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HIV, AIDS and Hygiene


2 CE Hours



Reiki Center of Venice

Francine Milford, LMT

P.O. Box 554, Venice, FL. 34285






HIV, AIDS and Hygiene by Paul Milford, MSW and Francine Milford, LMT



Updated 2014 Edition


Directions: The estimated time to complete this course is 2 hours.


To Complete this Course

1.      Read this study guide and complete the open-book test that was included in this course.

2.      Mail-or email-your answers to me at FrancineMilford@cs.com. Or you can mail in your answers to Reiki Center of Venice, P.O. Box 554, Venice, FL. 34285.

3.      Mail, or email, your course evaluation to address listed above.

4.      Please keep a copy of your answer sheet for your own records.



Neither the author of this study guide, nor the Reiki Center of Venice, School of Massage Therapy and Bodywork, assumes any liability for the learner’s application of the information contained herein. This course is NOT intended for use in prescribing treatments, therapies or recommendations of any kind.


Course Instructor

Francine Milford, LMT, NCTMB is a massage therapist, personal trainer and owner/instructor at the Reiki Center of Venice, School of Massage Therapy and Bodywork. She is the author of 45 manuals and more than a dozen home study courses. She resides in Venice, Florida where she continues to teach onsite classes at the Center.

Paul C. Milford, MSW, is the author of published research in the field of infant development and the mother-infant relationship. He has a Master’s Degree in Social Work with an emphasis in Maternal and Child Health at the University of South Florida.





HIV, AIDS and Hygiene

© Reiki Center of Venice, LLC. 2011

FL. Massage Provider# 50-9690

NCBTMB Provider# 31046-00





This course is designed to provide students with an understanding of HIV, AIDS, how they are transmitted, how HIV/AIDS affect the human body, and the risk factors associated with infection. You will be presented with recent statistics from the Centers for Disease Control (CDC) as well as information and graphs that help paint the picture of HIV and AIDS in America.

Unless otherwise stated, the figures and representations in the following course relate to HIV prevalence in the United States only. Additional information on global HIV/AIDS prevalence may be found online at the CDC’s website.

This course is part of a state-approved curriculum and is designed to convey the information necessary to be eligible for the state licensure exam in massage therapy. This course may also be used as part of a program designed to award certain Continuing Education (CE) credits in the state of Florida.








Learning Outcomes

  • You will learn the history of the AIDS/HIV infection in the United States
  • You will be able to implement safety precautions to control the spread of the virus
  • You will be able to identify key safety recommendations from the CDC to limit exposure
  • You will be able to identify key risk factors in the spread of the disease
  • You will be able to apply the Scope of Practice to sample cases
  • You will be able to set performance standards and expectations
  • You will be able to implement safety systems at your work station










Understanding HIV and AIDS: A State Required Course for Massage Therapists

Written by Paul C. Milford, MSW and Francine Milford, LMT




The year 2011 marked the 30th anniversary of AIDS in America. In 1981, doctors in New York City and California began reporting a collection of symptoms in certain gay male patients. These symptoms included a severely compromised immune system that ultimately led to death.

By 1982, scientists and doctors begin to suspect that this cluster of symptoms is transmitted through the blood after it is discovered in injecting drug users and recipients of blood transfusions.

This sparked the Centers for Disease Control to create the name AIDS, or Acquired Immune Deficiency Syndrome. As reported cases of AIDS rise dramatically, scientists discover the cause of AIDS to be the human immunodeficiency virus (HIV) in 1984. This discovery affirmed prior suspicion that the syndrome was spread through blood, allowing the CDC to establish prevention guidelines and determine risk factors.


By 1995, it was estimated that over 1 million Americans were now infected with HIV, and outlets began reporting that AIDS had become the leading cause of death in Americans between the ages of 25 to 44. This startling statistic pushes for additional research and funding into antiretroviral medications. By 1997, major advances in this research reveals that combination therapy, sometimes referred to as a “drug cocktail,” are the most promising treatment for those infected by HIV. This discovery decreases AIDS deaths in America by 42 percent. Though funding for HIV/AIDS research has declined in America, scientists worldwide continue to study the virus.



The human immunodeficiency virus (HIV) is spread through exposure to certain human bodily fluids. These fluids include: semen (including pre-seminal fluid), vaginal fluid, blood, and breast milk. It is important to understand which behaviors can expose someone to these bodily fluids, facilitating the transmission of this virus.

The most common form of transmission is unprotected sex with an HIV-infected individual. This type of contact can cause infection. Sexual contact is considered to be any behavior that can result in exposure to the bodily fluid of another person. This includes anal intercourse, vaginal intercourse, and oral intercourse. The receptive partner in any form of sexual intercourse is considered to be at the highest risk of transmission. It is important to note that ejaculation is not necessarily required to transmit HIV. Pre-seminal fluid, vaginal fluids, and blood in the mouth, anus, or vagina can facilitate transmission during sexual intercourse.


Exposure to the blood of an individual infected with HIV is also a common method of transmission. Typical routes of transmission by blood include: using needles to inject drugs, receiving a blood transfusion, skin graph, or organ donation from an infected individual, exposure to unsterilized tattoo or piercing needles, and exposure of a fetus during pregnancy or through birth by an infected mother.

Less common routes of blood-borne transmission include:

·        Sticks by contaminated needles in a healthcare setting

·        Direct blood-to-blood contact (such as through open wounds)

·        Blood being splashed into the eyes.

·        Consuming the breast milk of an HIV infected mother


Not all human bodily fluids contribute to the spread of HIV. These include: sweat, urine, feces, and tears. Though these fluids do not transmit the virus, it is important to remember that blood present in any one of these fluids can result in an exposure to the virus.

