HIV is a World Fact

by Miriam Meijer

As more and more young people go on class trips, Junior Year abroad programs, foreign language school programs, and summer vacations, parents have to have "that talk" with them. The talk must explicitly deal with the youthful characteristics of sexual risk-taking and denial. Knowledge=Survival is the motto of ĘGIS, a web site devoted to HIV/AIDS. In the AIDS era we have no choice but to openly talk about HIV, learn to live with it, and take action to prevent its spread.

The virus that causes the fatal disease of Acquired Immune Deficiency Syndrome (AIDS) is the Human Immunodeficiency Virus or HIV. People with HIV have what is called HIV infection and most of them will develop AIDS as a result of their HIV infection. While the HIV virus has existed in the United States since at least the mid- to late 1970s, HIV infection and AIDS are globally distributed. The risk to international travelers is determined less by their geographic destination than by their individual behavior.

The incubation period for AIDS is very long and variable, ranging from a few months to many years. Some individuals infected with HIV have remained asymptomatic for more than a decade. Intense international research efforts have resulted in treatment for HIV infection and prophylaxis for several opportunistic diseases that characterize AIDS, but, otherwise, there is no vaccine to protect against HIV infection and no cure for AIDS. The only certain way to avoid AIDS is to prevent getting infected with HIV in the first place.

The virus is passed from one person to another through blood-to-blood and sexual contact. It is impossible to tell if someone is infected. A man or woman carrying HIV might look completely healthy and, during this time of apparent health, he or she can infect someone else. The body fluids proven to spread HIV are blood, semen, vaginal fluid, breast milk, and other body fluids containing blood. Mainly a sexually transmitted disease, HIV can also be transmitted by infected blood or blood products (as in blood transfusions), by the sharing of contaminated needles, and from an infected woman to her baby before birth, during delivery, or through breast-feeding.

HIV is not transmitted through normal, day-to-day, casual contact. HIV is not transmitted through air, food, or water routes; contact with inanimate objects; through mosquitoes or other arthropod vectors. It is not possible to get infected from spitting, sneezing, coughing, tears or sweat. It is safe to play sports and work together, shake hands, hug or kiss infected people on the cheek or hands, sleep in the same room, breathe the same air, share drinking and eating utensils and towels, use the same showers or toilets, use the same washing water and swim in the same swimming pool. The use of any public conveyance (e.g., airplane, automobile, boat, bus, train) by persons with AIDS or HIV infection does not pose a risk of infection for the crew or passengers.

The World Health Organization (WHO) estimates the number of persons infected with HIV to be in the range of 13-14 million worldwide. Since comprehensive surveillance systems are lacking in many countries, the true number of cases is likely to be far greater than the numbers officially reported from some, particularly the non-industrialized nations.

Travelers should avoid sexual encounters with persons who are infected with HIV or whose HIV infection status is unknown. This includes avoiding sexual activity with intravenous drug users and persons with multiple sexual partners, such as male or female prostitutes. If, in some nations, the risk is higher among homosexual and intravenous drug using groups, on a global scale HIV is primarily a heterosexually spread disease. High proportions of prostitutes are infected. Casual sex puts one at risk for Sexually Transmitted Diseases (STDs). Gonorrhea and syphilis may cause serious long-term disability, especially if treatment is delayed. There are no cures for Genital Warts (HPV), Genital Herpes, or Hepatitis B, although treatment may relieve symptoms and, in the case of HIV/AIDS, prolong life. Condoms provide good but not complete protection. High-quality latex condoms are not always available overseas nor always available in the usual sizes (many Asian countries sell a smaller range of sizes). A free brochure on proper condom use can be ordered from the U.S. Centers for Disease Control's National AIDS hotline, 1-800-342-AIDS.

Travelers also risk HIV infection if they use or allow the use of contaminated, unsterilized syringes, or needles for any injections or other skin-piercing procedures including acupuncture, use of illicit drugs, steroid injections, medical/dental procedures, ear/body piercing, or tattooing. In many developing countries the re-use of medical supplies, including needles and syringes, is common. If you require an injection, ask to see the syringe unwrapped in front of you, or take a needle and syringe pack with you. Travel packs are available from some chemists and travel clinics, containing sterile equipment for use in an emergency. However, it is important to supply these kits with a certificate (showing contents and the reason for its purchase) for customs clearance.

Travelers are at risk for HIV as well if they use infected blood, blood components, or clotting factor concentrates. In most of Western Europe, North America, Japan and Australia, donated blood is now screened for HIV antibodies and therefore HIV infection by this route has become rare. In most developing countries, however, there may be only the most basic blood transfusion services. When much of the blood donated is unscreened, the risks from blood transfusion become high. Travelers should therefore consider the following points. Avoid accidents because they are the most common reason for needing a blood transfusion, i.e. drive carefully. Accept blood transfusion only when essential. Take pregnancy or any medical condition that may lead to heavy blood loss into account before traveling to destinations where good medical facilities will not be available. And, finally, knowing your blood group in advance makes it easier to find a blood donor in an emergency.

It takes enormous courage to find out whether you have contracted HIV but there are excellent reasons for you to want to do so. You can learn what to do to stay as healthy as possible for as long as possible. By taking extra care, people with HIV infection can live for many years. If you are infected with HIV and have sex with other people, you risk giving them the virus. If infected, you will not want to donate blood. Thebody.com is a good web site for people just learning that they tested positive.

An increasing number of countries require that foreigners be tested for HIV prior to entry. It is usually required as part of a medical exam for long-term visitors (i.e. students and workers), although Russia is a notable exception. U.S. test results are not always accepted. Check with the embassy of the country you plan to visit to learn about their entry requirements and specifically whether AIDS testing is a requirement. The U.S. State Department has compiled an unofficial list.

Stay informed. AIDS is a fast-moving field, and the "basics" are constantly changing. Web sites that are written for laymen rather than medical specialists include the British Broadcasting Corporation and Yahoo's entry page that has links to wider information sources. The Washington Post has completed a series of excellent articles about the impact of this global plague. Dr. Albert Goldberg discusses teenage realities, like the fact that the highest rates of gonorrhea of any age group in America are females aged 15-19, in a straightforward manner on MedicinePlanet.com.

Additional sources for this article derived from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, HHS Publication No. (CDC) 94-8280 (June, 1994): 66-67, the United Nations' web site, and the Scottish Centre for Infection and Environmental Health (SCIEH) Travel Medicine Division web site.

For questions and comments about Worldtravelcenter.comSM, its World Travel Health newsletter, or its travel companion jetStream, contact Miriam Meijer:
miriam@worldtravelcenter.com
Phone: 1-800-234-1862

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