by Sasha Alyson
HIV and AIDS needn’t be a barrier for travelers but even more consideration should be given, particularly when traveling abroad.
HIV and AIDS needn’t be a barrier to the world traveler. But some of the risks involved in travel change for those who are immuno-suppressed, who must carry drugs or needles, and medical complications may have graver consequences. Here are some of the major considerations for HIV-positive travelers.
Legal barriers to entry
Many of the countries you’re most likely to visit, especially in Europe, have no specific prohibitions on entry by persons who are HIV-positive. (Sadly, our own country has one of the most backward policies: A visitor with HIV or AIDS can legally be denied entry even for a short visit. In reality, this policy is rarely enforced unless someone seeks to make an issue of it.)
Once you seek to work, or to visit for an extended period (for which definitions vary from 30 to 365 days), regulations often tighten. Some countries get quite explicit: In Greece, women planning to work in “entertainment centers” must get an HIV test; in Singapore, it’s required of workers who earn less than $945 per month. A very few countries require a test even for relatively short visits: In Uzebekistan, you’ll need one if you want to stay more than 15 days. (But trust me — you don’t.)
For requirements of a specific country, call the embassy or consulate, or see the comprehensive listing at www.aegis.com/topics/travel.html. A number of links relevant to the HIV-positive traveler are provided by HIV InfoWeb.
Vaccines and prevention
Doctors don’t always agree about when vaccines should be used by people with advanced HIV-related conditions. Vaccines are sometimes less effective for individuals with a weakened immune system. In most cases, immunization for measles, cholera, rabies, influenza, and pneumococcus are considered safe, if warranted by your choice of destination. Discuss this your doctor a couple of months before departing, to have time for whatever is needed.
Yellow fever, a viral disease largely limited to tropical South America and sub-Saharan Africa and transmitted by mosquitoes, poses special concerns for travelers with HIV. The vaccine for yellow fever involves a live virus, and poses a theoretical risk of encephalitis for anyone with a suppressed immune system. The Centers for Disease Control advises against it; WHO (the World Health Organization) believes the vaccine is safe for those who are asymptomatic, but says evidence is still inconclusive for symptomatic HIV-infected persons. Many countries require a yellow fever vaccination if you’re coming from an “endemic” yellow fever region, but will waive that requirement if you have a documented medical reason not to receive this vaccine. If you travel to a yellow fever region without the protection of a vaccine, however, you’ll want to take extra precautions. HIV+ travelers to tropical South America or sub-Saharan Africa, read the CDC advisory at www.cdc.gov/travel/yelfever.htm.
Insurance
Some private insurance policies apply only in the country of origin; others will reimburse emergency expenses while you’re abroad. Medicare and Medicaid will not cover you outside of the United States. If your policy does cover you, contact your insurance company as soon as possible after any emergency; failure to do so will generally limit your rights.
Travel insurance, offered by tour companies and travel agents, will often cover what your regular insurance will not. To be covered against pre-existing conditions, most require you to sign up immediately after buying the tour or tickets, and you must be physically able to make the trip at the time you enroll. Read the small print carefully to be sure you’re covered; some policies exclude HIV-related conditions. Extent of coverage varies; some, for example, will cover emergency evacuation back to the United States; others will not.
Many credit card companies offer medical assistance for travelers who encounter an emergency. None of these programs actually covers the cost of medical care away from home, but their advice, referrals, translation services, and network of English-speaking doctors could make a big difference. Find out before you go what they offer, and whether it’s offered in the countries you’re visiting. — it may be worthwhile to upgrade to a gold card to get extra benefits.
Emergency services
For an annual fee of $50 to $75, several companies will maintain your full medical history, transmit it quickly to any place you need it, assist with referrals, or handle evacuations back to the United States. If you want certain services that are not already covered by another insurance carrier or credit card, then consider one of these. Out & About, the gay travel newsletter, recommends several at www.outandabout.com/travelHIV.html
Insects. Bites from mosquitoes, ticks, sandflies, and other pests can cause extra irritation for people with HIV, as well as carrying disease. Long, lightweight pants and long-sleeved shirts will help; sleeping under a net will greatly reduce insect bites in a tropical area: For $80 you can get a lightweight tent-like netting from Long Road Travel Services (800-359-6040) to protect you at night.
Food and drink
Travelers diarrhea (TD) is hardly limited to those with HIV, but a weakened immune system can make you more susceptible. It usually passes in 3 to 6 days, but without making the trip more fun.
Anyone who has vacationed south of the U.S. border has probably heard the precautions, and they apply in many other countries: Drink only bottled water from reliable sources, even for brushing your teeth. (Or sterilize water by boiling it, then allow to cool). Don’t use ice; avoid dairy products; eat only fruits and vegetables that you can peel yourself before eating. This is one time when Mom does not recommend a fresh salad every day.
Canned foods are safest. Well-cooked food that is still hot is generally safe, but seafood, especially shellfish, should be suspect even when cooked.
Certain antibiotics can reduce your risk of getting TD, but they are not recommended for people with HIV. However, your doctor can equip you with an antimicrobial such as ciprofloxacin, to shorten the misery if, despite your precautions, you come down with TD. Pepto-Bismol and Kaopectate work, too.
The Centers for Disease Control (www.cdc.gov/travel/foodwatr.htm) offers further advice on avoiding TD.
Transporting medications and syringes
Many immigration officials have the authority to keep out visitors for the flimsiest of reasons, including suspicion of “communicable” diseases. Keep drugs in their prescription bottles, but in an inconspicuous part of your luggage. Carry one copy of your prescription with the drugs, and another copy in a separate piece of luggage, to speed up replacement if they’re lost. If you’re carrying a syringe, bring a doctor’s note for that, as well.
Experienced travelers will tell you that nothing can be taken for granted once you leave home, but there’s one thing you can still count on: The airline will one day lose your luggage. Pack enough medicine in your carry-on to last until you can get replacements, and always carry two copies of your prescription — one with the medicine, one in your carry-on or fanny pack.
If your drugs require refrigeration overnight, hotels in most developed countries have long experience handling such requests. A re-usable ice pack, and a hotel with a freezer, should be all you need. In developing areas, ask before you go, and be aware that power outages may thwart even the best-intentioned hotel. Do not plan to buy ice in convenience stores as you travel; in few other countries is ice as ubiquitous as in the U.S.
January, 1999