Comprehensive information about diving and undersea medicine for the non-medical diver, the non-diving physician and the specialist.
Population At Risk
We should expect that a subset of people entering diving will be seropositive for the Human Immune Virus (HIV), just as there is a group of people entering the military who test positive. In the military, HIV testing is mandatory, and the mean prevalence of HIV seropositivity is 1.5 per 1000 entrants; 0.69 per 1000 person years seroconversion rates in Active duty Naval personnel and 0.28 per 1000 person years in the U.S. Marines.
The HIV infected age group is similar to the sport diving community population and one has to assume that a certain portion of sport divers will be seropositive and have the capability to transmit the virus via blood and saliva.
An area of concern is switching of masks after a scuba dive. It has been estimated that approximately 1/3 of all scuba divers have small amounts of blood in their mask exhaled or expectorated following sinus clearing. This is a potential source of HIV infectivity and should be considered. It is highly unlikely that buddy breathing or similar shared activity could lead to infection, but no studies have been done. (See Disease Transmission Using Scuba Gear)
Selection of Scuba as Recreation
One should expect known HIV seropositive or AIDS patients to select scuba diving as a recreational sport in an effort to deny their illness or to prove that they are as capable and able-bodied as the next person.
This phenomenon has been observed in large university populations of young men and women with chronic, disabling and sometimes routinely fatal illnesses. Examples of this abound, for example; blind and paraplegic divers, blind skiers, and sky-diving and scuba diving juvenile diabetics and hemophiliacs. (See A Real Diving Challenge)
Known HIV seropositive divers and AIDS patients contemplating diving should be aware of the high incidence of subtle neurologic and psychiatric involvement in otherwise normal HIV seropositive individuals.
The US Navy and Air Force do not allow HIV positive individuals to fly even though they are without evidence of clinical disease.
Neurologic sequelae may include changes in behavioral, cognitive and motor skills, eye movement, coordination, attention, mental processing and spatial orientation.
Ernest Campbell, MD, FACS All Rights Reserved