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While most sports have neither required testing nor banned HIV-positive athletes, the United States Boxing Commission denies licenses to HIV-positive boxers and bans them from further competition. Boxers are tested once a year, when they apply for a new license. By contrast, the National Collegiate Athletic Association institutes strict and extensive guidelines pertaining to blood-borne pathogens and communicable skin infections, but does not prohibit HIV-positive individuals from participating. Over time, leagues have developed what seem to be safe and reasonable policies for handling the threat of contagion.
Advances in treating HIV/AIDS mean that infected athletes can now enjoy prolonged involvement in sports. Further medical advances may eventually render fears about HIV/AIDS obsolete. In the meantime, it would seem that most leagues will adopt guidelines similar to the NCAA, adopting policies that regulate the treatment of all bleeding athletes, rather than discriminating against specific individuals.

Policies have now been adopted by most professional, amateur, and recreational sports leagues. Generally, most leagues advocate some variation of universal precautions. This means that leagues now operate on the assumption that any athlete may be infected and therefore have adopted safety policies and procedures to deal with bleeding athletes and blood spills. This requires that officials present be aware of policies and procedures for minimizing exposure to infectious agents. Policies and procedures vary by sport and league and generally focus on cleaning up blood, controlling bleeding, and exchanging or changing bloody uniforms. Teams or athletes requiring such accommodations are not penalized. Such issues become thornier in recreational settings, where there may be no qualified personnel to handle the situation.

A host of ethical and legal considerations surround HIV-positive athletes’ participation in sports. Foremost is the issue of confidentiality. Currently, most leagues and professional organizations do not require mandatory testing. However, U.S. boxers are tested when they apply for a license to fight and testing positive for HIV will lead to a revocation of the license. Boxers who compete against an opponent who he or she knows to be HIV positive also forfeits his or her license. The question of whether or not leagues can require testing and what the implications of that information should be is a thorny ethical dilemma. Given that the risk of contracting HIV is virtually nil, do leagues have the right to prohibit HIV-positive athletes from participation? Moreover, what responsibility do leagues and athletes have regarding informing other participants of potential risk? Does the perception of risk that the individual has matter? If mandatory testing is instituted, who would have access to information and what consequences are imposed on those who inappropriately disclose the status of others? What are the rules governing disclosure and what would be done to protect athletes from risk of disclosure? Indeed, an even more complex issue emerges when one considers how infected and noninfected athletes may use their status to intimidate or ostracize teammates or competitors.There are no clear-cut answers to such dilemmas. Ethicist Rodger Jackson (1999) suggests that any ethical inquiry into HIV/AIDS and sports should adhere to four rules: (1) specific details of any recommendations made must be given; (2) the goals of each recommendation must be stated clearly and honestly; (3) ethical and factual justification for the recommendation must be given; and (4) possible objections to the recommendation must be given.
In addition to ethical considerations are legal considerations. Leagues must deal with a host of issues pertaining to legal issues and HIV-positive athletes. In the first case, a person with HIV is viewed by the law as a person with a disability. Hence, leagues, personnel, and athletes must be familiar with the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990.The difficulty is that while the acts protect the rights of the disabled to restrict or limit physical activity, for athletes, sports participation is by its nature physical activity. The ADA further protects the rights of qualified athletes to reasonable accommodations from employers, unless undue hardship would result. Defining things like undue hardship and reasonable accommodations in the arena of professional and high-level amateur sports is difficult. Because physical ability is a necessity in sports, what types of accommodations are acceptable and what are not? What exactly constitutes an undue hardship and when is an athlete’s performance problematic because of HIV as opposed to a host of other factors?
Currently, there are no clear legal precedents governing the participation of HIV-positive athletes, though access to health and fitness facilities for HIV-positive athletes is clearly protected.While most leagues permit the participation of HIV-positive athletes, and such practices have remained legal, leagues that have prohibited their participation, such as boxing, have received legal support as well.The problem becomes even more complex at the recreational level.The ADA requires that accommodations for recreational sports be made for disabled persons; however, for the HIV positive, it is generally unclear what these accommodations should be. At what point can leagues deem an athlete a danger to himself or herself or others? Past cases have suggested that leagues can ban an athlete to protect him or her from undue injury. At what point is an HIV-positive athlete a risk to himself or herself? Could beliefs about risk to the self or others be used to couch discrimination against HIV-positive athletes? Who is in a position to make such a decision and what are the legal repercussions for leagues who remove such athletes and leagues that do not?
Further, when considering athletes with HIV, one must consider ethical and legal issues pertaining to confidentiality. Who needs to know about an athlete’s status? Recent legal cases have sent conflicting messages, sometimes ruling to protect the privacy of the individual, sometimes ruling that the HIV status of an individual should be revealed to colleagues.When considering such issues, two aspects are paramount: access to and control of the information. Recent rulings suggest that overall the confidentiality of the patient must be maintained. Given the complexity of the legal and ethical is-sues surrounding HIV-positive athletes, it is paramount that sports organizations develop clear legal guidelines in dealing with such athletes.

