Controversy seems to surround the topic of HIV-status disclosure when it comes to filling out massage therapy intake forms. Ask yourself: What do you ask clients to disclose?

Turned Away
In a recent Facebook public forum, a user relayed a friend’s story. The friend had filled out their required intake form before a massage session. When they reported their HIV-positive status, however, they were denied massage. The client was told to get a doctor’s note to receive any sort of treatment in the future. The Facebook post wrapped up with a basic question: Is there any real reason the HIV/AIDS question should be on the intake form?
What came next was a slew of follow-up posts from people claiming to be practicing licensed massage therapists and bodyworkers. Several of the responsive posts seemed to be based on misinformation and fueled by stigma. Some of the more questionable statements included: “Wear gloves,” “It should be on the intake form, along with treatment,” “Massage should not have been refused unless there was an open wound on the client,” “Denial could be OK if the therapist has kids who recently have been sick and the client’s immunity is compromised,” “Knowing keeps it safe for everyone,” “If an MT is not trained or educated about HIV/AIDS, it is responsible to turn a client away … just like it is for oncology-related massage,” “Our first order of business is ‘do no harm.’”
There were also well-intended comments: “HIV/AIDS is a major illness with its own MT considerations; nothing more, nothing less,” “It’s unethical and discriminatory to deny, as well as just a low, crappy thing to do.” Others posted in defense of the client who was on the unjust receiving end.
While many of us may think that having a client disclose their HIV status on a health intake form will better inform our work, it begs this question: By asking clients to mark their status on an intake form, are they opened up to potential discrimination? Some professionals have the best of intentions and would think nothing of seeing an HIV-status disclosure on an intake form. However, there are many in the profession who might see it differently.
Educate Yourself
First, bodyworkers should be educated about the difference between HIV and AIDS, because they are two different entities. One concern in the medical community regarding HIV and AIDS includes keeping tabs on the CD4 count—the higher the number, the better. CD4 is the name of the helper cells in our body that assist in combating disease and keep us at our premium level of health.
The other concern is the viral load in the body—the lower the viral load, the better. Viral load is, just as you probably have guessed it, the amount of virus that appears in the blood work of the person with HIV or AIDS. Each of these numbers has a target range that a physician tries to help the patient reach, mostly through medication.  
Standard Precautions
You might be asking yourself what you would do if a client with AIDS has an open wound. The answer is simple: proceed as you were taught to do. Would the thought that someone on your table has HIV change the way you would handle exposure to open wounds, blood, or any other bodily fluids? Your answer should be no!  
As licensed therapists, we are taught to avoid open wounds, to wear gloves when dealing with any bodily fluids we come across, and to always sanitize the tables, sheets, hands, and other tools we use in our profession. How, or why, would this particular knowledge about a client’s HIV status change our approach? Our approach should not differ in how we handle the actual massage, nor should it differ in how we handle our cleanup. Would you treat a new mother’s release of breast milk onto your sheets any differently than you might treat any other accidental fluid leakage? I hope that no one assumes any differentiation in the cleanup of bodily fluids in the treatment room.
Do you need a refresher in Standard Precautions?
Visit the Centers for Disease Control and Prevention
(www.cdc.gov) or see the article “Safety First,” page 40, in the November/December 2013 issue of Massage & Bodywork.
To Disclose or Not
I believe the only informative questions we should ask clients are those that may pertain to how we approach them when it comes to technique and treatment options. I believe in a need-to-know line of questioning. If my knowledge of any personal issues would adjust my treatment approach, I would need to know.
I would venture to guess that most of us are not health-care professionals who work with needles, nor would we have reason to be exchanging bodily fluids. We know what conditions contraindicate direct work or require special care (finger cots, gloves, etc.). If we have further concerns, we ask. Should we come across fluids other than sweat, we err on the side of caution. It’s all in our basic training, and there is no need to fan the stigma flame by suggesting any extreme measures or precautions should be taken with this particular segment of the population.
When it comes to disclosure about HIV and AIDS, the laws are different in every state, but most are confined to disclosure when dealing with potential sexual partners or medical professionals as it pertains to procedures. Disclosures are further required in some states when going to a dentist, medical professional, or medical facility where prescription medications may be prescribed. Though we are governed by HIPAA, and treat our intake forms as such, most, if not all, laws do not require an HIV-positive person to disclose this information to us.
Asking a client if there is any further medical information they wish to share may be a suitable way to approach this situation. This is a highly personal area for people who have HIV or AIDS, and the therapeutic relationship does not qualify as the type of relationship required to exchange this type of information. Though many therapists are respectful toward the information they receive from clients on their intake forms, some, as you can see from some of the aforementioned comments, unwittingly have/could exercise discriminatory actions or statements.
If your concern is about your client’s tolerance to massage, this is a discussion you can have as a part of intake; questioning any side effects from medications is also an easy way to open the discussion.  
There is nothing about HIV that contraindicates massage. Don’t add stigma to the already-existing stereotype—educate yourself from credible sources. Do some research, prepare yourself, and address your thought process, your questions, and your concerns. Then, move forward. 

Jeremy King is a licensed massage therapist in Illinois and has a degree in holistic health science from Pacific College of Oriental Medicine.