Summer's here, and for many of us that means planning a vacation.
Although I often travel in other seasons, summer always starts me yearning for a getaway. Still, along with dreams of lovely beaches, mountains, foreign countries, relaxation -- and maybe even a romantic fling -- there's always an element of tension in planning and preparing a vacation. Where do I really want to go? Can I afford it? Do I want to travel alone or with someone? With whom? These are the questions that plague me in the early planning stages.
Then, after I've chosen my destination and made my reservations, the practical considerations kick in: Do I need underwear, socks, a bathing suit, a haircut? When will I do the laundry and pick up the dry cleaning? And, of course, what should I pack (without having to use a steamer trunk)?
These are small matters, however, compared with those facing a vacationer living with HIV. Medications, food, water, possible exposure to disease, all become issues -- not to mention the relative acceptance of (or hostility to) HIV at your destination. Does this mean that you should stay home, or just visit Aunt Sally in the suburbs?
Not at all. As with so many other things, planning well in advance for possible travel-related problems can make them manageable if and when they occur.
Vacations are important for everyone. They provide a break from the daily routine, a change of scene, a time to reflect and refresh, to catch your breath.
Vacations are particularly important for persons living with HIV. Even if you are not working, a vacation can provide relief from medical and health preoccupations, time for relaxation and reflection. Depending on your destination, it may also give you an opportunity to look at alternative treatment approaches. Perhaps it simply lets you spend quality time with a partner or close friend.
Everyone has a different purpose for going on vacation, and that purpose, combined with your preferences and financial status, usually dictates where you'll go. Regardless of your destination, though, planning is essential.
After gathering and consolidating a large amount of information about travel considerations for persons with HIV, I've carved out six broad categories of things you need to think about when planning your vacation: Where You're Going; How You're Getting There; Medical Considerations; Nutrition Considerations; Personal Considerations; and Emergency Planning.
I'll address each individually. Before I do, though, let me state the most important, universally accepted piece of advice I've encountered: Consult your doctor as early in the trip-planning process as possible. The reasons will become clear.
Where You're Going
First and most important, are you traveling to a foreign land? Currently, no countries require HIV tests for short-term tourists. But this doesn't mean that they're necessarily friendly to people with HIV either.
Customs agents can get curious if they spot a traveler who's carrying a load of medications. If you're reluctant to reveal your serostatus, you may want to be prepared with a story about heart disease, lung disease, or cancer, just in case you're confronted. Your doctor can help you devise a credible tale that's in synch with your meds.
If you're going to a foreign country for an extended period, there may be HIV restrictions. The best source for which lands have long-term visitor restrictions is the U.S. Department of State. You can get the information you need about your destination country at the Department of State's website, http://www.state.gov, or by calling its offices in Washington, D.C. at (202) 647-4000.
As far as which countries are HIV-friendly (or, for that matter, gay-friendly), it's somewhat encouraging that there are no strongly forbidden destinations. According to Antonio, a travel agent at Council Travel in San Francisco, "We don't even consider telling people where to go or not to go. Right now there are no warnings about any countries. Besides, with the improvements in medications, many people with HIV are traveling more often and to more remote places. There don't seem to be any restrictions, at least as far as we know. This is San Francisco; if there was something to be known, we'd hear about it right away."
Then again, even if you're vacationing within the States, sensitivity to HIV varies by locale. If you're going to New York or San Francisco, there should be no problems; if you'll be visiting a rural area of the Midwest, things may be different. The only generalization to be made is: Do your homework. Find out from your travel agent, if you're using one, what experiences former clients with HIV have had at your proposed destination. (And, speaking of travel agents, unless you already have one you know and are comfortable with, it may be best to use one who is gay or gay-friendly, since she or he probably has had experience with HIV-positive travelers. For a referral, call the International Gay and Lesbian Travel Association, (800) 448-8550, or check the group's website at http://iglta.org.)
Some diseases are more prevalent in specific parts of the world, and if you're going to one of those areas you'll need to discuss vaccination and prophylaxis with your doctor. The following is not an all-inclusive list, but some primary examples are:
Cholera, an acute diarrhea illness, has occurred in epidemics recently in much of Latin America (with the exception of Uruguay).
