Acquired Immunodeficiency Syndrome (AIDS)
Description
AIDS is a serious disease, first recognized as a
distinct syndrome in 1981. This syndrome represents the late clinical
stage of infection with human immunodeficiency virus (HIV), resulting
in progressive damage to the immune system and in life-threatening
infectious and noninfectious complications.
Occurrence
AIDS and HIV infection occur worldwide. Comprehensive
surveillance systems are lacking in many countries, so the true number
of cases is likely to be far greater than the numbers officially
reported, particularly from resource-poor nations. The Joint United
Nations Programme on HIV/AIDS estimates that, as of the end of 2001,
40 million persons are living with HIV/AIDS worldwide. Because HIV
infection and AIDS are globally distributed, the risk for international
travelers is determined less by their geographic destination than
by their sexual and drug-using behaviors.
Risk for Travelers
The risk of HIV infection for international travelers
is generally low. Factors to consider when assessing risk include
the extent of direct contact with blood or secretions and of sexual
contact with potentially infected persons. In addition, the blood
supply in low-income 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 General
Information Regarding HIV and Travel.
Travelers should be advised that HIV infection is
preventable. HIV is transmitted through sexual intercourse and needle-
or syringe-sharing; by medical use of blood, blood components, or
organ or tissue transplantation; 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 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 travelers.
Travelers 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 skin-piercing procedures,
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.
Travelers should be advised to avoid sexual encounters
with persons who are infected with HIV or whose HIV infection status
is unknown. This includes avoiding sexual activity with intravenous
drug users and persons with multiple sexual partners, such as male
or female commercial sex workers. In many countries with high rates
of HIV, infection is common in the general population of persons
who have no known risk factors for HIV infection. Condoms, when used
consistently and correctly, prevent transmission of HIV. Travelers
who engage in vaginal, anal, or oral-genital sexual contact with
anyone who is infected with HIV or whose HIV status is unknown should
use a latex condom. Those 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, and travelers in
these areas who engage in sexual contact with persons who are infected
with HIV 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. Spermicides, including nonoxynol-9 (N-9),
and barrier methods other than condoms have not been shown to be
effective in the prevention of HIV transmission.
In many countries, needle-sharing by intravenous
drug users is a major source of transmission of HIV and other infections,
such as hepatitis B and hepatitis C. Travelers should be advised
not to use drugs intravenously or share needles for any purpose.
Travelers should also be advised to avoid, if at all possible, receiving
medications from multidose vials, which may have been contaminated
by used needles.
In the United States, Australia, New Zealand, Canada,
Japan, and western European countries, 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
and HIV-1 p24 antigen.
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 are
known to inactivate HIV; therefore, these products should be used
as indicated. Less developed nations might not have a formal program
for testing blood or biological products for antibody to HIV. In
those countries, travelers should (when medically prudent) avoid
use of unscreened blood-clotting factor concentrates or those 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
Blood Transfusion Guidelines for International Travelers, for
additional information.)
Needles used to draw blood or administer injections
should be sterile, preferably single use and disposable, and prepackaged
in a sealed container. Travelers with insulin-dependent diabetes
or hemophilia or who require 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.
International travelers should be advised that some
countries serologically screen incoming travelers (primarily those
planning extended visits, such as for work or study) and deny entry
to persons with AIDS and those whose test results indicate infection
with HIV. Persons intending to visit a country for a substantial
period or to work or study abroad should be informed of the policies
and requirements of the particular country. 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 the following Internet address: http://travel.state.gov/HIVtestingreqs.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).
— Renee
Ridzon
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