au/daily/980805/news/news7.html
The report indicates that Mr Hall's case is to go before the Victorian Civil and Administrative Tribunal on August 31, 1998. It details some of the VAFA's reasons for denying Mr Hall registration.

On August 5, 1998, The Advertiser published a report titled, Doctors 'must decide on HIV'
This is a report of a radio interview given by the AFL's chief executive in which he indicated that clear medical advice on the risk of infection was necessary before a final position could be adopted on HIV positive players and football.
The Advertiser article has been reproduced on the AFL's home page at http://www.afl.com.au/news/story_115854.htm

Also on August 5, 1998, The Sydney Morning Herald, published an analysis titled Positive Action. The analysis gives background on Matthew Hall's case, on the general issue of AIDS in sport and considers the position of sports administrators in a number of codes.
It can be found at http://www.smh.com.au/news/9808/05/sport/sport6.html

Arguments against HIV-positive people playing contact sports such as football
The main reason offered for not allowing those known to be HIV positive to compete in a contact sport is the fear that if the HIV positive player is injured and bleeds, he or she may infect other players.
This was the position put by the Victorian Amateur Football Association (VAFA) when it refused to allow Mr Matt Hall to play once it knew he was HIV positive.
The VAFA has argued that the physical well-being of others takes precedence over claims of discrimination.
The Association argued that the Equal Opportunity Act allowed discrimination where it could be found to be reasonably necessary to protect the health and safety of others.
The VAFA called on infectious diseases specialist, Dr Peter Stanley, who testified before the Victorian Civil and Administrative Tribunal that he would advise that Mr Hall not play.
The VAFA has also challenged suggestions that the risk of infection from an HIV positive player was minuscule.
Dr Stanley has claimed that where it was known that at least one player on the field was HIV positive, then the risk to each player of contracting the virus in any association season was about one in 10,000.
Dr Stanley has stated, `I would be concerned about the significant possibility of transmission.'
It has further been suggested that safety regulations in place to prevent infection with blood-borne diseases may not be being sufficiently observed to ensure the safety of all players.
Another argument offered against those who are HIV positive playing football is that by doing so they might threaten the continued survival of the sport.
According to this line of argument, if it were possible for those with HIV to play football, parents might prohibit their children from playing the sport for fear of infection.
A report in The Australian noted that when Matthew Hall's case was raised on a Melbourne-based radio phone-in discussion program, many of the callers supported his banning and claimed they would not allow their sons or daughters to play against or with someone who was HIV positive.
Similarly it has been suggested that in more senior competition the players themselves might withdraw from the game because they were concerned about the possibility that they could become infected.
This point has been made by Mr Phil Stevens, the head of the Victorian Amateur Football Association (VAFA).
Mr Stevens has claimed, `The issue could threaten the future of amateur sports. It has the potential to wreck our competition. If you get a few players who are hesitant about taking the field (because of HIV risk) there may not be enough for the game to go ahead.'
Richard Tracey, QC, acting for the VAFA, has suggested that players might choose to avoid competing against Mr Hall, leading to teams having to forfeit games against Mr Hall's team.
It has also been suggested that having to play against footballers known to be HIV positive could place unfair pressure on opposing teams.
This point has been made by some Australian Rules players.
Mr Jonathan Hassett, a 22-year-old St Kevin's reserves player, said he would approach a match with caution if he knew he would be playing against someone who was HIV positive.
Mr Hall has said, `I would play against him but I would be cautious. I'd be a bit intimidated.'
It has further been suggested that all sports, including contact sports, are discretionary activities. By this is meant the person participating in a particular sport is not compelled to do so; he or she is acting according to a preference not a necessity.
According to this line of argument, it is not appropriate for those who are HIV positive to put other competitors at any level of risk, when the HIV positive person could chose to play a non-contact sport.
This point has been made by the president of St Kevin's Old Boys football club, Mr Terry Quirk.
Mr Quirk has argued, `Having contracted HIV, the guy should have adjusted his life and played golf or marbles or tennis or something like that.'
It has also been noted that allowing HIV positive players to compete might put any code or competition in a difficult legal position as they could be sued for negligence.
Mr Terry Quirk has made this point, stating, `My concern is where we stand if we allow players to play against the player who is HIV-positive. That's very much an untried area in law.'
It has also been suggested that codes might have difficulty meeting their insurers' requirements if they allow those known to be HIV positive to compete.
The VAFA's insurer is requiring, if Mr Hall plays, that there be four qualified trainers on hand, spare socks and jerseys for every player and a special vehicle in case a player haemorrhaged.
The overall position of those who oppose the inclusion of HIV positive players in contact sports is that the well-being of other competitors, the viability of particular codes and fair competition within them should not be jeopardised for a small minority.
This view was summed up by Mr Phil Stevens, the head of the Victorian Amateur Football Association when he claimed, `We should be catering for the 10,000 uninfected players rather than the couple (with HIV) who want to play.'

