question about HIV

[Patrick Gordon]

Howdy folks,

I have a question regarding persons seeking Wing Chun instruction whom are HIV positive. Has anyone here had any experince with this? Would you except the student and if so, would you take any percautions with this individual? Would you tell your other students? If you are a student, would would want to train with someone who is HIV positive? Just curious to hear peoples thoughts and experinces. Thanks for your time, sincerely,

Patrick Gordon.

[Grendel]

Originally posted by Patrick Gordon
I have a question regarding persons seeking Wing Chun instruction whom are HIV positive. Has anyone here had any experince with this? Would you except the student and if so, would you take any percautions with this individual? Would you tell your other students? If you are a student, would would want to train with someone who is HIV positive? Just curious to hear peoples thoughts and experinces.

Just another thought. Hepatitis B is many times easier to transmit than HIV. The amount of blood to transmit Hep B is so small, it might not even be visible. Hep C is also transmitted through blood and both Hep B and C can be quite serious over time.

Andrew S., can you help us with these concerns?

For myself, I would continue to train with an HIV positive person, but would be very careful about any cuts or wounds, both mine and theirs.

Another concern is how are we to know if the person doesn't tell us? Assume all blood contact to be risky and wash it off immediately and discontinue practice with someone who is bleeding even a bit.

[Mr Punch]

1) I think it's common sense to take a medical at least once a year. Furthermore, I think it's common sense for anyone teaching a physical (maybe even full-contact!) activity to have a copy of their students' medical results just in case they have to get rushed to hospital at any time.

2) I don't think HIV is transmissible through small amounts of blood. Don't know what happens if you stick a baat through somebody's femoral artery though!:D

Check some medical literature. And unless that says there is a risk, it's none of your other students' business.

3) Grendel is right about hepatitis.

4) I always like to practise completely wrapped in cotton wool, and advise you to do the same: this cuts down on health risks and the risk of injury!:D

[S.Teebas]

I don't think HIV is transmissible through small amounts of blood.

I think it is.

[TheHype112]

Taken from:
http://www.sfaf.org/aids101/transmission.html#needles

"In sufficient quantity;
The concentration of HIV determines whether infection may happen. In blood, for example, the virus is very concentrated. A small amount of blood is enough to infect someone. A much larger amount of other fluids would be needed for HIV transmission."

So aparently all it takes is a bit.

~Eric

[Mr Punch]

From the same site:


quote
Needle sticks: A study of over 2,000 health care workers has been underway for several years to assess the risk of their exposure to people with AIDS. Over 1,000 of these workers had a needle stick accident with a needle that had been used on a person living with AIDS. The rest had some sort of mucous membrane exposure, such as being splashed in the face with blood or vomit.

Of all these people, only 21 show signs of being infected with HIV (as determined by the antibody test). One of these people was a nurse who had multiple needle stick accidents, including one where she tripped and fell on the depressor of a syringe full of blood, and the entire contents entered her body. Another was a lab worker who was working with a test tube of infected blood which broke and cut his finger, exposing the infected blood to his bloodstream. This study shows that AIDS is a difficult disease to get, and even the intimate exposure of these health care workers was not enough to infect them, except in the most extreme cases.


So, if you're doing defence against full syringe techniques, or using the famous snorting defence against the incoming fist, thus exposing your mucous membranes, you should be pretty careful! :rolleyes:

[Geezer]

Patrick Wrote>

Would you except the student and if so, would you take any percautions with this individual? Would you tell your other students? If you are a student, would would want to train with someone who is HIV positive

This question can only be answered by you at the end of the day, how comfortable would you be training with someone that's HIV Positive and how comfortable would you feel letting your students train with someone that's HIV positive????

I'm not saying that he/she should be treated like a leper, but I would seek advice from people in the know and then discuss it with your students and see how they feel about it.

The risk may be minimal but I think it's the stigma around it that does the most damage!!!

If I were one of your students and you asked me, I think I would seek independent advice.

Sheldon:)

[Matrix]

One key distinction.............
You can get vaccines to prevent Hepatitis. The same can't be said for HIV.

Matrix

[AndrewS]

Alright, briefly, as I have a 45 minute canned lecture on blood born diseases and training which I inflict on my family semi-regularily. . .