Notice that saliva was not mentioned as a bodily fluid that either does or does not transmit an HIV infection. According to the CDC, HIV is only present in saliva in “very minute amounts, insufficient to cause infection with HIV.” In fact, the CDC cites only one reported case of mouth-to-mouth transmission, which was actually the result of exposure to infected blood present in the mouth during kissing.  Because of this, the CDC classifies open-mouth (or “French”) kissing as a very low risk activity for transmission of HIV. The low risk of mouth-to-mouth transmission is important to note, as a massage therapist or other healthcare professional may be required to administer CPR to assist a client. Protective mouth guards are available to limit the exposure to saliva.  These are recommended for anyone who is CPR certified.

            According to the CDC website, HIV cannot reproduce outside the human body. In addition, HIV is not spread by:

  • Air
  • Water
  • Insects, including mosquitoes
  • Saliva
  • Tears
  • Sweat
  • Spitting
  • Casual contact like shaking hands
  • Sharing dishes
  • Closed-mouth or “social” kissing


Education and Prevention

It is estimated that more than 1 million Americans are currently infected with HIV. This number is only going to continue to grow, as approximately 56,300 new infections occur every year. Of these, 1 in 5 (21%) do not know that they have the virus. Though advances in medication, early detection, and healthy lifestyle changes can increase the lifespan of an infected individual, AIDS continues to claim 18,000 lives each year. Since its discovery in 1981, the death toll for HIV/AIDS has risen to over 576,000. 

Transmission of HIV continues to effect minority populations disproportionately. The category of “Men who have sex with men” (MSM), which includes gay males, bisexuals, and “down low” males, constitutes 53% of new HIV infections each year. This is the population most disproportionately affected, as MSM make up only 4% of the American population.

Those of African American descent follow closely behind, accounting for over half of all new infections, but comprising only 14% of the American population. Rates of heterosexual transmission continue to rise, contributing to 31% of new infections each year. The remaining transmissions are associated with injecting drug users, both homosexual and heterosexual.

The most effective way to prevent all HIV transmission is through education. Comprehensive sex education programs in schools, community resources, such as the local Health Department and Planned Parenthood, as well as government awareness campaigns have all been shown to decrease the rates of HIV transmission. However, these programs are costly and are often terminated due to their sensitive and controversial nature. 

There are simple, proven steps that individuals can take to reduce or eliminate their chance of HIV infection. Among these are the following:

  • Practice safer sex. This includes using a latex condom each and every time there is sexual penetration. Sexual penetration includes vaginal, anal, and oral penetration. Limiting the number of sexual partners decreases the chances of being exposed to HIV.
  • Have a mutually monogamous relationship with your sexual partner, along with both being tested for HIV and other STDs regularly, can also reduce your risk of infection.
  • Reducing or eliminating one’s exposure to blood. As a rule, you should treat all transmissible bodily fluids from other individuals as if they were infected.
  • Wear latex gloves when handling bloody material. Healthcare professionals, law enforcement officers, and tattoo artists who frequently come in contact with blood may reduce their risk by wearing latex gloves before handling any bloody individual or object, then thoroughly washing their hands with soap and warm water after exposure.
  • Avoid re-using needles. Those who inject drugs or use unsanitary needles for any reason should eliminate such behaviors to avoid infection. Several cities have implemented what is called a Needle Exchange Program. This program allows individuals to anonymously “exchange” their used needles for new ones. Though controversial, this type of program dramatically reduces the rate of infection among intravenous drug users.
  • Avoid breast feeding and breast milk. Mothers who are infected with HIV or AIDS can greatly reduce their risk of transmitting the virus to their fetus by adhering to a specific plan of antiretroviral medications and lifestyle changes prescribed by their doctor. Avoiding breast feeding and breast milk reduces the infant’s risk of infection.
  • Know you HIV Status. The most fundamental step in preventing the spread of HIV is to know your HIV status. This can be done by receiving a simple test at your doctor’s office, local clinic, the health department, and even most schools and universities. These tests are often offered for free or reduced rates. HIV tests work by determining the presence of HIV antibodies in the individual’s body. When a person becomes infected by any virus, the body starts to produce antibodies in order to fight the infection. Because HIV antibodies are only present in the body if the individual is infected with HIV, testing for the presence of these antibodies is effective in determining one’s infection status.


Two methods of HIV testing

There are currently two samplings that are used to test for the HIV antibodies: Blood Sampling and Saliva Sampling. Since each person’s response to infection varies, it can take up to 3 months after infection for amounts of HIV antibodies to be detectable during an HIV test. However, it is estimated that as many as 3% of people do not produce antibodies until 6 months after infection. The CDC recommends that individuals at risk for HIV exposure get tested every 6 months, ensuring accurate testing results. It is important to note that at least 1 in 4 people infected with HIV do not know that they have the virus, meaning that they can continue transmitting the virus without even knowing it. Education and testing are crucial in order to decrease these numbers.


What you should do

Should someone else’s blood get on you, it’s important to stay calm. As long as your skin is unbroken (no sores, cuts, burns, or wounds) then the infected blood will not travel through the skin. However, it is still important to thoroughly wash the area with soap and warm water.


Massage therapists, energy workers, and other bodyworkers have little to no risk of exposure to HIV during typical practice. However, should the client have an open wound, sore, or burn, it is best to avoid the affected area. It may even be appropriate to suggest that the client return once they have healed. If, during a session with a client, they should have a bloody nose, cut themselves, or vomit blood-it is important to stop the treatment. If you have been exposed to the client’s blood, immediately wash the affected areas with soap and warm water. You can provide the client first aid, if necessary, only after placing latex gloves on your hands.

