Gay Men's Health Crisis "Treatment Issues"; Vol. 8, No. 7 - August 1994
William Mandell, M.D., Jay Ward Kislak, M.D. and Dennis Karter, M.D.

Infections frequently are more severe or persistent in persons with HIV, however. HIV-positive travelers should exercise a little extra care to keep themselves safe, healthy and happy. The following are some of the major precautions.

Immunization

The immunizations necessary for travelers with HIV vary according to the destination. All travelers must have a tetanus-diphtheria booster within the past ten years. Those who have never had hepatitis A require gamma globulin shots. Most destinations still have polio, some have typhoid fever and a few have epidemics of meningitis. Vaccinations to prevent these illnesses are available. The live oral polio and typhoid vaccines are not appropriate for patients with HIV, though, so the injectable inactivated forms must be given.

The only available yellow fever vaccine is a live virus vaccine. To our knowledge, there are no reported cases of illness from this vaccine in persons with HIV, but it still is not generally recommended for HIV-infected individuals. Since the yellow fever risk varies greatly from locale to locale in South America and Africa, take into account your individual travel itinerary when deciding about this vaccine.

Other immunizations, such as those for measles, cholera, rabies, influenza, pneumococcus and hepatitis B, are safe and may be administered when circumstances warrant.

Food and Drink

Traveler's diarrhea is very common. It can be caused by viruses, bacteria or parasites. Some of these organisms may be difficult to treat and result in chronic illness. Just a tiny amount of tainted water or food can result in severe diarrhea. Strict safety measures are highly advised.

Avoid ice cubes, raw or undercooked meats, fish, seafood, vegetables, salads and unpeeled fruits, even on the flight home. Dairy products are acceptable only if cold and fresh. Some authorities recommended against all shellfish.

Water can be purified by boiling or with water purification tablets containing iodine. Bottled carbonated water also is safe. Unopened bottled still water is safe only if you are certain that the original seal is intact. Brush your teeth with bottled water and make sure water does not enter your mouth when taking showers.

If three or more loose stools occur during a 24-hour interval, or a single loose stool is associated with fever or severe cramps, then initiate treatment with an antidiarrheal agent (such as Immodium, Pepto-Bismol or Kaopectate) plus an antibiotic. If severe diarrhea continues for more than 72 hours, examination by a physician is in order.

Insects and Sex

Malaria is common throughout the tropical world. Since the medications that prevent malaria do not interact with medications commonly prescribed for HIV-related indications, they are acceptable for people with HIV. Malaria prevention, with either chloroquine or mefloquine, must begin two weeks before departure and continue until four weeks after return. Despite prophylaxis, certain forms of malaria can occur weeks to months after leaving a malaria-infested area. Fever is the prominent symptom, and a simple blood test determines the diagnosis.

Numerous other infections also are spread by mosquitoes, as well as by sandflies, ticks and fleas. Preventing insect bites is essential. Apply insecticides containing permethrin to your clothing and netting, and repellents containing DEET to your skin. Repellents last only up to four hours and need renewal after swimming. Long sleeve shirts, long pants and socks provide further barriers against bites. Make sure to sleep in screened areas or under netting. Since many insects are attracted by perfumes, colognes, after-shave lotions and scented soaps, it is wise to remain fragrance-free.

Finally, sexually transmitted diseases are much more common in developing nations than in the United States. Safer sex is imperative. You need not lead a chaste life, but bear in mind that even kissing can result in syphilis, gonorrhea, herpes or Epstein- Barr virus infection. A prompt visit to the doctor is essential if any sign of an STD appears, and that may not always be possible in developing countries.

Have fun this summer, but do not let this summer's fun interfere with the possibilities for the rest of the year!

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