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If so, the first step in your travel planning – before you even buy your airplane ticket – should be a consultation with your doctor, especially if you’re headed to the tropics or subtropics. Why? Because a host of diseases that are uncommon in the United States are still rampant in the developing world. And, unfortunately, people with HIV are more likely to be infected than people with fully-functioning immune systems.
Here’s an example: in the United States, rabies is almost unheard of in humans. The vast majority of humans who get rabies, worldwide, do so as the result of a bite from a rabid dog. In the United States, the law requires all dogs to be vaccinated against rabies, so it almost never happens. In the developing world, however, this is not the case. So rabies, which is extremely rare among humans in the United States, is still a scourge in parts of the developing world.
Other examples of diseases that are very rare in the United States and most of the developed world – but affect millions of people elsewhere – include malaria, yellow fever, dengue fever, typhoid fever, and cholera.
The first thing you need to discuss with your physician is whether or not you are well enough to travel. Your travel-related risks as a person living with HIV depend largely on the status of your immune system. It is crucial to have a current assessment of your CD4+ (T-cell) count and your plasma HIV RNA level (viral load).
If your T-cell count is below 200, your doctor will probably advise you to delay your trip until you’ve had the chance to get on HIV therapy and rebuild your immune system. This is for two reasons: to minimize your risk of acquiring new infections, and to make your system more responsive to whatever travel-related vaccines you may require.
If your T-cell count is between 200 and 500 cells you are considered to have “limited immune deficiency” from the perspective of travel-related recommendations. Again, your doctor will probably recommend that you put off your trip for at least three months after starting antiretroviral therapy to minimize the risks of travel.
and What You’ll Be Doing
A critical part of your pre-travel consultation is to share with your doctor your proposed itinerary, duration, and type of travel. That’s because the vaccines you’ll need and other protective measures you need to take depend on your destination.
Travel-related vaccines fall into three main groups: (1) routine vaccines to update your immunizations for things like measles, mumps and rubella (MMR), tetanus, and the flu; (2) recommended vaccines that depend on your destination and travel itinerary; and (3) required vaccines to obtain a visa or for entry into some countries.
Inactivated vaccines are generally acceptable for use in HIV-infected people (eg, pneumococcal, tetanus, hepatitis A virus [HAV] and hepatitis B virus [HBV], inactivated polio, meningococcal, and inactivated trivalent influenza vaccines). On the other hand, live viral and bacterial vaccines are generally avoided if possible, especially if you have a low T-cell count.
In tropical countries some of the nastiest diseases – including malaria, yellow fever and dengue fever – are spread by mosquitoes. Other diseases are spread by other biting insects.
So it makes sense to protect yourself as much as you possibly can. Stock up before you go on mosquito repellent containing at least a 30% concentration of DEET, and use it religiously. Stay indoors in screened areas as much as possible. Sleep under a treated mosquito net, even if you have to bring one with you. As much as possible, wear long sleeves and long pants, and keep the exposed parts of your body well treated with repellent.
In remote and resource-limited parts of the world, clean water may be hard to find. Take as much bottled water with you as you can. If possible, boil water before you drink it. Portable filtration units can help, but they do not screen out water-borne viruses and the smallest of microbes. Boiling is a better bet. A bottle of Coke or a beer may be a safer way to quench your thirst than the local tap water.
Be absolutely certain you bring your antiretroviral medications – and plenty to spare. Keep in mind that you may be there longer than you expect if the local air traffic controllers go on strike or the local volcano starts spewing ash. Carry your meds with you in your carry-on luggage, and keep a second supply in your checked luggage. Make sure you carry your prescriptions so you can prove what your medications are and why you need them.
But don’t stop there! Your favorite over-the-counter medications may not be available where you’re going – or you may not know how to ask for them in the native language. So carry your favorite diarrhea remedy and other meds with you as well.
Be aware that some countries still restrict admissions to people living with HIV. The United States only lifted its ban on visitation by foreigners with HIV on January 4, 2010. So don’t be in for a rude surprise at the border! The U.S. State Department maintains a list of countries with HIV travel restrictions on-line.
Also, make certain that your medical insurance covers you overseas. Get additional traveller’s coverage if necessary, including evacuation coverage. Find out if there is a reliable medical institution where you’re going, and make sure you have their address.
It is a documented fact that people have more sex when they’re travelling than they do at home. So make sure you take a good supply of condoms with you, and use them! You may already be HIV-positive, but you don’t want to get a strain you don’t already have. And other sexually transmitted diseases, like syphilis and gonorrhea, are no fun.
Copyright 2018, Positive Health Publications, Inc.
This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!