It is not unusual for an individual infected with HIV to also be infected with another sexually transmitted infection (STI). In fact, having HIV increases the chances of becoming infected with another virus. Recently, health professionals have noted an increased rate of co-occurring HIV and Hepatitis C infections. Hepatitis C is typically transmitted through blood and is a virus that affects the body’s liver. This infection, like HIV, is not curable. The presence of both of these viruses in the body is a cause for concern, as both can cause serious health problems and lead to serious disease. Screening for all sexually transmitted infections is available and recommended at least once per year for any individual who is sexually active or at increased risk for infection.


Treatment and Support

Though there is still no cure for HIV or AIDS, research continues to advance new medications and therapies that help to fight the symptoms of the virus.  A combination of medications is often recommended when treating HIV. This treatment, sometimes called a “drug cocktail” has been found to be the most effective way of fighting the virus’ replication in the body. Since each individual case is unique, it is important for the patient to meet with their doctor regularly to ensure the effectiveness of their medications. It is not unusual for certain medications to be added or removed or their dosages adjusted.

Currently there are five classes of anti-HIV drugs, and each of these classes blocks the virus by a different method. Some of these drugs block infected cells from replicating the virus’ genetic material, while others prevent the virus from attaching to new cells. It is recommended that those receiving antiretroviral therapy (ART) take at least three medications from two of the different classes of drugs. This helps to reduce drug-resistant strands of the virus from thriving in the body and allows for the best results for the patient.

Continuous monitoring by the individual’s healthcare team is necessary to determine the effectiveness of the medications and the progression of the virus. This is done by testing the patient’s CD4 levels and viral load.  CD4 levels in the range of 600 – 1,500 are said to be normal and healthy. If a person with HIV has a CD4 count that falls below 200, they are diagnosed with acquired immunodeficiency syndrome (AIDS). The viral load is also monitored because a lower viral load is associated with the better outcomes. Levels lower than 50 are optimal for the health of the HIV infected individual, though the number can be as high as 30,000 for women and 60,000 for men. Regular treatment by the healthcare team is also needed to treat the side effects of the medications, screen for any new symptoms or illnesses, and ensure that the patient is sticking to their treatment plan. 

Lifestyle changes are also recommended for those infected with HIV. Though medications are an important part in the individual’s treatment plan, they can’t do all the work. The individual must make adjustments to their diet and exercise habits. This includes reducing the intake of “junk food” and eating healthy options such as fruits, vegetables, grains, and proteins. Avoiding raw eggs, meats, fish, and unpasteurized milk are also recommended in order to decrease exposure to food-borne illness. Being active will also help strengthen the body’s immune system and increase the individual’s overall health.

In addition to medication, lifestyle changes, and continued monitoring with a healthcare team, it is crucial that those living with HIV/AIDS have a support network. This network can include friends, family members, or coworkers. Discussing one’s HIV status with others is often a highly sensitive and emotional subject. This type of disclosure requires a higher level of trust and comfort. Should someone share such information with you, the most important thing to do is to listen.  Often, doctors may advise that HIV infected individuals should speak to a specialized psychotherapist. This treatment can help the individual cope with the psychological and social impacts that the virus carries. Additionally, a therapist may be able to recommend local support groups and resources that the client may not have otherwise known about.


Outlook for the Future

Though advancements have been slow, research continues to be conducted to help us better understand both HIV and AIDS. Recently, it was revealed that certain people are born with a specific gene that apparently makes them immune to HIV infection. This trait is extremely rare, but gives new hope to the quest for a cure. In fact, knowledge of this trait was recently used to perform a series of blood transfusions on an HIV positive individual. Named the “Berlin Patient,” this individual received transfusions from a donor who had the trait making them immune from HIV infection. After years of treatment and monitoring, it was announced that this patient no longer tests positive for HIV infection. This treatment has little real-world applicability for a cure, as widespread blood transfusions of HIV infected individuals with donors who are immune are extremely impossible. However, it does open new doors for scientists and doctors to better understand how this virus operates in the human body.


2012 Updates

It is with greatest sadness that the HB 4163 Hudson/SB 1258 Benacquisto bill passed the Florida legislature. The bill deletes the requirement of massage therapists and athletic trainers to have to complete educational courses for HIV and AIDS as part of the renewal of their license. The bill goes into effect on July 1, 2012.

Why do I feel sad about this? Because HIV and AIDS are still around and I believe that continued education brings about continued awareness of your own hygiene practices. By retaking a one-hour HIV/AIDS course every two years, I believe that this helps to keep the health care provider from becoming too lax about their health care practices.

It is my hope that you too will continue to take HIV/AIDS courses and stay abreast of the newest findings in that field.





2012-2013 Updates



Pre-exposure prophylaxis, or PrEP, is a new prevention option given to people who are considered at high risk of contracting HIV. Taken in pill form, this drug is taken orally every day as a preventative measure. The drug, called ‘Truwada’ is a combination of two drugs (tenofovir and emtricitabine). Together, these drugs help block pathways that the virus uses to establish itself in the human body. The pill must be taken every day in order to provide enough medicine in the blood stream to successfully block the virus from taking hold in the body.

While the drug is safe for most users in clinical trials, there have been reported side effects. These side effects include stomach upset, loss of appetite, and a mild headache. With continued use, most of these side effects abated.

While not for everyone, PrEP was created for those people who come in contact with HIV people. These people bay have unprotected sex with HIV infected persons, with drug users, or with others who may be at risk with HIV infections.

