Preparation Tips for Traveling With HIV

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Travel for people living with HIV can be stressful, particularly when traveling abroad or over long distances. It may involve vaccinations or special medications when visiting certain countries or require you to alter your dosing schedule when flying over multiple times zones.

In some cases, there may even be laws or regulations that hinder travel for HIV-positive travelers. But, preparation is key to reducing travel stress and to avoiding the hassles and complications that can all but ruin the perfect trip.

Travel Vaccinations

Over 12 million Americans travel abroad each year, with an increasing number making the trek to exotic destinations in developing countries. According to the U.S. Centers for Disease Control and Prevention (CDC), more than half of these travelers will get sick, with causes ranging from infection to injury to food- or water-borne illnesses.

People with a suppressed immune system are especially vulnerable. This is not only of concern to people with later-stage HIV disease (CD4 counts under 200 cells/mL), but even those with moderately suppressed immune function (CD4 counts between 200-500 cells/mL).

When planning travel to a developing country, vaccinations are typically recommended for all visitors, HIV-positive or not. This is to help better ensure that infectious diseases prevalent in that region (such as typhoid fever or tuberculosis) are avoided. At other times, preventive oral medications might be prescribed.

While many of these products are strongly advised in the presence of HIV, others are not. In fact, many of the so-called live attenuated vaccines (vaccines made with a weakened form of a live virus) are contraindicated in people with HIV—given the potential to cause disease rather than prevent them.

Certain live attenuated vaccines, such as those for yellow fever, are perfectly fine for healthy, HIV-positive people. Others, like the oral typhoid virus, are to be avoided in all people with HIV, irrespective of CD4 count.

The best rule of thumb is to meet with your doctor four to six weeks in advance of an overseas trip to discuss which vaccines and/or preventive drugs are okay. You can check the Traveler’s Health website, managed by the CDC, for country-specific health recommendations and travel advisories.

If you unable to be vaccinated for any reason, your doctor can issue a certificate of exemption explaining why treatment cannot be delivered. Be advised, however, that the waiver may not be accepted in all countries (see below) and that it may include information about your HIV status that you’d rather not share.

And once arrived, be cognizant of any water- or food-borne diseases you may encounter. Avoid the following if visiting a developing country:

  • Raw fruits and vegetables (peeled fruits may be okay if you have peeled them yourself)
  • Tap water or ice made from tap water (that includes brushing your teeth with tap water)
  • Undercooked or raw meat
  • Unpasteurized milk or dairy products
  • Food purchased from street vendors
  • Bottled drinks that you have not opened yourself

International Travel Laws & Restrictions

While most countries have no travel restrictions barring people with HIV, there are 18 that do and several others with no clear laws or regulations governing entry. Enforcement of laws tends to vary considerably, with greater scrutiny typically placed on longer-stay visitors and immigrants rather than the casual tourist.

Before booking any overseas trip, be sure to get a complete picture of the laws of the land by visiting The Global Database, a non-profit website managed by the European AIDS Treatment Group, Deutsche AIDS-Hilfe, and the International AIDS Society.

The content is regularly updated and offers valuable insights into many of the concerns you may have as a tourist or business traveler.

Even if a country has no official restrictions regarding HIV-positive visitors, don’t assume you'll be welcomed with open arms. If in doubt, call the embassy, consulate, or high commission office of the country you’re planning to visit, and ask what the current laws are as they pertain to people with HIV. Try to be as direct as possible and remember that you neither have to reveal your name nor your HIV status.

If, for any reason, you have to visit a country with entry restrictions (say, for important business or a family visit), weigh the risks carefully and be sure to have the numbers of the local U.S. embassy or consulate on hand should you run into any problems.

In the end, it is highly unlikely you’ll be asked if you have HIV when entering. If an official at border control asks to search your bag and inquires about your HIV drugs, simply tell him or her that they are for a chronic condition. Unless you’re bringing in a lot of medications, they usually won’t press the issue. Use your best judgment and consider whether traveling to an HIV-restrictive country is in your best interest.

