International Travel and AIDS

Summary

The global scope of HIV has an impact on international travel. International travelers may be exposed to HIV in three general ways: through sexual contact with an infected person; through receiving blood transfusions; or through receiving injections or other invasive procedures with a contaminated needle/syringe or other skin-piercing instrument. The risk of sexual exposure for travelers may be enhanced by: ignorance about the global epidemiology of HIV or routes of HIV transmission, the escapist psychology of travel, or participation in frank sexual tourism. Specific measures to reduce risks of sexual and parenteral exposure to HIV during travel will be discussed. HIV-infected persons should be informed about theoretical risks of travel related to immune system activation (infections) or to the immunological impacts of medication, or the fatigue and stress of travel. While these risks are theoretical, they should be considered as part of an individualized programme for health protection of HIV-infected prospective travelers. Travel has certainly contributed in a general manner to the global spread of HIV. However, this is a truism, for excepting transmission through imported blood and blood products, HIV is transmitted directly (sexually) from person-to-person. Fears of traveling, like most fears related to HIV infection, usually result from exaggerated or distorted information about risks of exposure. Sexual contact, the major route of HIV spread worldwide, is under the traveler’s personal control. Blood transfusions are rarely needed and HIV-screened blood is increasingly available in developing countries. “Emergency injections” are virtually never required; the time needed to ensure sterilization before injection (usually by boiling) is almost always available. As HIV is not transmitted by casual contact, food, water, or insects, no additional precautions are required. Finally, many governments have considered imposing restrictions on short-term travelers based on HIV status, but most have agreed with WHO’s opposition to such measures, as such programmes would, at best and at great cost, slow only briefly the spread of HIV into and within countries. Physicians and others dealing with international travelers have an obligation to ensure that travelers are informed and educated about AIDS, that HIV-infected persons are carefully counselled, and to help ensure that coercive measures to prevent international HIV transmission, of deceptive simplicity and dubious value, are not adopted.