10 STEPS TO HOLIDAY HAPPINESS
Entry restrictions, holiday bugs, meds… travelling
with HIV can be a hassle, but you can beat them with our get-away guide
Image Raffaele Teo
By
this point in the year, most of us have had our fill of flu bugs, stiff joints
and vitamin D deprivation. Inevitably then, our thoughts turn to sunny beaches
and hot summer nights in exotic climes.
Sun, sea and foreign travel can be good for our health. As one PN reader put
it: “Over the years I have started to notice a pattern; my CD count
is always lower in January and highest when I come back from my holidays.”
But poor planning and a thoughtless choice of destination could have the opposite
effect. Short or long haul, business or pleasure, people living with HIV should
be able to enjoy international travel like anyone else. Sadly, some countries,
24 at the last count, do not see it like this. And even if we do manage to
reach our chosen destination, once there we still have to be extra vigilant
about protecting our health. After all, having one potentially fatal infection
doesn’t necessarily mean we want another. Smart travellers always research
their destination beforehand. People living with HIV have to be that bit better
prepared to make sure our voyages abroad are stress- and risk-free. If you
are thinking about booking a holiday, a bit of forward planning could make
all the difference.
1 Restrictive practices
Most tourist destinations don’t restrict entry to HIV positive visitors
who plan to stay for one month or less. Nevertheless, 24 of the 169 countries
surveyed can, and will, deport someone with HIV who turns up at their border
(see box, right). In practice, these regulations are unenforcable and if there
are no compulsory testing at borders, the truly determined HIV positive tourist
will usually find a way, though there is still a risk. A list of countries
and their restriction status can be found at www.aidsnet.ch/linkto/immigration.
For a more detailed list, download regulations from www.aidsmobility.org.
Type ‘travel’ in the website’s search engine to find it.
Alternatively, ask other positive friends and people at clinics for tips.
2 US and them
Notoriously, the United States is the leading abuser of the rights of people
living with HIV to travel freely. While many positive travellers have few
illusions about, say, Sudan’s commitment to people living with HIV,
the general consensus is that the US should know better.
The US refuses entry in principle to nationals known to be HIV positive. Positive
travellers can apply for a special 30-day waiver which may be granted for
family visits, medical treatment, business or participation in scientific
conferences, but the restriction in your entry to the US is then forever recorded
on your passport. If refused entry, you could also risk being jailed or deported.
Some people living with HIV, like UKC chief executive Stephen Bitti, refuse
to travel to the States on principle, but thousands of others continue to
take the risk. A 2005 study by London’s Mortimer Market clinic showed
that of 99 men who had travelled to the US since their HIV diagnosis, only
five per cent had obtained a HIV-specific visa waiver, but nobody was refused
entry. John, who recently travelled to New York, decided send his meds ahead:
“My drugs arrived fine, but it’s worth paying a bit extra and
use a delivery company like UPS for guaranteed delivery, rather than Royal
Mail.” Check out the ‘travel’ section of Aidsmap for more
tips on travelling to the States.
Border restrictions for PLWH, worst offenders:
• United States of America
• Kingdom of Brunei
• China (not Hong Kong or Macau)
• Iraq
• South Korea
• Solomon Islands
• Sudan
• Moldavia
• Mongolia
• Oman
• Russian Federation
• Saudi Arabia
3 HIV-friendly destinations?
There really isn’t any such thing as a truly HIV-friendly destination,
but any country with a good health service, clean water, mature Aids organisations,
liberal social policies and no entry restrictions are always a safe bet. Canada
and many European countries fit this bill. Ahead of hosting this August’s
XVI International Aids Conference in Toronto, Canada overhauled its entry
rules so people applying for a short-term visa no longer have to disclose
their HIV status. For a beach holiday, head for tried and tested gay Meccas
like Mykonos, Spain, the Balearics or Gran Canaria, which must have played
host to millions of HIV positive visitors over the years.
4
Treatment holiday? Think twice.
Although carrying your medications through customs can seem like a big hassle,
it shouldn’t be an excuse for a sudden or unplanned drug holiday. These
should only ever be considered in close consultation with your doctor. The
Mortimer Market survey found that 26 out of 216 respondents (12 per cent)
stopped taking HIV therapy on their journey. More than half of these did so
without consulting their HIV doctor. The main reasons for taking an interruption
were fear of: being found with meds and being deported from a country with
entry restrictions; fear of disclosure to travelling companions and to avoid
HIV-drug side effects. Those who stopped their medication were more likely
to fall ill; cut short their holiday due to illness or develop an opportunistic
infection than those who stayed on their meds.
5 Protect your pills
It’s generally advisable to carry meds in your hand luggage in case
your suitcase takes the scenic route to your destination or don’t bother
turning up at all. Take plenty of meds, and if you really want to plan ahead,
post some to friend or your hotel just in case. Make sure you visit your clinic
to stock up well in advance.