For women who want to get pregnant with an HIV infected partner, PrEP may offer some help. Taking PrEP daily may help an uninfected women who is trying to get pregnant, is pregnant, or who is nursing, to obtain protection against contracting the disease.

While taking PrEP, it is suggested that you continue to make regular follow-up visits with your doctor who will monitor the medicine levels in your blood and check to see how your body is reacting to the Truwada.If you think you may be at high risk for HIV, talk to your doctor about PrEP. If you and your doctor agree that PrEP might reduce your risk of getting HIV infection, you will need to come in for a general health physical, blood tests for HIV, and tests for other infections that you can get from sex partners. Your blood will also be tested to see if your kidneys and liver are functioning well. If these tests show that PrEP medicines are likely to be safe for you to take, and that you might benefit from PrEP, your doctor may give you a prescription after discussing it with you.


HIV Screening

The Centers for Disease Control and Prevention (CDC) developed the ‘HIV Screening Standard Care’ program to give primary care providers tools to help their patients get tested for HIV. The program offers a variety of resources for both the Health Care provider, as well as, the patient. For questions concerning the program, or to receive a resource kit, please send an email to: ScreenforHIV@cdc.gov.

Early testing offers patients improved morbidity and mortality by offering the patient medical treatment that will lower HIV viral load. It can also reduce the amount of unintended transmission to others who are not infected through improved hygiene habits and by reducing risk behaviors (such as needle sharing and unprotected sexual intercourse).

The CDC recommends that testing should be done on all patients ages 13-64 and that routine HIV screening should be given to all adults, adolescents and pregnant women in the United States. The CDC also recommends that HIV screening should be routinely given to everyone in all health care settings, whether they practice in a private practice, work in diagnostic centers, or practice in a public setting.

The CDC would like to see HIV screening provided in the routine panel of prenatal screening tests for all pregnant women, all patients ages 13-64, high risk individuals, and to all health care providers.



The Ryan White HIV/AIDS program (see updates to the program at the end of the manual.

(The following information was taken from the government website. For more information on this program, please visit: http://www.hab.hrsa.gov/).


The Ryan White Program was created for those people who do not have sufficient health care coverage to attain HIV-related services and medications. The program provides support for more than 500,000 people by working with cities, states, and local community-based organizations. Included in the program is primary medical care, support services, technical assistance, clinical training and research.

The program was named for Ryan White, a 13 year old who was diagnosed with AIDS on December 17, 1984. White was one of the first hemophiliacs to come down with AIDS. Up until that time there was little information on the disease and a lot of misinformation. The Western Middle School in Kokomo, Indiana did not want White to attend anymore. There was fear that he would spread AIDS to the other children.

But White wanted to attend school. So White, along with his mother, Jeanne White Ginder, had to fight the school system for his right to attend school. The duo spent several years fighting AIDS discrimination by offering education about the disease. White died at the age of 18, months before the bill, the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act, passed through Congress in 1996. In 2009, that bill was renamed and is now called the Ryan White HIV/AIDS Program.


The Ryan White legislation created a number of programs, called Parts: Part A, Part B, Part C, Part D, and Part F. Each Part was created to meet the unique needs of different communities and populations affected by HIV/AIDS. Each Part is listed and described below:


Part A provides emergency assistance to Eligible Metropolitan Areas and Transitional Grant Areas that are most severely affected by the HIV/AIDS epidemic. Here you qualify for either EMA or TGA status.

To qualify for EMA status, an area must have reported at least 2,000 AIDS cases in the most recent 5 years and have a population of at least 50,000. That means 4% or more of the population must be affected by the disease.

To be eligible for TGA status, an area must have reported 1,000 to 1,999 AIDS cases in the most recent 5 years and have a population of at least 50,000. That means that 2%-4% of the population must be affected by the disease.

Funding for Part A grants include formula and supplemental components and Minority AIDS Initiative (MAI) funds. Services include hospice, oral health, AIDS drug and pharmaceutical assistance, ambulatory medical care, home services, mental health services, substance outpatient care, home health care and medical case management.


Part B provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and 5 U.S. Pacific Territories or Associated Jurisdictions. To qualify for this grant, emerging communities must report between 500 to 999 cumulative AIDS cases over the most recent 5 years. Funding from Congress is in the form of ‘earmarks’ to ADAP. ADAP provides HIV medication, health insurance purchase aid and drug treatment monitoring services. 

ADAP is experiencing difficulty due to the growing numbers of poor minorities who need help is attaining costly medicines. One antiretroviral therapy (HAART) costs $12,000 a year per individual. As the numbers of HIV/AIDS individual living longer face additional health care costs due to opportunistic infections, ADAP may soon see too many people to help.


Part C provides comprehensive primary health care in an outpatient setting for people living with HIV disease. This component of the Ryan White HIV/AIDS Program is called the Early Intervention Services (EIS). These grants are given to organizations such as health clinics and facilities, Hemophilia Diagnostic and Treatment Centers, hospitals and nonprofit private entities that provide primary care to at risk population (whether religious or not). Services include health care providers, lab, x-ray, diagnostic testing, transportation to provide care, medical and dental equipment and supplies, evaluations and patient education as it relates to medical care.

The Part C is funded by law with no more than 10 percent of a Federal Part C EIS budget allocated to administrative costs.  And by law, at least 75% of the balance remaining after subtracting administrative and CQM costs must be used for core medical services. It is noted that approximately $205.6 million was appropriated in 2012.

Part D provides family-centered care involving outpatient or ambulatory care for women, infants, children, and youth with HIV/AIDS. Grants are given to public or private nonprofit entities that offer primary medical care for HIV-positive women, infants, children and youth. Money is also available to state and local governments and faith-based and community-based organizations who offer medical care and support services to above mentioned group.