I'm a critical care MD, I've had my share of needle sticks, and live a fairly interesting life. I get HIV and Hepatitis bloodwork done 1-2x a year.

I would be very comfortable teaching and training with an HIV positive person, and have volunteered to do so in the past.

Every person should be treated as possibly having a bloodborn disease. All open wounds should be covered immediately. Wristbands can be useful if you're doing serious chi sao for several hours and may lose skin (still have wrist scars from that).

All students should get a bloodborn disease lecture before starting training, and EVERYBODY SHOULD HAVE A HEPATITIS B VACCINE SERIES!!!

Once again-

EVERYBODY SHOULD HAVE A HEPATITIS B VACCINE SERIES!!!

and again

EVERYBODY SHOULD HAVE A HEPATITIS B VACCINE SERIES!!!

Here are some basic facts-

transmission of both Hep B and HIV is fluid born, primarily bloodborn, and requires blood get into an open wound. Oral transmission of HIV is low, so opening a knuckle on someone's mouth is not very high risk, unless you've busted open a nose or knocked their teeth out.

rates of transmission for hollow bore needle stick (i.e. a tiny hollow tube o' metal) are between 1 in 200 and 1 in 500 for HIV. It is *not* a hardy virus.

For HepB, the same stick has transmission rates between 1 in 4 and 1 in 2.

Splash transmission onto mucous membranes (i.e. eyes and mouth), I *believe* has occured, but I need to check my notes for numbers.

HepC's transmission pattern is still unclear. It appears not to be so hardy as married couples having unprotected sex with one partner positve have only a 1-2% incidence of Hep C in the uninfected partner (I believe after 5 years, but I'm doing this off the top of my head sans notes, so minor numeric errors may occur).

Hard exercise is immunosuppressive, when done to the point of 'overtraining'. Moderate training may be a better, safer, pattern for the HIV+ student. Heavy interval work, full-contact, etc. may not be the smartest training route from a disease standpoint.

Putting this together- cover all open wounds, train at an intensity and contact level at which only one person is bleeding at a time (or better yet , neither) and sprays of blood do not fill the air.

And GET A HEP B VACCINE SERIES!!! It's about 90% effective in stopping transmission, dramitcally increasing your chances of avoiding something very nasty.

Post-exposure prophylaxsis- if you do get exposed (this holds for post rape, too, btw, and should be covered when teaching about post-rape care) rapid initiation of antiviral therapy (i.e. AZT +/- a protease inhibitor, personally I'd do both if I was seriously worried) can prevent infection and is of some value. Personally, if a random sketchy person cut me in a fight and I opened them up seriously, I'd get to an ED and start some drugs that night.

Hope this helps,

Andrew

P.S. Could the moderator archive this somewhere? I think this question will probablu come up fairly regularily.

[morbicid]

i'm no doctor but as to the question of "is a small amount of blood contact enough to transmit HIV" , I've read that it depends on the person's viral load (which is dramatically reduced if the person is on effective treatment)

i remember reading of a reported incident in which an individual contracted HIV from colliding with another player (their heads/faces collided and both suffered some minor cuts) during a soccer game.

i saw on the news yesterday that there are over 30 HIV vaccines in different stages of development... wonder if we'll ever see one proven effective (and against all the different strains out there)

[AndrewS]

Morbicid,

yeah, and every case of HIV documented at Walter Reed in the '80s was heterosexual transmission. Amazingly, that story changed once those boys either got out of the Army or non- Army investigators got involved (I forget which).

While this is possible, I'd only believe that one if the viruses were genetically identical. The stigma associated with other routes of transmission has led to a lot of bad information.

Andrew

[Geezer]

First, let me say WOW,

Second, how long can HIV or HEP B last in open air??

Third, are there any known or rumored side effects from the HEP B VACCINE????

And thanks for passing on your knowledge;)


Sheldon:)

[Matrix]

I just spoke to my wife, who is a nurse who works for a local virologist. She's been involved in clinical trials for some vaccines for Hepatitis recently.