6 Time zones
The received wisdom used to be to stay on UK time when travelling abroad.
But this makes adherence hard. Changing the time of doses gradually may also
lead to sub-optimal levels of drugs in your system. Never extend the time
between drug dosing as this increases your risk of lower drug levels and drug
resistance. It is generally OK to bring the time forward, as you will just
have a slightly higher drug levels for a short period, and this is very unlikely
to be significant enough to cause side effects.
For example, with a twice-daily regimen, this usually means ‘every 12
hours’. You never want to stretch this to 13,14,15 hours, but it is
fine to bring it forward to 6, 7, 8, 9, 10 or 11 hours.
HIV i-Base usually advises people to change to the destination time for flights
when they board the plane and stick to the same schedule, eg: 8am UK time
changes to 8am destination time. On a twice-daily regimen where the morning
dose is taken at 8am in the UK, someone flying to New York at 8am would take
that dose on the plane, then set their watch back to 3am, and take a second
dose at 8am US time five hours later. When in New York they'd take their next
dose at 8pm US time etc.
7 Needles on the move
T-20 (Fuzeon) requires no special storage conditions until it is mixed, when
it then needs refrigeration for up to 12 hours. Anyone travelling with needles
and syringes requires a certificate of medical need. A letter from you doctor
saying the needles are for you and that you are fit and healthy to travel
should be sufficient. Syringes should be sealed and needles capped and disposed
of carefully after use. Keep all meds in your hand luggage. Check with the
consulate of your destination country about their laws on needles and syringes.
You could post them ahead and only carry what you need to inject on your journey.
Your may prefer to schedule your injections so you don’t have to inject
on-board. You can join a community-run email support group or obtain patient
support material from the manufacturers (see websites, right)
8 Bye-bye E111, hello EHIC
For those of us in the UK used to trailing down the post office for an E111
to cover us for reciprocal health care, life just got a whole lot better.
As of 1 January, the E111 has been replaced with a single European health
card (EHIC). This credit-card-sized card gives you access to reduced, or sometimes
free, medical treatment in EC countries, plus others like Switzerland and
Iceland. The UK also has reciprocal health care agreements with other countries
such as Russia and Australia. Check the Department of Health travellers’
website for details. The EHIC also covers you for pre-existing and chronic
illnesses (many insurance policies do not). The EHIC only applies to state-funded
treatments, which might not be the same as those provided by the NHS. To get
an EHIC apply online at www.ehic.org.uk,
call 0845 606 2030, or pick up a form any post office.
9 Extra protection
Most mainstream travel insurance policies exclude HIV positive people. If
you fail to mention your status and it comes to light after your make a claim,
your policy will be void. Specialist HIV travel insurance has many advantages.
If you are stop-checked at US immigration, the authorities can issue a temporary
visa, as they are much happier with HIV inclusive insurance. Some policies
ask for CD4 count, viral load and ARV status. Some may state your HIV status
or just mention a pre-existing medical condition. All the companies listed
below offer travel insurance to HIV positive people. Full cover for a week’s
holiday in New York will cost from £37 to £49.
10 General healthcare
Picking up an infection can spoil your trip. Look at the Department of Health’s
website (www.dh.gov.uk)
and type ‘travel advice’ in the search engine to bring up information
on which immunisations you will need for which country as well as tips on
how to avoid diarrhoea, hepatitis A and malaria, especially unpleasant conditions
for people living with HIV. People with HIV are generally advised to avoid
live vaccines but consult your doctor about this. Take enough prophylactic
medicines including acyclovir, antifungals, and pack plenty of condoms, lube,
high-factor sun block and insect repellent containing DEET. Avoid ice in your
drinks and when in doubt drink only boiled water.It’s important to consider
HIV when travelling, but a holiday also gives you a chance to forget your
worries about it. Follow these top tips and hopefully you’ll be well
on your way to a happy, stress-free holiday… we can’t however
stop you bickering with your travel partner! Enjoy.
USEFUL WEB LINKS
• For a full list of countries and their HIV restriction status:
www.aidsnet.ch/linkto/immigration
• To apply for a European Health Card: www.ehic.org
• For more information on travelling with Fuzeon: www.fuzeon.com,
FuzeonSupport-subscribe@yahoogroups.comTRAVEL INSURANCE COMPANIES
• It’s So Easy! Travel Insurance, 0845 222 2226, www.hivtravelinsurance.com
• Freedom travel Insurance, 0870 774 3760, www.freedominsure.co.uk
• Rothwell & Towler, 01404 41234, www.travelfirst.co.uk
• With special thanks to Simon Collins at i-base, www.i-base.info