            Services in this group include primary medical care, specialty care, adherence monitoring services, OB/GYN physician visits, dentists, dental hygienists, radiologists, lab technicians, dermatologists, medical assistants, nutritionists, behavioral health and substance abuse professionals, mental health services, lab, x-ray, diagnostic testing, and transportation to care. Approximately $77.3 million was appropriated in 2012.


Part F provides funds for a variety of programs: The Special Projects of National Significance (SPNS) Program is responsible for the development of HIV treatment models. It deals with advancing knowledge and skills to underserved populations diagnosed with HIV infection. This program not only evaluates current implementations and costs of programs but it funds projects to develop standard client date systems and client reporting data.


The current SPNS Initiatives include: 

1.      Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations [2012 – 2017] delivers intervention to homeless people living with HIV infection.

2.      Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative [2012 – 2017] delivers intervention to transgender women of color.

3.      Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative [2011 - 2015] Funds seven demonstration states for up to four years to design, implement and evaluate strategies to care for hard-to-reach populations who are at high risk with HIV but are unaware of their HIV status, or have never been referred to care.

4.      Hepatitis C Treatment Expansion Initiative [2010 - 2014] Designed to increase access to Hepatitis C treatment for HIV positive patients.

5.      Enhancing Access to and Retention in Quality HIV/AIDS Care for Women of Color Initiative  [2009 - 2014] Demonstration and evaluation of HIV/AIDS services for women of color in five urban and six rural locations.

6.      HIT Capacity Building to Develop Standard Electronic Client Information Systems Initiatives [Ongoing] To support the development of standard electronic client level date systems to improve the collecting and reporting of data to HRSA.

7.      The Special Projects of National Significance Program grants fund innovative models of care and supports the development of effective delivery systems for HIV care.

8.      The AIDS Education and Training Centers Program supports a network of 11 regional centers and several National centers that conduct targeted, multidisciplinary education and training programs for health care providers treating people living with HIV/AIDS.

9.      The Dental Programs provide additional funding for oral health care for people with HIV.

10.  The Minority AIDS Initiative provides funding to evaluate and address the disproportionate impact of HIV/AIDS on African Americans and other minorities.

Ryan White is administered by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). Federal funds are awarded to agencies located around the country, which in turn deliver care to eligible individuals under funding categories called Parts, as outlined below. First authorized in 1990, the Ryan White HIV/AIDS Program is currently funded at $2.1 billion.



The Power of Touch

            For those of us in the health care or fitness industry, the power of touch is something we can all relate to. For those suffering from the stigma of HIV or AIDS, that touch may mean so much more.

In 1996, the Touch Institute took 29 men with HIV and offered them massage therapy services. The men in the study showed an improvement in their overall health as it related to improvements in their immune system.


In 2000, the Touch Institute tried another study, this time using HIV infected teenagers ages 13 through 19. The Institute took have of the group of teenagers (12 of them) and gave them seated relaxation massage twice a week for 20 minutes. The other group of teenagers was given just a guided relaxation exercises twice a week for 20 minutes. At the end of the study, the massage group showed an increase in T-cells and noted that they had less anxiety.

If you have HIV or AIDS and would like to add massage therapy to your current program, then it is important for you to find a therapist that is both skilled and knowledgeable about working with people who are infected. It is important that your therapist feels comfortable about your condition. By informing your therapist of your disease, they will be able to take precautions in case an accident occurs.

If you are a therapist, you should never work on someone with HIV or AIDS when you are sick. When a client has a suppressed immune system, your illness put them at risk of becoming ill and even opens them to developing more severe and serious illnesses.

As far as massage go, you don’t have to work hard in order to give your client much needed body work. A gentle massage can reduce anxiety, tension and stress. It can also help to ease muscle aches and pains, bring oxygen to organs and tissue, increase circulation and overall well-being.





Hygiene for Massage Therapist and Body workers

One of the most effective methods to prevent the transfer and spread of pathogens during massage is through hygienic hand washing techniques. Not only should you wash your hands before and after a massage, but you should also wash your hands during a session if you are planning on touching the face after massaging the feet.


The Hygienic Hand Washing Technique is a nine step process.

1.     Adjust water so that it is not too hot or too cold. Be sure that a sufficient stream of water is coming out of the tap to wash away any pathogens.

2.     First wet the forearms and hands moving from the elbows down to the fingertips. You should keep your hands lower than the elbows at all times so that the water will flow off your fingertips.

3.     Be sure you own a nail brush and use it to scrub the nails both on the outside of the nail as well as under the nail.

4.     With soap, create lather and spread the soap from the hands to the elbows. It is best to use a liquid soap over a bar soap as the bar soap must be cleaned after each use. Don’t forget to wash in between the webs of your fingers and thumb.

5.     Rub the soap over your skin for at least 2 minutes.

6.     Rinse the soap off completely from fingertips to elbows (just like a surgeon). The water will flow off your forearms and elbows.

7.     Dry your hands and forearms with a clean paper towel.

8.     Use the same paper towel to turn off the faucet and to open the door handle to exit the area.

9.     Be sure to toss the used paper towel in the waste basket.


At this point, be away that you have not cleaned your pump bottle or the door knobs leading in to, and out of, your massage room and bathroom. If you touch any of these items with your cleaned hands you will only serve to contaminate them again. In fact, I have seen massage therapists wash their hands and then go back in to the massage room when the client leaves to take off the dirty sheets, wash down the massage table and reset the table with new sheets. The entire time they are doing this, there is any number of contact points for them to come in to contact with pathogens.


