Acquired Immunodeficiency Syndrome (AIDS)

Description

AIDS is a serious disease, first recognised as a distinct syndrome in 1981. AIDS represents the late clinical stage of infection with human immunodeficiency virus (HIV), which progressively damages the immune system. Without an effective immune system, life-threatening infections and other noninfectious conditions related to failing immunity (such as certain cancers) eventually develop.

Occurrence

AIDS and HIV infection occur worldwide. Many countries lack comprehensive surveillance systems, so the true number of cases is likely far greater than officially reported, particularly in developing countries. The Joint United Nations Programme on HIV/AIDS estimates that, as of the end of 2003, 40 million persons were living with HIV/AIDS worldwide and that there were 14,000 new infections daily. Because HIV infection and AIDS are distributed globally, the risk for international travellers is determined less by geographic destination and more by behaviours that put them at risk of becoming infected, such as sexual and drug-using behaviours.

Risk for Travellers

The risk of HIV infection for international travellers is generally low. Factors to consider in assessing risk include the extent of direct contact with blood or other potentially infectious secretions and the extent of sexual contact with potentially infected persons. In addition, the blood supply in developing countries might not be adequately screened.

Prevention

No vaccine is available to prevent infection with HIV. For information on the safety of vaccines for HIV-infected persons, see section on The Immunocompromised Traveller.

Travellers should be advised that HIV infection is preventable. HIV can be transmitted through sexual intercourse and needle- or syringe-sharing; by medical use of blood, blood components, or organ or tissue transplantation; through artificial insemination; and perinatally from an infected woman to her infant. HIV is not transmitted through casual contact; air, food, or water routes; contact with inanimate objects; or by mosquitoes or other arthropod vectors. The use of any public conveyance (e.g., an airplane, an automobile, a boat, a bus, or a train) by persons with AIDS or HIV infection does not pose a risk of infection for the crew members or other travellers.

Travellers should be advised that they are at risk if they—

  • Have sexual contact (heterosexual or homosexual) with an infected person.
  • Use or allow the use of contaminated, unsterilized syringes or needles for any injections or other procedures that pierce the skin, including acupuncture, use of illicit drugs, steroid or vitamin injections, medical or dental procedures, ear or body piercing, or tattooing.
  • Use infected blood, blood components, or clotting factor concentrates. HIV infection by this route is rare in countries or cities where donated blood and plasma are screened for antibodies to HIV.

Travellers should be advised to avoid sexual encounters with persons who are infected with HIV or whose HIV infection status is unknown. Travellers should also be advised to avoid sexual activity with persons who are at high risk for HIV infection, such as intravenous drug users, commercial sex workers (both male and female), and other persons with multiple sexual partners. In countries with high rates of HIV infection, many persons without these risk factors may be infected and be unaware of their status. Condoms, when used consistently and correctly, prevent transmission of HIV. Travellers who engage in vaginal, anal, or oral-genital sexual contact with a person who is HIV-infected or whose HIV status is unknown should use a latex condom. Persons who are sensitive to latex should use condoms made of polyurethane or other synthetic materials. Some areas may have a limited supply and selection of condoms, or available condoms may be of inferior quality. Persons travelling to these areas who engage in sexual contact with persons who are HIV-infected or whose HIV status is unknown should carry their own supply of condoms. When a male condom cannot be used properly, a female condom should be considered. When no condom is available, travellers should abstain from anal, vaginal, and oral-genital sexual contact with persons who are HIV-infected or whose HIV status is unknown. Barrier methods other than condoms have not been shown to be effective in the prevention of HIV transmission. Spermicides alone have also not been shown to be effective, and the widely used spermicide nonoxynol-9 can increase the risk of HIV transmission in some cases. In many countries, needle-sharing by intravenous drug users is a major means of HIV transmission and transmission of other infections, such as hepatitis B and hepatitis C. Travellers should be advised not to use drugs intravenously or share needles for any purpose. Travellers should also be advised to avoid, if at all possible, receiving medications from multidose vials, which may have become contaminated by used needles.

In many developed countries (e.g., Australia, Canada, Japan, New Zealand, western European nations, United States), the risk of transfusion-associated HIV infection has been virtually eliminated through required testing of all donated blood for antibody to HIV. In the United States, donations of blood and plasma must be screened for HIV-1 and HIV-2 antibodies, the HIV-1 p24 antigen, and traces of HIV genetic material that may indicate infection.

If produced in the United States according to U.S. Food and Drug Administration-approved procedures, immune globulin preparations (such as those used for the prevention of hepatitis A and B) and hepatitis B virus vaccines undergo processes that inactivate HIV; therefore, these products should be used as indicated. Developing countries may have no formal programme for testing blood or biological products for contamination with HIV. In those countries, travellers should (when medically prudent) avoid use of unscreened blood-clotting factor concentrates or concentrates of uncertain purity. If transfusion is necessary, the blood should be tested, if at all possible, for HIV antibody by appropriately trained laboratory technicians using a reliable test. See Seeking Health Care Abroad for additional information.

Needles used to draw blood or administer injections should be sterile, single use, disposable, and prepackaged in a sealed container. Travellers with insulin-dependent diabetes, haemophilia, or other conditions that necessitate routine or frequent injections should be advised to carry a supply of syringes, needles, and disinfectant swabs (e.g., alcohol wipes) sufficient to last their entire stay abroad. Before travelling, such persons should consider requesting documentation of the medical necessity for travelling with these items (e.g., a doctor's letter) in case their need is questioned by inspection personnel at ports of entry.

International travellers should be advised that some countries screen incoming travellers for HIV infection and may deny entry to persons with AIDS and evidence of HIV infection. These countries usually screen only persons planning extended visits, such as for work or study. Persons intending to visit a country for an extended stay should be informed of that country's policies and requirements. This information is usually available from the consular officials of the individual nations. An unofficial list compiled by the U.S. Department of State can be found at http://travel.state.gov/travel/tips/brochures/brochures_1230.html.

Further information is available from 1-800-342-AIDS, toll free from the United States or its territories (for Spanish-speaking callers, 1-800-344-SIDA; for hearing-impaired callers with teletype equipment, 1-800-AIDS-TTY).

Bibliography
  • CDC. HIV Prevention Bulletin: Medical Advice for Persons who Inject Illicit Drugs. Available at: http://www.cdc.gov/idu/pubs/hiv_prev.htm. Last accessed July 6, 2004.
  • CDC. Management of possible sexual, injecting-drug-use, or other nonoccupational exposure to HIV, including considerations related to antiretroviral therapy. MMWR Recommendations and Reports 47(RR-17): 1-19, 1998. http://www.cdc.gov/mmwr/preview/mmwrhtml/00054952.htm. Last accessed July 6, 2004.
  • Memish ZA, Osoba AO. Sexually transmitted diseases and travel. Int J Antimicrob Agents 2003;21: 131-4.
  • Perrin L, Kaiser L, Yerly S. Travel and the spread of HIV-1 genetic variants. Lancet Infect Dis 2003;3:22-27.
  • Wright ER. Travel, tourism, and HIV risk among older adults. J AIDS 2003; 33(suppl. 2): S233-7.

- John T. Brooks

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