Arguments in favour of HIV-positive people playing contact sports such as football
The first argument offered in favour of those who are HIV positive being able to play contact sports is that the risk of others players contracting the virus from them is extremely low.
It has been argued that for any player to become infected with HIV by playing footballer with an HIV positive person, a substantial quantity of the infected player's blood would have to enter the other player's eyes or mouth, or enter a wound suffered by the other player.
Dr Andrew Grulich of the National Centre for Epidemiology and Clinical Research has claimed that a large quantity of HIV-infected blood would have to enter deep into a bleeding open wound of another player or pass through the mucous membranes of their mouth or eyes.
Dr Grulich has claimed that the odds of this happening are so low that it was likely to occur once in 125 million games. Other experts, while also considering the risk infinitesimal, have suggested that infection might occur once in every 40 to 80 million games.
Those who hold this point of view claim that to date there have been no verifiable instances of HIV being passed on through participation in contact sports.
It has further been argued that whatever risk of blood-borne infection there may be in contact sport is not best dealt with by bans on players.
According to this line of argument the most effective way of ensuring that the risk of contracting HIV through contact sport is kept to a minimum is for all codes to strictly adhere to the Universal Precautions recommended by the WHO.
(The WHO recommends that no player take the field with an open wound that has not first been cleaned and dressed.
It also recommends that any player who begins to bleed while playing should be sidelined until their wound has been dressed and the bleeding has stopped.
There are further recommendations that trainers and sports doctors should wear gloves when treating open wounds, that dressings should be carefully discarded, and that care should be taken to avoid infection through blood-soiled towels.)
Those who favour these Universal Precautions argue that such measures are the only sure way of protecting against HIV infection.
According to this line of argument, not all infected players will disclose their HIV status. Some may not know they are infected; others may deliberately chose to keep secret the fact that they are infected.
Thus, it has been argued that considering the level of HIV infection within the general community some 20 to 27 players of the 10,000 in the VAFA are likely to be infected with HIHH HIV. To date only one has made his status known.
It has further been argued that even compulsory testing of all players would not overcome the problem as there is an initial period of some months during which time most tests are unable to detect the virus.
It has been claimed that if many infected players are not going to be known to their teammates then the best means of ensuring the virus is not spread is to treat all players as though they are carriers.
Those who argue against bans claim that they will have a negative effect as all they are likely to achieve is to ensure that no player will volunteer his or her HIV status and many who suspect they are infected may not even seek testing or treatment for fear of discrimination.
This point has been made by Mr Chris Puplick, the president of the Anti-Discrimination Board of New South Wales.
Mr Puplick has said that the effect of a ban on Mr Hall would be that other young footballers would be less likely to be tested.
Similarly, Professor Doreen Rosenthal of La Trobe University has claimed that HIV players who feared being identified would fail to get the best treatment.
It has further been suggested that any development which discourages those with HIV from coming forward for treatment makes it more difficult to contain the disease within the general community.
This point has been made by Professor Dwyer, medical director of Prince Henry's Hospital, Sydney.
In addition, it has been claimed that banning HIV players from participating in contact sport feeds popular prejudice against HIV sufferers.
In the instance of Matthew Hall, for example, once he was banned by the VAFA and his HIV status became general knowledge Mr Hall was sacked from his job in a Melbourne restaurant because customers were concerned that they would become infected.
It has also been claimed that in addition to the general adoption of the Universal Precautions, the community at large (as well as those who participate in contact sport) needs to be better educated about HIV and the limited means by which it can be transmitted.
Finally, it has been argued that being able to participate in their preferred sport is important for the psychological and physical well being of HIV sufferers.