So what should you do?


In order to provide a safe and effective environment for you to work in, you must first give yourself ample time to properly take care of yourself and your massage equipment. That means that I will leave the room and wait for the client to exit the room. After they have left, I would strip down the massage table and wipe down the table and any equipment that I used during the session, including the massage lotion pump bottle. Then I would wipe down the doorknobs both inside and outside of the room. With the disinfected paper towel in my hand, I would use that towel to open the door to the rest room where I would then perform the Hand Washing techniques discussed earlier.

Too many places do not give you enough time to provide adequate and healthy techniques to your massage sessions. This is unfortunate and could be dangerous to you and your family. So insist on at least 10 minutes between clients to properly prepare your room for clients.

Another item often overlooked is your hands. If you have any scrapes, cuts or wounds on your hands or forearms then you should cover them before coming in contact with your client. You can use finger cots, gloves, or even liquid skin to help put a barrier between you and your client. Your room should always have a pair of disposable gloves on hand just in case you come in contact with blood or other body fluids during your session.

Be aware that carpeted areas in a massage room are breeding grounds for pathogens of all kinds. Unless you are steam cleaning your rugs after each client, chances are your carpets are very unhealthy. If you drop a pillowcase, Kleenex, etc. on the floor-do not pick it up and use it. Treat it as contaminated and follow standard procedures for removing it from the room. I have already seen a therapist drop a face cradle cover on the floor, pick it up, and put in back on the face cradle for her client. What was worse was actually seeing a waitress dropping a sheet of paper on the floor in the kitchen of a restaurant, pick it up and put it inside of a food basket where the client’s order was then put in to and served. If possible, your floors should tiled or wooden.

All massage therapists and body workers should follow simple rules to insure an optimal healthy working environment.

1.     Keep your nails cut. The longer the nail-the greater the opportunity for you to harbor dead skin cells and pathogens.

2.     Do not jewelry during sessions. Jewelry can harbor dead skin cells and pathogens.

3.     Wear short sleeves. Be sure that no part of your clothing comes in contact with your client. Long sleeves can harbor dead skin cells and pathogens which you can then pass on to your next client or bring home to your family.

4.     Be sure to practice good hand washing protocols.

5.     Keep disposable gloves on hand in case of emergency.

6.     Cover all cuts, wounds and scrapes with gloves, finger cots or liquid skin.

7.     Take a shower before you go to work and again when you are finished with work

8.     Be sure that the clothes that you wear in your session are clean when you begin your day and place in the dirty hamper at the end of the day. To be on the safe side, bring a change of clothes to work with you so that you can change before going home.

9.     Be sure to sterilize your equipment in between each client. Do this not only for your own wellbeing but for the wellbeing of your client.

10.  Wear disposable gloves when cleaning out the bathrooms and other surfaces to protect yourself against contaminated secretions. Discard the gloves when finished.

11.  Wash all skin that comes in to contact with contaminated body fluids with a bleach solution of 1 part bleach to 10 parts water (or other disinfecting solution).

12.  Be sure to wash contaminated linens in hot water with bleach added (or throw them away).



Exercise and the HIV/AIDS individual

Exercise is an important component to the health of the HIV/AIDS individual offering those opportunities and group activities and socialization. Individuals who can maintain their health while undergoing a regimen of drug therapy for their disease, will be better able to cope both physically and mentally with their situation.

Another component of the fitness regime is that it offers the infected individual with a more positive body image. Keeping physically fit will go a long way to keeping up the hopes and positive attitudes of infected individuals.

Just 30 minutes of exercise at least 3-5 days a week will help to maintain good health benefits. These exercises could include swimming, walking, aerobics, dancing, weight training and more. It is important to work within the client’s ability to perform an exercise routine. Some days will just be better than others. Stretching is an important part of the exercise routine and should be done before and after any exercise activity chosen.

Be aware that having HIV can increase the risk of developing foot pain, fatigue, dizziness and other symptoms unique to the individual. Should your client develop any of these symptoms while under your supervision, be sure that they stop the activity and rest. Have your clients stay properly hydrated by drinking plenty of water before, during and after the exercise activity.


Some HIV/AIDS medications can cause lipodystrophy. This is a condition where the arms and legs lose their fat stores and instead fat starts to accumulate in the breast and abdomen area. Having your client add resistance training to their exercise routine may help to correct this condition.

How much activity your client will be able to do will be totally up to your client’s current health condition. Give these individuals enough time to complete their exercises at their own pace.



Hygiene for Fitness Specialists

All fitness specialists should follow simple rules to insure an optimal healthy working environment.

1.     Keep your nails cut. The longer the nail-the greater the opportunity for you to harbor dead skin cells and pathogens.

2.     Do not jewelry during sessions. Jewelry can harbor dead skin cells and pathogens.

3.     Wear short sleeves. Be sure that no part of your clothing comes in contact with your client. Long sleeves can harbor dead skin cells and pathogens which you can then pass on to your next client or bring home to your family.

4.     Be sure to practice good hand washing protocols.

5.     Keep disposable gloves on hand in case of emergency.

6.     Cover all cuts, wounds and scrapes with gloves, finger cots or liquid skin.

7.     Take a shower before you go to work and again when you are finished with work

8.     Be sure that the clothes that you wear in your session are clean when you begin your day and place in the dirty hamper at the end of the day. To be on the safe side, bring a change of clothes to work with you so that you can change before going home.

9.     Be sure to sterilize your equipment in between each client. Do this not only for your own wellbeing but for the wellbeing of your client.

