Phil Baker offers handy advice on how to prevent your HIV status turning a dream trip into a holiday from hell
For those of you who read Edwin J Bernard’s withering
exposé of the current US stance on immigration requirements for positive
people in NAM’s Aids Treatment Update, the reflexive twitch of booking
a holiday after the frozen fogs of February has no doubt become an activity
requiring far more deliberation.
According to the PN readers’ survey, some 42 per cent of you have taken foreign holidays more than five times in the last five years and spend at least 10 days abroad in each year. Given this, you’d think we were all experts on the intricacies and variations in global rules and regulations for travel-hungry pozfolk.
But a quick chat over a cup of Lapsang Souchong at PosNation Towers reveals this is far from the case. Moreover, those countries with a seemingly politically correct stance towards positive tourists and business folk really make life as hard as possible, so a little guile is often necessary.
While EU countries generally present few problems in terms of getting in and accessing services when there, more exotic and far-flung destinations are less straightforward; a major blow considering our increasingly exotic travel tastes.
What we assume as normal here may not always be the case abroad. Almost all countries in the world require an HIV test if you plan to emigrate to work for longer than three months, but stranger strictures apply.
You should always verify with your own enquiries, if you have concerns about the quality of reception and care wherever you finally choose to go.
You should take an ample quantity of your treatment regime drugs with you on holiday allowing for some loss, spoilage or delay. If your drugs are lost or mislaid in an EU country you will usually be able to replace them by going to a pharmacy in most cities, or hospital pharmacies in remoter areas. You are likely to be charged for the prescription. This cost can be around £150 for a week’s supply but you may be covered by your insurance. Alternatively, ring up your UK physician (always take their contact details) who will often know a local doctor where emergency supplies may be had for free.
It is a good idea to know all three names for your combination drugs (as well as the dosage) for example Zerit - d4t - stavudine. In many countries these names will not always be the same. In some countries generic, non-branded analogous drugs, are identical but may bear a different name.
In countries with less developed HIV services, you may choose to have a fallback of keeping a replacement stock of your combination ready and have these Fedexed to you. This usually takes a day but it must be accompanied by the original prescription to clear customs. Anti-retrovirals can command a high black-market price in some countries. Finally, some drugs are environmentally sensitive. For example soft gel saquinavir and ritonavir need to be kept chilled or it will spoil and become ineffective. This may influence your choice of destination, or at least the quality of the hotel/accommodation.
Anyone considering travel within Europe, and presumably within its newly extended borders, is entitled to free healthcare under a European claim-back system. Usually you’ll be able to access healthcare in any EU country without charge. But you will be expected to pay for the service upon return to the UK unless you can produce an E111 form that proves that you are an EU member citizen. Inexplicably, this is not retrospective nor is it cheap. An ambulance call-out in France can set you back £300 before you have any treatment. And they will chase you up for it afterwards until it is paid. The good news is you can apply for an E111 in any post office and once validated don’t have to renew it unless you use it to obtain treatment and it is not given back to you.
Almost all travel insurance companies will offer you a policy that specifically excludes HIV in its small print. Does this mean that if you are knocked over by a bus then, if the insurance company finds out that you are living with HIV they will refuse to pay, even though your injuries are completely unrelated to HIV? Yes it does. Your policy will exclude you from taking the policy if you are HIV positive and becomes invalid if they find out you are lying. Companies specialising in HIV include: Rothwell and Towler, Freedom Travel and Easy Travel insurance.
Everyone is trying to get undetectable and preserve and grow their CD4s. However upswings in your bloods will rarely coincide with your holiday plans or when flights and packages are affordable, so consider the risks to your health rather than the time of your holiday. If your CD4 count is below 200 then you are more vulnerable to opportunistic infections such as the serious pneumonia, PCP. Discuss this with your clinician. In certain circumstances they may prescribe you prophylaxis against one or more HIV-defining illnesses. It is better for everyone to keep you healthy rather than to try and cure a consequence on your return.
It is well knows the USA refuses to allow entrants with ‘communicable diseases’ to enter the country, so unless you lie and conceal your status, then you will not be allowed in. Ironically, Iraq has no such controls and you are welcome to enter regardless of status.
As a disaster check, the Foreign and Commonwealth Office will give their advice on all countries in the world on http://www.fco.gov.uk/ including updates on political, crime and epidemic situations, aimed at British passport holders.
This gives a view on the percentage of HIV infection in a country (often very understated through lack of data) but will not provide much information for HIV positive people needing resources in a remote land.
Always check with your clinician about the need for vaccinations and their interaction with your therapy and find out about the possible effects of sunshine, temperature etc upon the drugs that you are taking. For example, sunlight can cause rashes for patients on Septrin. Many other drugs have similar and little known side effects. However, if you are stuck in an unfamiliar country and need either medical help for your HIV condition or need to arrange delivery of medication you should go to the nearest consular office or embassy where staff are available to help with UK subjects requiring medical assistance. Be aware that consular opening hours can vary from country to country. It’s a good idea to check the location and opening hour of your nearest one.
With an irony that is familiar to those working within the HIV sector,
it is paradoxically the US with one of the most rigid HIV emigration bars,
provides
us with perhaps the most useful resource. Check out their Center for Disease
Control website http://www.cdc.gov/travel and specifically their http://www.cdc.gov/travel/hivtrav.htm HIV advice page and you’ll get an excellent rundown on what to expect from
some of the more exotic holiday destinations
And finally a tip from Dr Mike Youle, of the Royal Free Hospital, Hampstead,
based upon his own patients’ experience: “Remember to take a copy
of your current prescription and a travel letter just in case your medication
is uncovered in customs. This is nothing to do with HIV stigmatisation, but
in many countries, where anti-retrovirals are scarce, you will need to be able
to
prove that the drugs are yours and for your own use and that you are not importing
onto the black market.”
Have a great time and send us a post card
RESOURCESThe UKC’s Treatments and International Travel booklet includes a ‘pill planner’ to help keep on step with your drug regimens across time zones. Email: jclarkson@positivenation.co.uk
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