HIV / AIDS

January 2001

Know before you go!

Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.

The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.

Risk assessment consultation
The Public Health Agency of Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician 6 to 8 weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease.

Some facts from the experts
The information below has been developed and is updated in consultation with Public Health Agency of Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT). The recommendations are intended as general advice about HIV/AIDS prevention for Canadians travelling internationally.

Disease profile

Human immunodeficiency virus (HIV) attacks the body's immune system and weakens it, resulting in chronic, progressive illness. The advanced stage of the illness is called the acquired immunodeficiency syndrome, or AIDS. HIV makes infected individuals vulnerable to other infections and cancers that would not ordinarily be a threat. It is these "opportunistic diseases" that become fatal.

Transmission

HIV is spread through the exchange of infected body fluids: blood, semen, vaginal fluids and breast milk. If HIV-infected blood is present in saliva, there may be a risk of transmission. It can also be transmitted through contaminated blood or contaminated blood products, such as through a blood transfusion or organ donation.

HIV is not transmitted through everyday social contact, air, food or water. For instance, shaking hands, touching and swimming are safe. Furthermore, no risk of infection comes from sharing transportation (e.g., aeroplane, cruise ship, bus, train, etc.) with people living with HIV/AIDS.

Geographic distribution

HIV/AIDS occurs worldwide. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that by the close of 1999, 34.3 million adults and children were living with HIV/AIDS around the globe.

The disease appears on every inhabited continent. Some sobering figures supplied by UNAIDS demonstrate, in part, the global reach of this disease. By the close of 1999:

• 900,000 adults and children were living with HIV/AIDS in North America,
• 1.3 million in Latin America, and
• 5.6 million in South and South-East Asia.

Sub-Saharan Africa has the severest epidemics with 24.5 million people living with HIV/AIDS cases; the rate of HIV infection among 15- to 49-year-olds has reached or exceeded 10% in 16 countries.

In Canada, it is estimated that nearly 20,000 AIDS cases occurred between the first reporting of AIDS in 1982 and the end of 1999, and that by the end of 1999 between 45,000 and 53,000 Canadians were living with HIV.

For Table 1: Rates of infection worldwide including UNAIDS estimates of the rate of HIV infection in adults (ages 15 to 49) by individual country, click here.

Symptoms

Infection with HIV often first appears as a flu-like illness that eventually passes. Although the infection progresses relentlessly, an infected person may not have symptoms for 10 years or more. However, throughout this symptom-free period, an infected person can transmit the virus to sexual partners or needle sharers.

Following the initial flu-like period, many people living with HIV may periodically experience fever, weight loss, loss of appetite, extreme fatigue. The onset of opportunistic infections and cancers characterizes the advance to AIDS, the last stage of HIV infection. During this period, many people develop unusual types of pneumonia such as pneumocystis carinii, skin cancers such as Kaposi's sarcoma or other types of cancer, which lead to death.

Testing

The HIV-antibody blood test will tell if you are infected or not. However, receiving a negative result means only that no antibodies to HIV were found in your blood at the time of testing. Most positive HIV results will show up within three months of a person being infected, but HIV antibodies can take as long as six months to appear. Therefore, a second test may be required to confirm a negative result.

Treatment

Several drugs have been developed that can slow the progression of HIV disease, but there is no cure for HIV/AIDS at this time. These drugs have many side effects, are difficult to take and are costly.

Prevention and personal precautions

There is no vaccine for HIV, but your risk can be reduced by taking personal protective measures.

To prevent HIV infection during travel, Public Health Agency of Canada recommends the following:

• Don't have sex (vaginal, oral or anal) with strangers or commercial sex workers, and avoid casual sexual contacts.
• If you are going to have sex with a new partner, use latex (or if allergic, use polyurethane) condoms consistently and correctly for every sexual contact. Before departure, pack your own supply of high-quality latex condoms.
• Don't share needles or syringes.
• Don't share razors, toothbrushes or shavers.
• Don't receive tattooing, body-piercing, acupuncture or other skin-piercing treatments and cosmetic procedures.
• Don't receive injections or transfusions unless it is an emergency. If you must receive blood while travelling, try to ensure the donated blood has been tested for HIV. If you cannot ensure the blood has been screened, and you do not require emergency care, return home for treatment.
• Pack a supply of syringes, needles and blood products to cover the length of your trip if you require any of those for regular treatment. Also carry a medical certificate explaining the supply.
• Consider packing a suture kit containing sterile needles, syringes and suture material.