10.  Wear disposable gloves when cleaning out the bathrooms and other surfaces to protect yourself against contaminated secretions. Discard the gloves when finished.

11.  Wash all skin that comes in to contact with contaminated body fluids with a bleach solution of 1 part bleach to 10 parts water (or other disinfecting solution).

12.  Be sure to wash contaminated linens in hot water with bleach added (or throw them away).


Updates on HIV and Life Expectancy in 2014

            According to the article titled, “Update on HIV and Life Expectancy in 2014,” Dr. Dennis Sifris and James Hyhre looked at survival rates for the afflicted population. The pair noted that a recent study published in the medical journal, PLOS/ONE, discovered that if people who had a CD4 count above 350 cells/mL and took combination antiretroviral therapy (cART) early, that they could enjoy a life expectancy equal to that of the general population. But on the whole, people living with HIV are expected to live 15 years less for men and 19 years less for women. The recent update of HIV Treatment Cascade revealed that only 33% of the 980,000 Americans diagnosed with HIV are receiving cART and only 25% are able to maintain undetectable viral loads.

            In their article titled, “Guidelines for Starting HIV Therapy in Adults,” Sifris and Myher saw that in 2013, the U.S. Department of Health and Human Services (DHHS) expanded their treatment guidelines. The DHHS now recommended an earlier implementation of cART in people infected with HIV and for use in people with CD4 counts below 500 cells/mL.

            Evidence has shown that early treatment of HIV can reduce HIV-related and non-HIV-related illnesses and deaths, it can increase life expectancy; it can lower incidence of HIV transmission from mother to child and lowers the incidence of HIV transmission in the community. While early treatment can slow disease progression, little is known about the long-term toxicity of this type of treatment.


HIV/AIDS and the Affordable Care Act

When President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010, it set in motion some important pieces of legislation to help people at risk for, and living with, HIV/AIDS. The ACA removed barriers to those with HIV/AIDS of applying for and obtaining healthcare coverage (pre-existing conditions). According to the U.S. Department of Health & Human Services, the ACA provides Americans affected with HIV/AID, not only better access to healthcare coverage but more health insurance options.


Starting on January 1, 2014, no one can be denied health insurance or charged more because of a pre-existing health conditions. And this includes HIV and AIDS. And it is just not obtaining coverage that has changed, now, healthcare insurers can no longer limit how much they’ll spend on your medical care either. That includes restrictions on the amount of days, or years, as well as the total amount of service over your lifetime. You should receive benefits such as prescription drugs, hospital care, doctor visits, mental health care, and HIV testing.

There are many people with HIV who are already covered by government-run healthcare programs such as Medicaid and Medicare. Please note that if you are already covered by a healthcare insurance policy with your employer, or have already purchased a healthcare policy on your own, that you do not need to purchase coverage elsewhere. What ACA does is to offer a health insurance marketplace, or exchange, where those who do not have insurance can go to purchase insurance and those with insurance can compare their policies. You may even qualify for financial assistance depending on your monthly/yearly income and family size. The next open enrollment period for the marketplace runs from November 15, 2014 through February 15, 2015. You can visit the official website at the following link: https://www.healthcare.gov/glossary/open-enrollment-period.


Another healthcare option is to be covered under Medicaid. If you are a single person earning less than $16,000 a year ($21,000 or less as a couple), then you may qualify for coverage. Enrollment for Medicaid is at any time of the year.


Thanks in part to ACA, no American with HIV or AIDS can ever again be dropped from health insurance coverage or denied coverage because of their condition. This extends to all pre-existing conditions such as high blood pressure, asthma, cancer, and others.  And that is not all. Below is a list of other requirements that may affect you and your ability to obtain and maintain adequate healthcare coverage:

  1. Insurers cannot cancel, deny or rescind your healthcare policy because you made a mistake while filling out your application.

  2. Your healthcare insurance policy cannot impose a lifetime cap on insurance benefits that it pays out on your behalf. Such policies used to say a maximum of $100,000 in benefits and then when you used up that amount, they would stop paying out any more money. This is now illegal.

  3. States now have the option to expand Medicaid services to those with incomes at or below the poverty line ($16,109 for single and $32,913 for family of 4)

  4. In states that offer Medicaid expansion, people living with HIV and who meet the income threshold don’t have to wait for an AIDS diagnosis before they start receiving life-extending care and treatment.

  5. ACA created the Health Insurance Marketplace (exchange) in every state to offer more affordable coverage.

  6. The ACA provides financial assistance and tax credits for people who meet certain income thresholds that depend on income and size of household.

  7. Medicare recipients have lower prescription drug costs and the ACA will eventually close the ‘donut hole’ of people not being able to afford their medications in the future. This includes drugs for HIV and AIDS.

  8. Thanks to ACA, the AIDS Drug Assistance Program (ADAP) benefits are now considered contributions toward Medicare Part D’s True Out of Pocket Spending Limit (“TrOOP”).

  9. The ACA also expanded HIV preventive services through the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Services (NCHHSTOP).

  10.  The ACA requires most new health insurance plans must cover HIV testing for people between the ages of 15 to 65.

  11. The ACA requires most new health insurance plans to cover certain recommended preventative services and a minimum set of benefits (called “essential health benefits”) that includes prescription drug services, hospital inpatient care, lab tests, services and devices and mental health.

  12.  ACA promotes the patient-centered medical home model of care as an effective way to strengthen the quality of care with those with chronic health conditions.

  13. ACA authorized an optional Medicaid State Plan benefit for states to establish Health Homes to care for Medicaid patients with certain chronic health conditions, such as HIV/AIDS.