AIDS has impacted sporting bodies in a number of ways. In the first case, the world of sports has had to seriously consider risk of transmission. In addition to actual risk, the fear of risk of transmission also needs to be considered. Second, the ethical and legal consequences of policies and procedures must be considered. Special attention should be paid to the rights and protections afforded to infected and uninfected athletes. Third, the role of sports institutions in developing, adopting, and enforcing policies, procedures, and protections must be considered.
At the center of current debates is risk of transmission. The risk of transmission of HIV/AIDS through sports participation appears to be infinitesimally small. Most medical experts agree that there have been no cases of HIV being contracted during an athletic competition. Though a few anecdotal reports exist, these cases are questionable at best. Given the low level of risk, the question becomes, is the level of risk acceptable? Is the risk of contracting HIV/AIDS comparable with other risks assumed by athletes? Certainly, participating in sports carries with it the acceptance of an assortment of varying degrees of risk of injury and infirmity that are far more likely and extremely debilitating. Studies on masculinity, gender, and sport by Brian Pronger, Michael Messner, Don Sabo, and others note the myriad of ways in which men’s sports encourage risky behavior. For example, athletes routinely play with injuries, exacerbating the existing injury and risking further injury. Moreover, sports sometimes overlook medical evidence of risk in favor of preserving elements of a sport or competition. As Rodger Jackson (1999) notes, while U.S. boxing federations prohibit HIVpositive individuals from participating once diagnosed, other risky practices are ignored. Despite incontrovertible medical evidence that links blows to the head with the risk of death or long-term debilitation due to head injuries, headgear is not imposed at the professional level. In addition, many athletes engage in a variety of risky practices in an attempt to gain an athletic advantage. The triad of women’s sports (eating disorders, exercise compulsion, amenorrhea) common among female athletes involved in sports such as track, cross country, figure skating, and gymnastics; rampant use and abuse of legal and illegal substances (recall that Tommy Morrison contracted HIV through sharing needles used to inject steroids); and excessive training regimes have lasting consequences on the health of individuals. Athletes are considered competent to accept these risks as part of participation in sports.While some of the risks assumed by athletes are questionable at best, the risk for contracting HIV/AIDS is extremely low, and therefore similar to or less than a host of other assumed risks. As a result, few sports organizations have chosen to ban HIV-positive individuals.

The public response to athletes with AIDS has varied widely depending on the status and sexual orientation of the athlete. While heterosexual high profile Magic Johnson was labeled a hero for publicly acknowledging his HIV-positive status, Greg Louganis was faulted for failing to disclose his status to the doctor who treated him during the 1988 Olympic Games. The doctor has publicly acknowledged his clear understanding of universal precautions and that he holds Louganis blameless. While Louganis was stigmatized as a carrier of the illness, sportscasters and writers lambasted athletes like Karl Malone for having expressed concern at having to face Magic Johnson on the court, claiming their fears were groundless and citing ignorance about the disease. While heterosexual Arthur Ashe’s illness was front page news, gay Glenn Burke’s departure from baseball and subsequent death went largely unnoticed. Burke contended that he was blackballed from baseball because of his sexual orientation. Certainly the difference in the relative status of an athlete has some correlation with public exposure. However, athletes whose heterosexuality was unquestioned were treated very differently than openly gay or sexually ambiguous athletes. While Magic Johnson was appointed to presidential committees on HIV/AIDS, Greg Louganis was banned from speaking on a college campus and was unable to transition into a prominent diving commentator role in subsequent Olympic games.While the media was heavily criticized for forcing Ashe to reveal his illness, Greg Louganis was heavily criticized for failing to disclose his. It is clear that the social location of the athlete affects media and public response.

In a November 1991 press conference, the star basketball player Magic Johnson told the world he had tested positive for the HIV virus. In an instant, his announcement changed the face of AIDS/HIV from a “gay disease” to a disease that, in Johnson’s words, “can happen to everybody.” Below are excerpts from his announcement.
I plan on going on, living for a long time . . . and going on with my life. . . . I will now become a spokesman for the HIV virus. I want people, young people, to realize that they can practice safe sex. Sometimes you’re a little naïve about it. . . . You only thought it could happen to other people. It has happened. But I’m going to deal with it. Life is going to go on for me, and I’m going to be a happy man. . . .