She said that side effects include slight soreness at the injection site, slight fever. With the possibly headaches in about 3% of those vaccinated. Not too shabby. I had the vaccine myself recently since we were travelling. No side effects worth mentioning.

Hope this helps.

Matrix

[anerlich]

Geezer, I'm no doc either, but I work at a Health Care standards organisation. I attended a talk by an RN on this very subject here a few months ago.

From what I rember of what she said, HIV can live for about 30 mins out of the body. Hep B can last for up to TWO DAYS. Hep B is way more easily transmitted and much more hardy. There was a case here in Oz where people who assisted a bleeding motorcycle accident victim all ended up with Hep B through infection wia small cuts or skin lesions.

You could get it from sharing boxing gloves or a towel.

There is a vaccine. But, untreated, it can kill you just as dead as HIV can.

Andrew S is of course correct.

Grendel, a KF instructor friend of mine in Oz teaches syringe defenses. It's funny until you get confronted by a mugger with a bloody syringe. In Oz at least assault with a syringe is probably more likely than being threatened with a firearm.

[Matrix]

Originally posted by anerlich
From what I rember of what she said, HIV can live for about 30 mins out of the body. Hep B can last for up to TWO DAYS. Opps. forgot to mention that point. Yes, it's up to two days for Hep B. It can also be transmitted from saliva, not just blood. So as the Doctor has been saying. Get your vaccine series!!!

Matrix

[Grendel]

Originally posted by anerlich
Grendel, a KF instructor friend of mine in Oz teaches syringe defenses. It's funny until you get confronted by a mugger with a bloody syringe. In Oz at least assault with a syringe is probably more likely than being threatened with a firearm.

For a while a few years ago, I worked as a volunteer in the Diocese of San Jose with HIV infected young gay men and helped raise money for various AIDS causes. I had training for the task, but for the most part, most of us volunteers were unconcerned about the very slight risk. As far as threats from syringe wielding assailants, a person with HIV is still a person. If they were sociopathic before contracting it, they very likely were still sociopathic afterwards. :) Some seem to have very little concern about spreading the virus, but others are virtual saints in their life response to their dilemma. :(

Here in California, children receive Hepatitis A and B vaccinations---I think before high school (~13 years). There is no proven vaccine for the Hep C retrovirus, but it is not as contagious as the other two and is treatable in some cases. It's a good idea to wash your hands before and after workouts to hopefull remove unseen pathogens.

Law enforcement folks encounter infected people all the time in their jobs. Recently, a criminal in San Jose slashed his own throat at his sentencing hearing and was saved by a quick thinking, brave deputy on the scene who was drenched in HIV-positive blood in the process of staunching the blood flow with his hands. Since the deputy was uncut in the process, it is unlikely that he will catch the virus, but he's still undergoing tests.

I figure if Mike Tyson hasn't gotten AIDS from boxing or prison, then we shouldn't have to worry about it. :D

[Laughing Cow]

I once worked with an HIV infected person who died later on.

Now here is what I know about transmission of the HIV virus (might be wrong).
Transmitting fluids are:
Semen, Vaginal fluids, Saliva.

Blood is the virus carrier.

Either of this has to enter an open wound in order to effect transmission, transmission is NOT guaranteed.

The HIV Virus can be present in 2 types of people:
1.) Carrier that has not got the sickness but carries the Virus, might never get sick from it.
2.) A Person that actually shows the symptoms of the HIV infection.

Unless you train full-contact and often have open wounds during training I would not be worried too much about receiving aids from a trainings partner.

As was mentioned care should be taken as many more sicknesses can be transmitted in the same way as HIV.

cheers.

[AndrewS]

Geezer,

I have to look up the open air figures.

A couple of more notes (having just curbsided my favorite ID doc)-

post exposure prophylaxis is is usually a triple drug regimen these days (reverse transcriptase inhibitor, nNRT, and protease inhibitor).

there's been at least one reported case of HIV transmission from an open hand wound in a bar fight. I've gotta hunt down the reference but it's a NEJM case report, so it's pretty solid.

Later,

Andrew

[edward]

regardless of how careful you are wing chun still invovles contact... why put yourself and the other students at risk.

