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 (HIVGG), 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.

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.

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.