Health Insurance

Health insurance is just as important when traveling as it is when safely at home. Be sure to check if your policy will cover "customary and reasonable" hospital costs if a travel illness or injury occurs. This also includes overseas evacuation costs, which are rarely covered in insurance policies.

If your policy coverage falls short, you can find a list of recommended travel insurance providers from the U.S. Bureau of Consulate Affairs. This searchable database can also offer recommendations about local doctors and hospitals as well as provide contact information for your nearest U.S. embassy, consulate, or diplomatic mission.

Be advised that neither medicaid nor medicare recipients are covered when traveling abroad. Seniors can opt to purchase a medicare supplement plan (C through J), which includes a foreign travel emergency benefit for the first 60 days of your trip. Others will need to purchase supplemental insurance appropriate to their needs.

Smart Packing

The loss or shortage of your HIV drugs can not only ruin a holiday, it can hurt your health. When planning a trip, whether domestic or overseas, be sure to pack extra medication in the event your trip is extended, a flight is delayed, or some of your drugs get damaged or go missing.

For shorter trips, it’s often a good idea to pack double the amount needed. Be sure to always carry your medications in your hand luggage (not your checked bags) and keep them well away from any liquids or gels you may have packed. A sealable zip lock bag can usually do the trick in preventing accidental water damage.

Other recommendations to consider include:

  • If traveling to countries where mosquito-borne diseases (like dengue fever or malaria) are prevalent, be sure to bring ample supplies of insect repellent with a minimum 30 percent DEET. Mosquito netting (including models infused with DEET) can be purchased from online retailers and provides an additional protective barrier when sleeping.
  • To make things easier at border control, you can ask your doctor to provide you a letter and prescription explaining that your drugs are for personal use to treat a chronic medical condition. Alternately, you can bring your pills in an unsealed pharmacy bottle with your printed name on the label. Again, information about you HIV diagnosis does not need to be included.
  • Bring your insurance ID card and several claim forms should you need to visit a doctor, clinic, or emergency room while traveling. You can sometimes download the forms on your insurance providers website or request that the company mail you copies in advance of your departure.
  • A number of HIV drugs need to be taken with food. While most long-haul carriers will offer snacks during a flight, take along food just in case. It is recommended, for example, that Edurant (rilpivirine) be taken with a minimum 390 calories of food. Protein bars are often a good fall-back option.

Dosing Schedule Changes

If traveling over one or more time zones, prepare to make changes to your dosing schedule to avoid gaps in treatment. For shorter trips, you may be able to keep to your regular schedule with no impact on your sleeping or waking schedule.

For longer trips over multiple time zones, work out a dosing schedule in advance that you can adhere to reasonably, ideally spacing doses 24 hours apart for once-daily regimens and 12 hours apart for twice-daily regimens. Automated cell phone alerts can be especially helpful, particularly on westbound trips where you lose hours rather than gain them.

Allowing large time gaps between doses (or missing doses altogether) reduces the therapeutic level of the drug in your blood stream. This is something to try to avoid as it can lead to the return of viral activity and potentially contribute to premature drug resistance. However, if you do miss a dose, don't double dose in an effort to catch up. Simply return to your 12-hour or 24-hour routine, using whatever adherence tools you need to keep track.

Sources:

Centers for Disease Control and Prevention (CDC). "Travel-associated Illnesses Trends and Clusters, 2000-2010." Emerging Infectious Diseases. July 2013; 19(7):1049-1073.

National Travel and Tourism Office (NTTO). "Monthly U.S. Outbound Air Travel to International Regions." Washington, D.C.; 2016.

The Global Database on HIV-related Travel Restrictions. "Countries with restrictions for short-term stays (

U/S. Centers for Medicaid and Medicare Services (CMMS). "Travel (when you need health care outside of he U.S.Medicare.gov. 

U.S. Food and Drug Administration (FDA). "Edurant - Highlights of Prescribing Information." Silver Springs, Maryland; August 2015.

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