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Acquired Immunodeficiency Syndrome (AIDS)
Background Information
AIDS is a severe, often lifethreatening, illness caused by the human immunodeficiency virus (HIV). The incubation period for AIDS is very long and variable, ranging from a few months to many years. Some individuals infected with HIV have remained asymptomatic for more than a decade. Currently, there is no vaccine to protect against infection with HIV. Although there is no cure for AIDS, treatments for HIV infection and prophylaxis for many opportunistic diseases that characterize AIDS are available.
HIV infection and AIDS have been reported worldwide.
Comprehensive surveillance systems are lacking in many countries, so that the true number of cases is likely to be far greater than the numbers officially reported from some areas, particularly the non-industrialized nations. The number of persons infected with HIV is estimated by WHO to be approaching the range of 18 million worldwide. Because HIV infection and AIDS are globally distributed, the risk to international travelers is determined less by their geographic destination than by their sexual and drug using behaviors.
Transmission and Prevention Information
The global epidemic of HIV infection and AIDS has raised several issues regarding HIV infection and international travel. The first is the need of information for international travelers regarding HIV transmission and how HIV infection can be prevented.
HIV infection is preventable.
HIV is transmitted through sexual intercourse, needle or syringe sharing, by medical use of blood or blood components, and perinatally from an infected woman to her baby. HIV is not transmitted through casual contact; air, food, or water routes; contact with inanimate objects; or through mosquitoes or other arthropod vectors. The use of any public conveyance (e.g., airplane, automobile, boat, bus, train) by persons with AIDS or HIV infection does not pose a risk of infection for the crew or other passengers.
Travelers should avoid sexual encounters with a person who is 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 prostitutes. Condoms, when used consistently and correctly, prevent transmission of HIV. Persons who engage in vaginal, anal, or oral-genital intercourse with anyone who is infected with HIV or whose infection status is unknown should use a condom.
In many countries, needle sharing by IV drug users is a major source of HIV transmission and other infections such as hepatitis B and C. Do not use drugs intravenously or share needles for any purpose.
Safety of Blood, Blood Products, and Needles
In the United States, Australia, New Zealand, Canada, Japan, and western European countries, the risk of infection of transfusionassociated HIV infection has been virtually eliminated through required testing of all donated blood for antibodies to HIV. In the United States, donations of blood and plasma must be screened for antibodies to HIV-1 and HIV-2 and HIV-1 p24 antigen.
If produced in the United States according to procedures approved by the Food and Drug Administration, immune globulin preparations (such as those used for the prevention of hepatitis A and B) and hepatitis B virus vaccine undergo processes that are known to inactivate HIV and therefore these products should be used as indicated.
In less-developed nations, there may not be a formal program for testing blood or biological products for antibody to HIV. In these countries, use of unscreened blood clotting factor concentrates or those of uncertain purity should be avoided (when medically prudent). If transfusion is necessary, the blood should be tested, if at all possible, for HIV antibodies by appropriately-trained laboratory technicians using a reliable test. For WHO blood transfusion guidelines for international travelers.
Needles used to draw blood or administer injections should be sterile, preferably of the single-use disposable type, and prepackaged in a sealed container. Insulin-dependent diabetics, hemophiliacs, and other persons who require routine or frequent injections should carry a supply of syringes, needles, and disinfectant swabs (e.g., alcohol wipes) sufficient to last their entire stay abroad.
HIV Testing by Countries
International travelers should be aware that some countries serologically screen incoming travelers (primarily those with 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 who are intending to visit a country for a substantial period or to work or study abroad should be informedof the policies and requirements of the particular country. This information is usually available from consular officials of individual nations.