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Golden rules for traveling with HIV: key guidelines and precautions for the positive traveler to make vacationing easily enjoyable, not life-threatening.

Travel can be rejuvenating, which is why Celi Adams, RN, the founder and clinical director of San Francisco's Center for Caregiver Training, heartily recommends getaways for her HIV-positive clients. But her encouragement comes with an important caveat: Careful preparation to protect one's health is always the first order of business. "Unfortunately, you can't just pack your bags and go," she notes.

Here are a few vital areas to examine and helpful tips to consider for HIVers planning a holiday.

Before You Depart

Visit your doctor. The first step any HIV-positive traveler should take is to evaluate overall health with a physician, with a close eye kept to CD4-cell levels, says Vladimir Berthaud, MD, associate director of the Vanderbilt-Meharry Developmental Center for AIDS Research at Meharry Medical College in Nashville. For HIVers with CD4-cell below 200--counts below 200--which indicates severe immune system damage--trips to areas where parasitic, bacterial, and viral diseases are prevalent can be very dangerous and should be avoided.

Get vaccinated. Some countries require vaccinations against common endemic diseases. Check with the State Department or a foreign embassy or consulate to see which inoculations are needed. All HIV-positive travelers should be vaccinated against polio, typhoid, and hepatitis A and B, but travelers with a CD4-cell count below 200 should avoid "live vaccines" like those for the measles and yellow fever.

Pack the essentials. Jonathan Craig, a global traveler who has been HIV-positive for 22 years, was careful to pack mosquito repellent--and use it liberally--when traveling to Swaziland and South Africa in late 2004. "I sprayed it all over me, day and night," he says with a laugh. Health experts say avoiding mosquito bites, as Craig did, is a key disease-prevention step when traveling. Other important items to pack include over-the-counter anti-diarrheal and antinausea medications, a waterless cleanser or small bar of anti-bacterial soap, antibacterial wipes, condoms (they may not be available in some countries), chlorine tablets or filters to disinfect water in an emergency, and a signed letter from your physician that lists all the medications you take.

Insure yourself. HIV-positive travelers should check to see if their health insurance offers coverage while overseas. Some plans cover only emergency services, and others, like Medicare and Medicaid, have no international coverage at all. Supplemental health insurance is available from most carriers and guarantees a health-care safety net while out of the country.

Watch how you pack. When packing your antiretroviral drugs there are two options: You can either leave them in their original, clearly marked prescription bottles to avoid any possible delays at security checkpoints or confiscation by customs agents, as Adams advises; or you can put 'all the pills you'll need into a Baggie or plastic drug-dosing box so that your HIV infection is not obvious when entering countries that may discriminate against HIV-positive visitors. (A full list of countries with HIV entry prohibitions can be found on two U.S. State Department Web sites.) Whatever approach you choose, pack your medications in your carry-on and avoid exposing them to sunlight and severe temperatures, which can cause them to break down.

While Travelling

Avoid the raw. Though it might be tempting to sample a wide array of local specialties while traveling, they can pose significant health risks. Avoid fruit juices, raw vegetables, salads, and any raw or undercooked eggs, meat, and seafood. Streetside vendors' wares can be less than hygienic and should also be skipped. With local fruits, make sure the outer skin is intact before you peel it yourself and eat it. The basic rule is "Boil it, cook it, peel it, or forget it."

Drink carefully.

Every traveler has heard the admonition "Don't drink the water," but HIV-positive vacationers should take the warning especially seriously, Contaminated water can cause traveler's diarrhea and even such life-threatening conditions as cryptosporidiosis, salmonella, cholera, and typhoid. Stick to bottled water and canned soft drinks, fruit juices, and alcoholic beverages. Avoid ice, coffee, tea, and other hot drinks made from local tap water. Use bottled water to brush your teeth, as even tiny amounts of contaminated water can cause illness When swimming, be sure to avoid swallowing any water. Wear shoes when walking on beaches or river-banks, and lie on towels or blankets near the water to minimize exposure to contaminants.

Plan for medication backup.

Losing anti-HIV medications can be one of the most frightening experiences for an HIV-positive traveler, which is why Craig has a contingency plan in place for the frequent overseas jaunts he makes for his work as an internationally renowned designer. "I put someone in charge at home who can FedEx the rest of my medications left at home to me if I need them," he says. But even express shipping to some remote locations can take from 24 to 48 hours--time enough for missed medication doses to allow HIV to mutate defenses against the drugs once they're started again, health experts warn. In many European countries it's possible to refill anti-retroviral prescriptions, Adams says. But in developing countries or those where brand-name anti-HIV drugs are scarce, it may be impossible to get antiretroviral drugs locally. Contact the local U.S. embassy or consulate for assistance if you are facing this problem, Adams advises.

Schedule your dosing. Changing time zones can cause major headaches in sticking to a complicated antiretroviral regimen. Program an alarm watch, beeper, or pager to alert you to take your medications on schedule. Other options may be to simplify your drug regimen to once-daily dosing or even to take a short treatment break. Talk with your doctor about these and other possibilities so you can enjoy one of life's healthiest pursuits--the art of traveling.

Adams is senior editor of HIV Plus.
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Title Annotation:TRAVEL MATTERS
Author:Adams, Bob
Publication:The Advocate (The national gay & lesbian newsmagazine)
Date:Jul 5, 2005
Words:947
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