Sexual violence while travelling

The occurrence of sexual violence varies around the world. Sexual assault and rape can be traumatic and bewildering for the victim, particularly when travelling overseas. If you are raped or assaulted, seek medical attention immediately so that HIV and STD counselling can be provided. Travellers should be aware that some medical services overseas may not be up to Canadian standards. The Consular Services of the nearest Canadian Diplomatic or Consular Mission can assist you with medical and emergency services.

Precautions for people living with HIV/AIDS

For persons living with HIV or AIDS, travel can increase the degree and range of disease risks if you are living with HIV/AIDS. Opportunistic pathogens, and food- and water-borne diseases encountered while away from home pose greater threats for an immuno-compromised individual. Access to adequate medical care and medications may not be available in some parts of the world.

The severity of your immune system suppression is one factor in determining what preventive and advance treatment (i.e., prophylaxis) measures to take before travel. A common method for the prevention of some diseases -- through the use of live-organism vaccines -- is not advisable if you are severely immuno-compromised. If killed vaccines are deemed safe for you to receive, they may not perform as well as under normal immune system conditions, thus reducing your level of protection.

Some countries screen incoming travellers by requiring a blood test; most often from those who stay for a longer period for work or study. These countries will deny entry to those found to be living with HIV as evidenced by the blood test.

If you are living with HIV/AIDS, Public Health Agency of Canada strongly recommends that you consult with a travel medicine professional and your personal physician well in advance of departure.

Estimated percentage of adults (ages 15 to 49) living with HIV/AIDS by country and region at the end of 1999. Source: UNAIDS, June 2000.

Region/Country Adult rate (%) SUB-SAHARAN AFRICA 8.57 Botswana 35.80 Swaziland 25.25 Zimbabwe 25.06 Lesotho 23.57 Zambia 19.95 South Africa 19.94 Namibia 19.54 Malawi 15.96 Kenya 13.95 Central African Republic 13.84 Mozambique 13.22 Djibouti 11.75 Burundi 11.32 Rwanda 11.21 Cote d'Ivoire 10.76 Ethiopia 10.63 Uganda 8.30 United Rep. of Tanzania 8.09 Cameroon 7.73 Burkina Faso 6.44 Congo 6.43 Togo 5.98 Dem. Republic of Congo 5.07 Nigeria 5.06 Gabon 4.16 Ghana 3.60 Sierra Leone 2.99 Eritrea 2.87* Liberia 2.80 Angola 2.78 Chad 2.69 Guinea-Bissau 2.50 Benin 2.45 Mali 2.03 Gambia 1.95 Senegal 1.77 Guinea 1.54 Niger 1.35 Mauritania 0.52 Equatorial Guinea 0.51 Madagascar 0.15 Comoros 0.12* Mauritius 0.08* Reunion .. Somalia ..   EAST ASIA & PACIFIC 0.06 Papua New Guinea 0.22 China 0.07 Fiji 0.07 Hong Kong 0.06 Japan 0.02 Republic of Korea 0.01 Dem. Peo. Rep. of Korea <0.01* Mongolia 0.00   AUSTRALIA & NEW ZEALAND 0.13 Australia 0.15 New Zealand 0.06   SOUTH & SOUTH-EAST ASIA 0.54 Cambodia 4.04 Thailand 2.15 Myanmar 1.99 India 0.70 Malaysia 0.42 Nepal 0.29 Viet Nam 0.24 Brunei Darussalam 0.2* Singapore 0.19 Pakistan 0.10 Sri Lanka 0.07 Philippines 0.07 Lao People's Dem. Rep 0.05 Indonesia 0.05 Maldives 0.05* Bangladesh 0.02 Afghanistan <0.01* Iran (Islamic Republic of) <0.01* Bhutan <0.01   EASTERN EUROPE & CENTRAL ASIA 0.21 Ukraine 0.96 Belarus 0.28 Republic of Moldova 0.20 Russian Federation 0.18 Latvia 0.11 Poland 0.07 Hungary 0.05 Czech Republic 0.04 Kazakstan 0.04 Estonia 0.04 Bosnia and Herzegovina 0.04* Romania 0.02 Lithuania 0.02 Croatia 0.02* Armenia 0.01 Bulgaria 0.01* Turkmenistan 0.01 Azerbaijan <0.01 Georgia <0.01 Kyrgyzstan <0.01 Slovakia <0.01 Tajikistan <0.01 Uzbekistan <0.01