[Grendel]

Originally posted by Stumblefist


On the other foot.. no i wouldn't train with others if i was positive and i would expect the same.
That's one perspective. Obviously, some of us aren't exactly living in dire fear. AIDS, after all, has become a manageable disease, which in fact, does not significantly shorten your lifespan with treatment with the drugs that have been cited (protease inhibitors, AZT, et al.)


It's death come.
You exagerate the danger. You might walk out of the kwoon in fear of a tiny virus and into the path of speeding lorry. :D Eventually, we'll all be dead. :D Don't work out with them if you're worried. I agree that HIV or Hepatitis-positive individuals should definitely let their school and training partners know.


Not to be flirted with. At that point everything is over, the only choice is a slow death or a quick one and the decision has to be made when to take an exit when the quality of life has fallen too low. To make that decision one has to push oneself to insanity.
Reread Andrew S.'s post. He's a medical doctor and he's not afraid in spite of encountering HIV positive individuals in the course of his work as an emergency room doc or in the context of a work-out.


Facing all that you have to accept increasing limitations on your lifestye. One of them is not contact practising. Just fight your enemies if you want to practice because it doesn't matter what the result..

How can you face life in such an uncertain world? :rolleyes:


It's wrong to expose others to risk a similar fate. If you mean a fate of unreasoning fear and censure, then I would tend to agree. :D

I suggest you educate yourself on the risks and decide for yourself from knowledge, not fear.

Regards,

[Geezer]

Thank you for sharing your knowledge;)

Prior to this thread I had the approach of "Out Of Sight Out Of Mind", ignorance won't help me out at the end of the day.

Now when I moved Stateside, I had to have a full medical, blood test, chest xrays the full monty so I know from 96 prior I was fine. I'm not a high risk candidate but I'm going to pursue the Hep Vacines.

I have a question for Stumblefist,

Stumblefist Wrote>

Blood will do it. So...
...
No, i woulnd't accept such a student.
No, i wouldn't train with such a student.
..
On the other foot.. no i wouldn't train with others if i was positive and i would expect the same.

What if new perspective students weren't as forthcoming with information as we would like them to be??????

Should Kwoons/Schools almost demand a blood test and physical prior to joining???, almost like buisness's do in the States???


Grendel Wrote>

As far as threats from syringe wielding assailants, a person with HIV is still a person. If they were sociopathic before contracting it, they very likely were still sociopathic afterwards. Some seem to have very little concern about spreading the virus

Should we not screen potential students then???

Sheldon;)

[Geezer]

Stumblefist Wrote>

Blood will do it. So...
...
No, i woulnd't accept such a student.
No, i wouldn't train with such a student.
..
On the other foot.. no i wouldn't train with others if i was positive and i would expect the same.

Then Wrote>

HaHa!
Why is that a question for me?
I'm not a lawyer and don't wantta be.
Am I your nursemaid?
Am i societies nursemaid?
Life is a lot rougher than that.
...
You think a test is a guarantee?
Is society incorruptible?
One 10 minute hooker later and you're infected and can infect outhers.
High risk, low risk: you got it then you got it.

So do you "train" with others or live in a cardboard box???? there are no guarentees but something is better than nothing?????

They showed something on MTV about Porn Stars a while back and they said they have to have mantotory bloodtests before "Performing".

Sheldon;)

[Geezer]

Buster Keaton Wrote>

You still keep asking me?
Do I owe you something?
Didn't your mother wean you?
You gonna pay me for social and legal advice here?

Maybe you need to add some sort of "Disclaimer" saying that your not open for discussion;) if I had seen that I wouldn't have asked you in the first place:confused:

Don't bother replying to this, seeing as I'm only interested in serious discussion on the subject at hand, Man what's wrong with me:confused:.

Sylvia Saint!!!!!!

Sheldon;)

[AndrewS]

Stumblefist,

your decisions about the risks you take are yours.

The way you choose to interact with those around you is your community's.

If you choose not to train with an HIV positive person and others in your school do, how will you work it out?

How will you chose to treat someone daily confronting their own death with more immediacy than most?

You will watch more people die in your life. People close to you. How would you want them treated? How would you want to be treated in that position?