Lyme disease, as you probably know, is transmitted by deer ticks and is prevalent in the coastal and wooded regions of the northeastern United States. Recently, there have been more and more cases documented in northern California, the Oregon coast, Wisconsin, and Minnesota.
Bubonic plague is still at high risk in Vietnam, a country that is becoming popular as a vacation destination.
Rabies, almost always transmitted by animal bites, runs high in Central and South America, the Indian subcontinent, southeast Asia, and most of Africa. If you're going on safari, or any vacation with close exposure to animals, be particularly aware of this.
Besides your doctor, the best source for travel health information is probably the Centers for Disease Control. The CDC has an international travelers' hotline that explains health risks and preventive measures. It will also provide some publications by mail upon request, such as its "Blue Sheets," which list current disease risks by country. You can call the CDC at (404) 332-4559, or check out its website, http://www.cdc.gov/travel/index.htm.
Aside from your destination, the other "Where You're Going" issue to plan for is the type of accommodations you'll have. Are you going to stay in a traditional hotel? A bed-and-breakfast? Or will yours be an outdoors vacation, such as camping? Or might you be a houseguest? Each requires a bit of thought.
If you'll be in a hotel, it's probably a good idea to get a room with a mini-refrigerator. You may have to store medications; also, special food items and water might need cold storage (I'll discuss food and water in detail further along). If you'll be staying at a B&B, call ahead and ask if you can keep things in their fridge.
If you're camping, the appropriate and protective clothing is most essential: Do you know the weather of your locale? Are there possibilities for major shifts in temperature? You don't want to expose yourself unnecessarily to the elements and run the risk of sickness.
Finally, if you'll be the guest of friends or relatives, consider whether they know your HIV status. Aside from your host's emotional issues regarding your health, there are again practical considerations, such as medication storage and special dietary needs. Also, if you're staying in someone's home, your ability to have your meals on schedule and plan your activities is important. It's probably best for your host to know the details of your health status, and any special needs you may have, before you arrive.
How You're Getting There
Trains and boats and planes -- all fun ways to get around the globe, but all also potential sources of illness.
Whenever you share an enclosed space with other people, you've got their germs to contend with, and this is even more important if you're living with HIV. If you're seated near a person who is coughing or sneezing excessively, you'll want to reseat yourself. The recommendation is to be at least six rows removed from someone who appears to be ill.
Changing seats can be embarrassing, and many of us don't like to make a fuss or draw attention to ourselves. But is it worth getting sick over? This is one of those situations where you need to assert yourself. Calmly ask the attendant or the conductor to help you find a new seat. If the vehicle is fully booked, ask to swap a seat with someone. It's the attendant's job to help you, so claim your rights if you must. If you're uncomfortable about disclosing your HIV status, you can say that you're undergoing chemotherapy, or prepping for an organ transplant, both of which conditions require shelter from germs. If you get no satisfaction on your first request, bump it up a notch: Take it to a supervisor or the cabin crew.
There's also the issue of food during your travel. Is airline food acceptable for HIV-positive people? (Is it acceptable for anyone?) This depends on the quality of preparation, and the temperature of the food when it arrives -- not easy things to determine in advance. If you're traveling by train, do you want to rely on the club car? Is there anything available besides prefabricated sandwiches of unknown pedigree? If you're taking a long automobile trip, do you want to stop frequently to eat? What's the quality of the food at roadstops? Perhaps the best answer in all of these cases is to bring your own. It's not difficult to tote fruits, sandwiches, prepackaged foods, and snacks that are nutritious, satisfying, and safe. Make it fun; think of it as a picnic.
A seemingly obvious consideration: if you're traveling by ship (or if you're going fishing by boat when you get there, or going on a whale-watching excursion) there's always the threat of sea sickness, or "motion" sickness, as it's becoming known. Dramamine is quite effective on a short hop; for a long trip, "the patch" (which contains a drug named scopolamine) is quite effective. But remember, these are drugs that can interact with other things you're taking or have their own undesirable side effects. Always check with your doctor before using any of these medications.