  14. The ACA supported the expansion of community health centers to provide preventative, primary, and comprehensive HIC care services to more than 20 million Americans affected with HIV/AIDS.

  15. The ACA expands initiatives to strengthen cultural competency training to ensure that all populations are being treated equally.

  16. The ACA supports the  National LGBT Health Education Center, that helps healthcare organizations better address the needs of lesbian, gay, bisexual and transgender individuals, including needs for HIV prevention, testing, and treatment.

  17.  ACA increases the healthcare workforce for underserved communities by providing loans and scholarships through the National Health Service Corps for doctors, nurses and health care providers.


An Important Note about Ryan White and ADAP

If you are currently receiving support for your HIV care and treatment from the Ryan White HIV/AIDS Program and the AIDS Drug Assistance Program (ADAP) you will still need to have health coverage. These programs will continue to be available, but some of the services these programs currently cover may be replaced by your insurance.


Ryan White and the ACA

The Ryan White HIV/AIDS Program will still continue to provide medical and non-medical services to many people living with HIV.








Sifris, Dennis and Myhre, James (2014, June 4). “Update on HIV and life expectancy in 2014.” Web. Retrieved from http://aids.about.com/b/2014/02/17/update-on-hiv-and-life-expectancy-in-2014.htm.

Sifris, Dennis and Myher, James (2014, May 20). “Guidelines for starting HIV therapy I adults: recommendations from the U.S. Department of Health and Human Services. Web. Retrieved from http://aids.about.com/od/treatmentquestions/a/Understanding-HIV-therapyfacts.htm.







Open Book Test for HIV, AIDS and Hygiene





Open Book Test for HIV, AIDS and Hygiene






Name__________________________________________________  Date ________________


MA #_________________________ Other License Number ___________________________


Email Address ________________________________________________________________


Contact Number _______________________________________________________________




After reading this course, choose the ONE best answer for each question and circle it. Remit test for grading to Francine Milford, P.O. Box 554, Venice, FL. 34285, or email answers to FrancineMilford@cs.com.


  1. The AIDS virus has been in America since:

    1. 1900

    2. 1800

    3. 1950

    4. 1981

  2. The word, AIDS, stands for:

    1. Acquired Immune Deficiency Syndrome

    2. Active Immune Deficiency Syndrome

    3. Activated Immunity Deficiency Syndrome

    4. None of the Above

  3. The cause of AIDS is the HIV virus. The word, HIV, stands for:

    1. Humanity Immune virus

    2. Human Immunodeficiency virus

    3. Humane Immune Deficient virus

    4. None of the above

  4. HIV is spread through which of the following fluids:

    1. Semen

    2. Blood

    3. Breast milk

    4. All of the above

    5. None of the above

  5. The most common form of transmission of HIV is:

    1. Unprotected sex with an HIV-infected individual

    2. Protected sec with an HIV-infected individual

    3. Kissing with open mouth

    4. None of the above

  6. The receptive partner in any form of sexual intercourse is considered to be at the highest risk of transmission.

    1. True

    2. False

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  8. HIV can be found in which of the following fluids:

    1. Pre-seminal fluid

    2. Vaginal fluid

    3. Blood in the mouth

    4. None of the above

    5. All of the above

  9. Typical routes of transmission of HIV by blood include which of the following:

    1. Needles to inject drugs

    2. Receiving blood transfusion

    3. Skin graph

    4. All of the above

  10. Less common routes of blood-borne transmission include:

    1. Infected blood being splashed in to the eyes.

    2. Direct blood-to-blood contact

    3. Sticks by contaminated needles in a healthcare setting.

    4. All of the above

  11.  Not all human bodily fluids contribute to the spread of HIV. Some of these bodily fluids that do not contain HIV is the following:

    1. Sweat

    2. Urine

    3. Feces

    4. Tears

    5. None of the above

    6. All of the above

  12. According to the Center for Disease Control, HIV cannot reproduce outside of the body is not spread by:

    1. Air

    2. Water

    3. Insects

    4. All of the above

    5. None of the above

  13.  You can catch HIV by sharing dishes or through closed-mouth kissing.

    1. True

    2. False

  14.  The most effective way to prevent all HIV transmission is through:

    1. Abstinence

    2. Wearing condoms

    3. Washing your hands

    4. Education

  15.  Some of the ways that you can use to reduce your risk to HIV is:

    1. Practice safer sex

    2. Have a mutually monogamous relationship

    3. Reduce exposure to infected blood

    4. All of the above

    5. None of the above

  16.  Lifestyle changes are recommended for those infected with HIV and include:

    1. Individual treatment plans

    2. Diet

    3. Exercise

    4. All of the above

  17. In addition to medication and lifestyle changes, it is crucial that those living with HIV/AIDS have:

    1. A vacation

    2. A job

    3. A support network

    4. None of the above

  18.  What does the word, PrEP, stand for:

    1. Pre-exposure prophylaxis

    2. Prep exposure prophylaxis

    3. Pre-prep prophylaxis

    4. None of the above

  19. The drug called Truwada is a combination of how many drugs?

    1. Two

    2. Three

    3. Four

    4. None of the above

  20.  The Center for Disease Control recommends that testing for HIV be done on all patients in what age group?

    1. Infants

    2. Teenagers

    3. Patients ages 13-64, high risk individuals and all health care providers.

    4. Seniors

  21. As a massage therapist, giving a massage to someone with HIV can help:

    1. Reduce anxiety, tension and stress

    2. Helps to ease muscles aches and pains

    3. Helps to bring oxygen to organs and tissues.

    4. All of the above




Cost: $10 plus $1 processing fee, $11 total for HIV, AIDS, and Hygiene-2 ce's.