The above is irrespective of whether or not you chose to risk fluid exchanges. I would suggest that in implementing that decision you attempt to do so with whatever decency and compassion you would otherwise attempt to display towards someone with a terminal illness.

I'm not trying to place a guilt trip on you here. Your decision is a valid one. I've been needle-stuck (tested negative multiple times since, all the sticks from people negative for bloodborn disease). I know the feeling and the fear and can't ask anyone else to risk it. If you choose not to undertake the risk, cool. If do so in such a way that you increase the pain of a person whose life is already complicated enough, solely because of their disease, then you're a worthless human being, and were you in my presence I would treat you a something of no value to me.

Andrew

[Geezer]

What are your thoughts on the questions I put to Stumblefist???

I Wrote>

What if new perspective students weren't as forthcoming with information as we would like them to be??????

Should Kwoons/Schools almost demand a blood test and physical prior to joining???, almost like buisness's do in the States???


Sheldon:)

[AndrewS]

Geezer,

I believe requiring HIV status for employment is actually illegal in the states.

When I have been defacto teaching, I have discussed bloodborn diseases prior to training as part of my interview of prospective students, recommended Hepatitis B vaccines to all who have not received them, and requested HIV blood work on anyone at high risk. Unsurpisingly, all the folks I've known who engage in higher risk behaviors have already be pretty diligent about getting tested regularily.

I think if you were going to stage serious full contact matches in class with no stoppage for bleeding, then requesting bloodwork would be reasonable, and I would probably do so.

When I open a school, I will request a Hep B series from all students within 6 months, and hold them responsible for making clear their HIV status, and being careful of their peers safety, whether it be not breaking someone's neck or their immune system. I would also probably include some language in the initial contract to keep myself covered in case of in-school transmission, liability-wise.

Of course, the best way to make this work is to make sure you create a positive environment in which people are comfortable and feel safe. If someone you're training with doesn't feel comfortable letting you know they're gay, or used to shoot up, or were rape (male or female- male rape happens, and is probably massively under-reported due to social stigma); they're sure as hell not going to tell you they're HIV positive.

Later,

Andrew

[Geezer]

AndrewS Wrote>

I believe requiring HIV status for employment is actually illegal in the states.

Sorry, I should have been a bit clearer on what I was saying. The job I'm at now did the physical, there was no blood work that was only for the US Embassy.

Once again I'm going to pursue the Hep B vac and I thank you for bringing out of the dark!!!!!

Sheldon;)

[AndrewS]

Stumblefist,

the entertainment value in hearing myself referred to as 'politically correct' and 'neurotic' is vast. I'm so far off the left/ right map, I'm not even on the page.

Death and disease are profoundly apolitical, as is compassion for the sick and dying. How you can construe acting compassionately towards someone whether or not you chose to train with them, trying to at least decline to train with them kindly, as political, is either simple inflammatory trolling or pure stupidity.

I'm not sure what the point of your whole incoherent screed is other than to assert your right to be as sh*tty as you care to be to the sick and dying. Fine, just don't get all bent when those of feel differently exercise that right towards you.

My point is very simply that, with reasonable precautions, I am comfortable training with someone who is HIV positive, just as I have cared for that population in the hospital.

Andrew

[AndrewS]

Now, you're implying that I'm stupid. More amusement.

In all probability many people you love will die before you do. Time will tell if your attitude survives that.

Andrew

[John Weiland]

Originally posted by Stumblefist
Oh Dear!
Not Woody Allen's "Love, Death and Suffering" again!
Truckloads of dead bodies!

Hi Stumblefist,

Don't forget the scene in one of his movies in which he's shown as a child fretting about the end of the universe and its implications. :D

Enough already with the taunting/raving, whatever screed. :rolleyes: If you don't like the thread, you don't have to read it. Andrew was invited to comment on the thread because of his undisputed expertise in medicine. I find it exasperating that you treat his and others' kindly and empathetic impulses so lightly. I certainly appreciate the insight he brings to this and other discussions.

Like you, I'm in California. Maybe we could get together sometime to exchange Wing Chun views and ideas. Look me up in San Jose, if you'd like. Several forum members plan to meet in S.J. April 27. Look for details here as the date gets nearer.

IMO, this thread is exhausted. :cool:

Regards,