It's worth mentioning again: Consult your doctor before making your plans!
If at all possible, you should start the consultation process six months before your vacation is scheduled to start. This is not always practical, but common sense should prevail. If you're only traveling 200 miles, by car, to a neighboring state, the medical consultation probably need not be so far off. But, if the neighboring state is tick-infested, get moving early.
You need to talk with your doctor about vaccinations, food, special medications, extra copies of prescriptions, physical restrictions -- in other words, everything to ensure that you have a happy, healthy trip. Some things to consider in discussions with your doctor are the current status of your immune system; your overall medical history; conditions that you may be susceptible to, whether related to HIV or not; the amount and types of medications that you take; and specific diseases that may be endemic to your destination. Evaluate all of these, including your proposed accommodations and the length of your trip, and get your doctor's concurrence that it's feasible. Also, consider access to medical care at the site of your vacation.
If you're taking a lot of medications with you, especially if you're visiting a foreign country, certain preparations are wise. Most countries (including our own) are waging war on illegal drugs these days. If you show up with a bushel full of different colored pills, you may be suspect. For your own protection, you may want to ask your doctor to write a letter explaining your need for these medications.
It also helps to carry your medications in their original containers, so that they're identified. You may also want to take original prescriptions for all your meds with you. The originals will prove the authenticity of the drugs you're carrying, and, in case you run out of or lose your medications, you can replace them.
Food and water -- we can't live without them. Food is also a great source of pleasure, especially on vacation. One of the things I like best about travel is sampling the local cuisine, whether in the United States or abroad. But under the wrong conditions, this life-sustaining and pleasure-giving substance can cause sickness, minor or major. Luckily, there are many ways to ensure that your nutrition needs can be met in a healthy and enjoyable manner while you're away.
Robert Dostis is a nutritionist who was the first head of Nutrition Services at Gay Men's Health Crisis. He has also, for the past fourteen years, traveled extensively with his HIV-positive partner. His advice is quite specific: "Individuals who are HIV-positive should take special precautions when traveling abroad. A food-borne illness can ruin a vacation, not to mention being potentially lethal. Most Americans have had some experience with food poisoning. You know the symptoms: stomach pain, vomiting, diarrhea, headache, and general malaise. Often we get mild food-borne illnesses and attribute the symptoms to a cold or the flu, never suspecting that it was the chicken we ate last night, or the tuna salad from the salad bar. Symptoms can begin within hours, days, or even a month of consuming contaminated food.
"The cause of a food-borne illness can be live bacteria thriving in the food at time of consumption, or toxins left over by bacteria that are killed when the food is cooked. Cooking food to proper temperatures kills the bacteria but not necessarily the toxins.
"If you let common sense be your guide, you can probably avoid getting sick while traveling to other countries. There are some very obvious situations to avoid. Do not eat off the street. I'm talking street vendors, not the piece of burger left by the park bench in front of the Eiffel Tower (although you should probably avoid that as well). Street vendors selling food containing meat or any kind of food that requires either refrigeration or cooking, like kabobs, hot dogs, gyros, shrimp, or lobsters, should be avoided. There is just no way to know if the food was properly handled: Was it refrigerated? Has it been cooked to a temperature that kills bacteria? Was it kept hot enough to avoid recontamination while waiting to be served? When you eat food from a street vendor you put your health and life in his or her (possibly not-so-clean) hands. You trust that the vendor is properly concerned with avoiding getting someone sick, which is not necessarily so. And you believe that vendor has undergone extensive training on how to avoid spreading food-borne illnesses ... NOT!!!"
Dostis warns that even the most clean-looking establishments can have problems. "What about restaurants? You must take precautions here as well. As important as it may be for a restaurant owner to avoid getting customers sick, there are a few things that you must consider before trusting the establishment. I'll take a leap here and say that I doubt that there is a restaurant anywhere in the world that has not caused someone's illness at one time or another. When I traveled to Mexico, one day I ate a sandwich at poolside. I won't go into the gory details, but I was sick for weeks. I figure if the 'American-style' hotel at which I was staying couldn't get it right, who could? Which is exactly my point.
