Traveling can be one of life's great luxuries and is often a daily necessity for many whose work requires them to be on the road or in the air. Traveling with HIV infection is possible, but it is wise to be aware of special concerns related to both domestic and international journeys. With a little bit of additional preparation and planning, HIV-infected individuals can travel as safely as anyone else. Travel preparation depends on a person's stage of HIV infection, their destination, and the length of travel. A traveler with well-controlled HIV usually requires less planning than someone with advanced AIDS or poorly controlled disease.

Destination

The degree of risk associated with travel depends on the destination and the activities that each traveler wants to pursue. A jaunt to a 5-star hotel in a major metropolitan area in a foreign county is far less risky than a camping trip in the wilds of Southeast Asia. Risks associated with camping, such as drinking and swimming in contaminated water and exposure to insects, are much more problematic than those associated with a week at a luxury resort on the Mediterranean.

Vaccination

Patients should be encouraged to talk to their healthcare provider as soon as they develop travel plans. Journeys to developing countries may require several months of travel preparation in order to obtain necessary travel documents and appropriate antibody responses from required immunizations. While travel clinics are available in most major cities to advise patients on appropriate vaccines and travel advisories, most healthcare practitioners also have access to texts and Internet sites that provide detailed information about proper preparation. Common vaccines such as those for hepatitis A and B, pneumococcal diseases, and tetanus should be up to date. Visits to areas that have endemic malaria may require prophylactic medication prior to arrival and for several weeks after returning from the area.

Over fifty countries restrict the entry of immigrants and travelers with HIV infections. While restrictions primarily affect only long-term travelers, it is wise to check with the embassy of the country to be visited well in advance of any travel. Current restrictions can also be found online at www.travel.state.gov/hivtestingreqs.html

Different parts of the globe pose a variety of potential health threats to travelers. Developing countries often pose the greatest threat because of poorly developed infrastructures for sewer and water service. It is not uncommon to find lakes, streams, and even public water supplies contaminated with bacteria or parasites. Immune systems weakened by HIV infection are likely to be at higher risk of infection in these areas. Tropical climates often pose unique situations with rare or unusual pathogens causing potential harm. Education and behavior modifications can reduce the risk associated with travel.

Up-to-date health warnings and requirements are available in written and electronic format from the US Centers for Disease Control and Prevention.

Depending on the travel destination, clinicians may want to suggest bringing along a customized first aid kit with antibiotics for  diarrhea or other destination-specific potential infections.

Getting to and from the travel destination can have health consequences. Long airline flights predispose for deep vein thromboses (DVT) or blood clots. Commonly referred to as "economy class syndrome," clots can form when someone remains in a cramped airline seat for long periods of time. It is important to stretch, walk around, and keep blood circulating to prevent DVTs. Other healthy flying measures include drinking lots of water or fruit juices and avoiding alcohol to help prevent dehydration.

Patients with  a cold or sinus problem might want to postpone flying. Changes in the cabin pressure can be damaging to the middle ear if it cannot adjust to pressure and altitude changes.

It's one thing to take a drug holiday, but another to take drugs on holiday!

One of the most important considerations when traveling with HIV infection is making sure patients bring all of  their required medications and remain on schedule as much as possible. Medications should be packed in carry-on bags because they may be lost or delayed if packed in checked baggage. Patients should pack more medication than they will need for their holiday in case of delays. If the patient is on an antiviral regimen that needs to be taken with food, then some food should be brought on board the plane. Travelers can no longer count on the airline to provide food in flight.

Adherence

One of the most difficult aspects of traveling with HIV infection is staying on schedule with medication dosing. It may be necessary to post notes in the hotel room and rental car to serve as daily reminders. Traveling across multiple time zones can complicate medication schedules. When traveling from west to east, take each successive dose one hour earlier. When traveling east to west, take each successive dose one hour later until the travel destination is reached. Jet lag associated with travel across time zones may further complicate adherence to therapy.

Many travelers purchase travel insurance, which could provide monetary protection in the event of unexpected illness, delays, or medical evacuation. Patients should research policies carefully to find one that meets specific needs. Depending on the length and location of travel, it may be wise to investigate sources of healthcare in the destination(s) before leaving home. While no one ever expects to become ill while traveling, pre-planning can save hours of frustration.

 

Safe Food, Safe Sex

Contaminated food and water can cause a variety of diseases, most notably hepatitis A and traveler's diarrhea. These problems are easy to prevent by following a few simple guidelines. Travelers should be immunized against hepatitis A prior to travel. Exposure to potentially infectious food and water should be avoided. In general, raw fruits, salads, and vegetables; raw or undercooked seafood and meat; tap water and ice made with tap water; unsealed bottled water; unpasteurized milk and dairy products; and food and beverages from street vendors should also be avoided. Hot foods, bottled beverages, coffee, tea, wine and beer  are usually safe while traveling.

HIV should not preclude anyone from traveling. However, the HIV-positive traveler needs to do some extra planning and research in conjunction with their healthcare provider.

Don Kurtyka, ARNP, MS, MBA is administrative director of HIV services at Tampa General Hospital in Tampa, Florida. He is also a nurse practitioner in HIV care at the Hillsborough County Health Department's Specialty Care Center and a clinical instructor at the University of South Florida College of Medicine's division of infectious and tropical diseases.

References

The following materials were consulted in the preparation of this paper:

Rose SR. International Travel Guide 2001. USA:

Travel Medicine.

Thompson RF. Travel and Routine Immunizations:

a Practical Guide for the Medical Office. Milwaukee: Shoreland Medical Marketing, Inc.; 2000.

Weiss EA Comprehensive Guide to Wilderness and Travel Medicine. USA: Adventure Medical Kits; 1998.

Internet Resources  

OUT & ABOUT Travel Health Online: 

<www.outandabout.com>

Traveler's Health, Centers for Disease

Control and Prevention:

<www.cdc.gov/travel/ index.htm>

Travel Health Online:

<www.tripprep.com/ index.html>

The World Traveler Hepatitis Information Center:

<www.travelsafely.com>

International Society of Travel Medicine:

<www.istm.org>

International Traveler's Clinic,

Medical College of Wisconsin: 

<http://healthlink.mcw.edu/ content/topic/Travel_Medicine>

Minnesota Department of Health- Health Information for International Travel-links 

<http://www.health.state.mn.us/divs/dpc/adps/travel/travel.htm>

U.S. Department of State, Bureau of Consular Affairs:

  <http://travel.state.gov/>

World Health Organization International

Travel and Health:

<www.who.int/ith/index.html>.