Region/Country Adult rate (%) WESTERN EUROPE 0.23 Portugal 0.74 Spain 0.58 Switzerland 0.46 France 0.44 Italy 0.35 Austria 0.23 Netherlands 0.19 Denmark 0.17 Luxembourg 0.16 Greece 0.16 Belgium 0.15 Iceland 0.14 Malta 0.12 United Kingdom 0.11 Ireland 0.10 Germany 0.10 Yugoslavia 0.10* Sweden 0.08 Norway 0.07 Finland 0.05 Slovenia 0.02 Albania <0.01 TFYR Macedonia 0.00   NORTH AFRICA & MIDDLE EAST 0.12 Sudan 0.99* United Arab Emirates 0.18* Bahrain 0.15* Kuwait 0.12* Oman 0.11* Cyprus 0.10 Qatar 0.09* Lebanon 0.09* Israel 0.08 Algeria 0.07* Libyan Arab Jamahiriya 0.05* Tunisia 0.04* Morocco 0.03* Egypt 0.02* Jordan 0.02* Yemen 0.01* Saudi Arabia 0.01* Syrian Arab Republic 0.01* Turkey 0.01 Iraq <0.01*   NORTH AMERICA 0.58 United States of America 0.61 Canada 0.30   CARRIBEAN 2.11 Haiti 5.17 Bahamas 4.13 Dominican Republic 2.80 Barbados 1.17 Trinidad and Tobago 1.05 Jamaica 0.71 Cuba 0.03   LATIN AMERICA 0.49 Guyana 3.01 Belize 2.01 Honduras 1.92 Panama 1.54 Guatemala 1.38 Suriname 1.26 Argentina 0.69 El Salvador 0.60 Brazil 0.57 Costa Rica 0.54 Venezuela 0.49 Peru 0.35 Uruguay 0.33 Colombia 0.31 Mexico 0.29 Ecuador 0.29 Nicaragua 0.20 Chile 0.19 Paraguay 0.11 Bolivia 0.10   GLOBAL TOTAL 1.07 * For country estimates marked with an asterisk, not enough data were available to produce an estimate of HIV prevalence for the end of 1999. For each of these countries, the 1994 prevalence rate published by WHO's Global Programme on AIDS was applied to the country's 1999 adult population to produce the estimates given in the table.

Some things to think about...

1. People tend to shed their normal social and sexual inhibitions when they travel.
   
2. They often feel anonymous, isolated and adventurous.
   
3. HIV/AIDS is sexually transmitted and occurs worldwide.

Discuss your planned activities and itinerary, along with your risk of HIV/AIDS (and other sexually transmitted diseases), with a travel medicine physician before departure.

For more information...

• Latest global statistics, demographics and related information on HIV/AIDS worldwide, visit UNAIDS, the Report on the Global HIV/AIDS Epidemic .
• Canadian treatment and care information for people living with HIV/AIDS and their caregivers, visit the Community AIDS Treatment Information Exchange (CATIE).
• Latest Canadian information and stats on HIV/AIDS, visit Public Health Agency of Canada Bureau of HIV/AIDS, STD and TB.
• General information about immunizations recommended for travel outside of Canada, click here.
• More Know before you go! information, click here.