Treating clients with blood-borne viruses

Cancer patients aren’t the only group being turned away from treatment unnecessarily. Georgia Seago examines the issues surrounding clients with blood-borne viruses

The treatment of cancer patients in salons and spas was a huge industry focus last year, with organisations speaking out to promote the benefits of therapies such as massage to those undergoing cancer treatment, and to dismiss outdated thinking that the illness is a contraindication to almost every treatment. But what about other client groups that are still being turned away from salons and spas or denied certain treatments due to different medical conditions? At best it can be disappointing; at worst it can leave people feeling ostracised and discriminated against.

Blood-borne virus HIV is often treated as a complete contraindication to treatment, especially in the case of invasive procedures that can draw blood, such as semi-permanent make-up and dermal-rollering. Now, some industry experts are pushing to raise awareness and increase therapists’ education of this and other blood-borne viruses, in an attempt to shed the stigma and ensure HIV-positive clients have fair access to treatments. Sam Marshall, who runs beauty business consultancy The Beauty Guru and is a member of the Habia Skills Active Advisory Committee, plans to launch a campaign to address HIV stigma in the industry. “I want to raise awareness that people with HIV aren’t contraindicated for beauty treatments,” she says.

Risk assessment
HIV and other blood-borne viruses are often regarded as a contraindication due to the potential danger of a therapist being pricked by an instrument contaminated with the client’s blood (known as a needle-stick injury), creating the possibility of cross-infection. However, Marshall believes that knowing whether or not a patient is HIV positive should not affect the way you carry out a treatment or react to a problem. “The only way you could catch it is if you stabbed your finger, with tweezers for example. Then you’d go immediately to seek medical advice, which is what you should do if you stab yourself with anyone’s blood,” she says. In a salon setting, the only other reasonable way a virus could be passed on is if infected blood or other bodily fluids entered through an existing break in the skin.

“People think you can catch it so easily but you can’t. It’s very rare that I encounter someone who actually knows it isn’t a contraindication,” says Marshall. Dr Stephen Higgins, consultant physician in the department of sexual health and HIV at North Manchester General Hospital, explains: “HIV is much more difficult to catch [than viruses like cold and flu]. Healthcare professionals very rarely get HIV from their patients,” adding, “Most HIV patients in the UK are on medication that makes transmission of the virus even less likely.” While Dr Higgins would advise his patients to disclose their status if they are HIV positive before an invasive treatment, this isn’t to say that the procedure shouldn’t go ahead.

Tiffany Tarrant, development manager at Habia, agrees that HIV shouldn’t preclude people from treatment, adding, “You can’t blanket ban anyone for anything, it’s a form of indirect discrimination really.” She admits that the beauty industry has faced criticism from health organisations because of salons outright banning clients with various conditions, possibly through a fear of therapists catching the illness themselves or potentially worsening the client’s condition or interfering with medication. However, she does say: “Before any procedure you should try to establish whether the client has something that potentially could impact on that treatment. Whenever you’re dealing with sharps and there’s a potential to spread blood-borne viruses, that’s critical.”

Right questions
The consultation should predominantly be about establishing whether the treatment would pose any risk to the client, rather than the therapist. “It’s not about the condition itself, it’s about establishing if due to the condition or potential medication the treatment will endanger the client, make the condition worse, or impact on the results of the treatment,” explains Tarrant. Instead of asking a client outright whether they are carrying any blood-borne viruses, she suggests asking more inclusive questions like: “Are you well? Are you undergoing any treatment? Are you taking any medication?”

“I explain that any medication could potentially affect the result of the treatment, so it’s important they let me know if they are taking anything. I’ll go straight to that rather than giving them a checklist [of conditions],” she says. Marshall advises asking clients how they normally react to waxing and how effectively their skin heals to establish whether there is reason to not go ahead with the treatment. “The emphasis should be, ‘I’m not worried about myself, it’s about protecting you, and the treatment may be unsuccessful if we don’t get all the facts’,” adds Tarrant.