In the early stages of the epidemic, the emerging threat was largely ignored by the sports world in the United States. As it was incorrectly perceived as a disease contracted mainly by homosexuals, sporting institutions did not develop cohesive AIDS/HIV policies early on. The conflation of AIDS with gay men and the largely erroneous assumption that male athletes are heterosexual allowed sports leagues to avoid considering the risks posed by the disease. The role sports has played in defining masculinity in American culture, cultural conflations of effeminacy and male homosexuality, and the discrimination and loss of endorsement dollars that threaten out gay athletes led to a pervasive belief that there were and are no homosexual athletes in “manly sports” such as baseball, football, and basketball.
Hence, the world of sports largely ignored HIV/AIDS during the early years of the epidemic. The problem of the athlete with HIV and AIDS could no longer be ignored after 7 November 1991, when future Hall of Fame Laker point guard Earvin “Magic” Johnson announced that he had tested positive for HIV during a routine physical. Charismatic, popular, and respected, Johnson’s announcement shook the world of sports. Johnson alleged that he had contracted HIV through heterosexual contact. This announcement revealed the risk of contagion among heterosexuals, something significantly underestimated in the United States. Because AIDS/HIV had long been associated with homosexuality, and specifically promiscuous homosexuality, the disease carried a significant social stigma, and Johnson’s announcement was considered a courageous act. At the time Johnson choose to retire from the league, but he subsequently returned to play for the Lakers during the 1995–1996 season. He also continued to participate in basketball internationally after having been diagnosed. Though some expressed hesitation at competing with an athlete known to be infected, the public and league support Johnson received indicated a willingness to accept infected athletes, or at least extraordinarily talented ones.
Some debate has centered on the role of the media in “outing” those infected with the disease, and what obligations athletes have as public figures. Many point out that as public figures, athletes must raise awareness about the risks of the disease and the ability to live with contagion. By the same token, others are critical of a media that forces athletes to publicly discuss a painful diagnosis. This debate came to a head in 1992.When made aware that USA Today intended to reveal his previously undisclosed infection, Arthur Ashe announced he had AIDS. Ashe had previously contracted the virus during a blood transfusion in 1983. Though currently retired, former Wimbledon champion Ashe was still well known for his breaking down of racial barriers in the world of tennis and was a prominent philanthropist. Ashe died in 1993 of AIDS-related complications. Public response to Ashe was largely sympathetic, but the media’s role in forcing Ashe to announce his status remains a point of contention.
Several other notable athletes have since announced HIV positive status or their status has been revealed posthumously. In 1995, diver Greg Louganis, arguably the best diver in the world for over a decade, revealed to Barbara Walters that he had AIDS and had been HIV positive in 1988 when he won two gold medals at the Olympic Games. Louganis had won his second medal only after recovering from an accident during competition, when he hit his head on the board and required stitches prior to continuing. In 1996 boxer Tommy Morrison, known for his portrayal of a young fighter in Rocky V, announced he had contracted HIV through heterosexual sex. Later he acknowledged it was most likely contracted through sharing needles while injecting steroids. Though banned from boxing in the United States, Morrison has participated in events since his retirement, including a much-publicized fund-raiser in which he knocked out his opponent in the first round. Other notables include former Olympic decathlete and founder of the Gay Games,Tom Waddell, who died of complications related to AIDS in 1987; Esteban de Jesus, the former World Boxing Council lightweight champion who died of AIDS while serving a life sentence for murder; Jon Curry, former Olympic and world champion figure skater who died from AIDS-related illness in 1994; and Glenn Burke, former Los Angeles Dodger and Oakland A’s outfielder who died of AIDSrelated complications in 1995. Further, Jerry Smith, former member of the Washington Redskins, died of complications related to AIDS in 1986; stock car racer Tim Richmond died of complications caused by AIDS in 1989; Alan Wiggins, former member of the San Diego Padres and Baltimore Orioles, died of complications caused by AIDS in 1991; and Bill Goldsworthy, National Hockey League veteran and one of the original Minnesota North Stars, died of complications from AIDS in 1996. Certainly, the problems faced by many athletes after revealing their status may have led many others to remain silent.

In 1978 gay men in Sweden and the United States and heterosexuals in Tanzania and Haiti began developing unusual symptoms and ailments. In 1982, what at first seemed like a host of diseases was identified as a virus that attacked the immune system. Transmitted through sharing body fluids, the disease was named acquired immune deficiency syndrome or AIDS. Many individuals may be carriers prior to the onset of symptoms; these people have contracted the human immunodeficiency virus (HIV).Though HIV-positive individuals experience no symptoms, they may spread the virus to others. AIDS/HIV is generally contracted through unprotected sex, sharing contaminated needles, or prenatal contact (mother to fetus).
The AIDS epidemic has had tragic global consequences. Globally, AIDS is the leading cause of death due to infectious disease and the fourth leading cause of death overall. It is estimated that there are 33.6 million people worldwide living with HIV/AIDS. Though the majority of AIDS infections are found in poor nations (over 90 percent of cases reported), over a million people in the United States have contracted HIV since the emergence of the disease, and twenty thousand new cases are reported annually.The emergence of a deadly incurable contagious disease has had significant consequences in many areas of social life, including sports.