Further implications
The decision of the Victorian Civil and Administrative Tribunal will have significant implications for all sporting codes, both those within Australia and overseas.
It has been claimed that this is the first time that any HIV positive player has sought confirmation from a legal tribunal of his right to participate in a contact sport.
The decision of the Victorian Civil and Administrative Tribunal is thus likely to set a precedent which will be influential in many other countries.
The AFL had indicated that it was likely to follow the lead set by the Victorian Civil and Administrative Tribunal's decision in the VAFA case.
It has been suggested that now that Matthew Hall's right to play amateur football has been legally confirmed there is likely to be an immediate need for all footballers to be educated about the means by which HIV is spread.
This is likely to be necessary to ensure that players are not needlessly concerned about the risks they face. If their fears can be allayed then the known presence of HIV positive players is likely to have a minimal impact on the conduct of games.
It has also been suggested that the Tribunal's decision means that all codes, including the VAFA, will now have to ensure that they fully implement regulations designed to limit the spread of HIV.
Though the Tribunal's decision now probably absolves all codes from legal responsibility for allowing HIV players to compete in their sports, each code could still be sued for negligence if their ineffective management of player bleeding meant that a sports person or official contacted HIV through a sporting contact.
Also of interest is the way Matthew Hall's right to confidentiality was breached in that his HIV positive status was made public.
Initially Mr Hall was not named in reports on his situation. Later television coverage showed close-ups of his football registration documents, which included his name.
By the time Mr Hall appeared on a number of television programs to argue his case it is probable he no longer had any anonymity to protect.
It is also noteworthy that Mr Hall paid a significant price for his loss of anonymity. He lost his job as a direct consequence of his HIV status becoming publicly known. He has not been able to find other employment since.
Now that he has secured his right to play football, Mr Hall may turn his attention to getting some form of compensation from those television networks which indirectly revealed his identity.
Finally the VAFA's position may not be completely resolved. Immediately after the Tribunal's ruling the VAFA indicated that it might challenge the decision. Were this to occur it currently seems unlikely that the Tribunal's original decision would be overturned.

Sources
The Age
1/9/98 page 3 news item by Sue Cant, `20 HIV football cases: expert'
2/9/98 page 4 news item by Sue Cant, `HIV football ban flouts UN guide, tribunal told'
3/9/98 page 4 news item by Sue Cant, `Footry HIV ban condemned'
17/12/98 page 6 news item by Sue Cant, `HIV a low sport risk, court told'
24/4/99 page 1 news item by Sally Finlay, `HIV footy verdict sets precedent'
24/4/99 page 20 (News Extra) news item by Paul Dafey & Len Johnson, `Doubts linger on HIV player'

The Australian
1/9/98 page 3 news item by Benjamin Haslem, `HIV `does not make footballer a risk'
2/9/98 page 10 news item by Benjamin Haslem, `HIV footballer ban "chilling"'
3/9/98 page 3 news item, `Teammates back HIV footballer'
4/9/99 page 2 news item by Benjamin Haslem, `Advice to ban HIV footballer'
24/4/99 page 1 news item by Dan Gafney, `HIV player's 3-year battle to be an ordinary bloke'
24/4/99 page 6 news item by Benjamin Haslem, `AIDS groups hail watershed football ruling'

The Herald Sun
1/9/98 page 11 news item by Natalie Sikora, `HIV players stay secret'
2/9/98 page 21 news item by Natalie Sikora, `Footy AIDS threat'
4/9/98 page 16 news item, `Warning on HIV footy risk'
6/9/98 page 6 news item by Mary Viscovich, `Poverty stalks AIDS sufferers'
15/12/98 page 17 news item, `Players may have HIV'
24/12/98 page 5 news item by Genevieve Lally, `HIV man tells of rape'
24/4/99 page 2 news item by Kelly Ryan, `Umpire rules for Hall'
24/4/99 page 6 news item, `Tribunal's ruling a world first'
24/4/99 page 3 analysis by Kelly Ryan & Phil Skeggs, `Historic win for HIV footballer'
24/4/99 page 3 news item by Daryl Timms, `Players applaud ruling'