Take precautions
There is always the possibility that a client may be carrying a virus without knowing it, supporting the premise that every treatment should be approached as though the client could have a blood-borne virus, in terms of infection control and hygiene procedures. Even if a client is aware, Tarrant points out that they might choose not to share the information. “Not everyone is going to disclose that they are HIV positive because of the stigma that is attached to it, and there’s nothing you can do about that. Regardless, the procedures you put in place should stop you from being at risk,” she says.

Marshall agrees there is no reason for therapists to be concerned about catching any kind of infection from a client, providing hygiene and infection-control procedures are followed correctly. Her advice is to read up on your code of practice. She also suggests getting rid of towelling covers on couches used for waxing treatments – in which blood can be drawn – so the bed can be wiped down thoroughly with disinfectant after every client, and following basic practices like wearing gloves for all treatments where you may come into contact with the client’s blood. “A lot of salons are definitely not following the codes of practice for waxing,” she adds.

Tarrant agrees that this is an area that could be built upon in some beauty curriculums: “When we review [the curriculum] next time maybe we ought to put more emphasis on the knowledge behind blood-borne viruses, because I don’t think we push that aspect of it enough in things like waxing. Even when you do a manicure you can sometimes draw blood.” It’s also vital that therapists know what to do if they do come into contact with a client’s blood through a needle-stick injury, whether the client has disclosed that they are carrying a virus or not. “I doubt many therapists would know that the general rule is you go to A&E and, depending on the risk, they provide you with medication,” says Marshall.

Dr Higgins emphasises how important it is that beauty businesses have the correct protocol in place for needle-stick injuries: “If any treatments are needed then the sooner they are used the better the outcome. Post-exposure prophylaxis for HIV can be initiated up to 72 hours after a possible exposure, but is more effective the earlier it is started.”

Insurance issues
Many beauty businesses are concerned about insurance requirements that mean they have to ask clients certain questions in order to be covered, and insurance companies often stipulate that a medical referral or doctor’s note is required for clients with certain conditions. “The insurance companies need educating more, because they take our lead and they’re quite frightened when it comes to mitigation problems,” says Tarrant.

Habia lists HIV as a contraindication requiring medical referral for semi-permanent make-up because medication may affect the colour retention of pigment and could affect the skin’s ability to heal properly. But this often isn’t practical for the client or the doctor, and Tarrant thinks more education would be beneficial to re-examine the need for medical referral in some cases. “Doctors get fed up and the client isn’t always happy about it,” she says. “So, for some of the things we blanket banned before or said we can’t do without a doctor’s note, we really need to think ‘can we treat that?’ because some we can.”

Next steps
The consensus is that therapists need more education at learner stage about contraindications and the finer details of how different conditions could impact the outcome of a treatment or put the client at risk. “I feel that we need to get therapists to do more research and have an understanding,” says Tarrant. In the case of HIV and other blood-borne viruses, she suggests advising learners and qualified therapists alike to contact organisations such as the Terrence Higgins Trust for more detailed information in order to make better-informed decisions when treating HIV-positive clients.

“As an industry we absolutely should be making more of an effort to understand these conditions and not immediately saying ‘no, I can’t treat you’,” adds Tarrant. Marshall also thinks the NHS could do more to support therapists by providing free vaccinations against other blood-borne viruses such as hepatitis B: “People whose jobs place them at risk of contact with blood or bodily fluids, such as nurses and dentists, get it as standard on the NHS. I touch blood every single day in my job but I have to pay for it,” she says.

Just like for cancer patients, many therapies are not contraindicated for people carrying a blood-borne virus, and to prevent clients being turned away unnecessarily experts suggest therapists need to research the finer details of HIV and how it is caught to avoid indirectly discriminating against clients with the virus. “Therapists have to be so conscious that they shouldn’t be refusing any client a treatment without a very good, carefully thought out reason,” says Tarrant. “It’s not about you, it’s about them.”