"Does this mean you can't eat on vacation? Absolutely not. Just be careful and follow these tips. Avoid restaurants that are not busy. A busy restaurant is more likely to have fresh foods. Order meats and poultry well cooked. Some diehards who must have their meat red hate to hear this, but is it worth destroying your vacation? If you must have your steak medium or rare, order something other than steak.
"Food that is supposed to be hot must be served hot! If it is lukewarm, don't be shy -- send it back. And keep sending it back until it is steaming. Forget the notion that you taste food better when it is at room temperature. You want it served hot; it can cool down while in front of you. Foods that are supposed to be cold must be cold to the touch. Salads containing meat, fish, poultry, and any kind of dressing -- which is about every salad I know -- that have been sitting in an improperly cooled refrigerator are a disaster waiting to happen. Remember the old adage: When in doubt throw it out. This could save your vacation and possibly help you avoid some very nasty symptoms.
"Other tips: If you're uncertain about the water, order bottled; most hotels have it in stock. Avoid foods commonly know to be vectors of food-borne illness, like all shellfish and soft-ripened cheeses such as brie; they may harbor some potentially nasty bacteria."
Dostis's advice reminded me of a strange experience I had when I traveled to Santo Domingo over twenty years ago. I'd been warned beforehand not to drink local water; indeed, I caught myself buying cheese at a local market that had been soaking in water, and changed my mind. The week passed, the trip was great fun, and I felt fine. Waiting to board the plane in the hot airport, however, I took a huge drink from the public water fountain. Before we were in the air for an hour, my stomach distress began. The diarrhea ended three weeks later. The moral of this story: Don't take anything for granted; think before you put anything in your mouth. It had never occurred to me that a public fountain in an airport would contain unpurified water, but I was wrong.
If you're taking an outdoors vacation, and you're cooking food over a fire, make sure everything is well done. Of course, you'll have a cooler if you're camping. Some nice things to keep are sandwich fixings. Bread and rolls are usually safe for a day or two without ice. Small cans of tuna are the perfect size for a sandwich. Fruits and vegetables, raw or properly cooked, travel well and make for healthy eating on the road. If you suffer from diarrhea, however, and fresh fruits are an irritant, or you just don't want to take up all that space in the cooler, canned fruits are a fine alternative. They travel even better than fresh in that they don't need ice and won't rot. Packs of chips and trail mix make good snacks on a trip.
Of course, carry or buy bottled water during your vacation. It's just an extra insurance that you won't get ill. But what you drink is not the only water consideration: Infections may also come from recreational activities in the water during which you inadvertently swallow some.
Most important, don't swim, bathe, or even wade in water that may be contaminated. Even when you're in water that's seemingly safe, be aware of keeping your lips sealed, especially if you put your head under.
If you're traveling with a same-sex domestic partner, there are some specific issues that need to be addressed, particularly on a trip to a foreign land. In case of a medical emergency, the lack of recognized legal rights in a gay partnership comes strongly into play. There are no guaranteed solutions, but carrying some form of documentation of your relationship will probably help. The Seattle-based Partners Task Force for Gay and Lesbian Couples recommends carrying copies of powers of attorney, particularly powers of attorney for medical care. These documents give your partner legal decision-making rights, at least in the United States, in case you become incapacitated. The copies you carry must be signed and notarized to be recognized.
The Partners Task Force has a website, http://www.buddybuddy.com, that contains detailed information. This site also contains a wallet card, which you can print and carry with you, identifying your partner as the person to contact in case of an emergency if you're traveling alone, or with someone other than your partner. Domestic partner registrations have little clout, although it can't hurt to carry a copy of yours if you have one.
So, what if you're away and you become ill?
There are several ways to address this possibility. One is preventive: You can buy travel medical insurance, on a per-trip basis, if you feel the risk of sickness warrants such a purchase. These policies can be expensive, but may be worth it to you since they traditionally cover up to a specified dollar amount in medical expenses that are not covered by your normal insurance. The expenses covered must usually be incurred within 180 days of the trip in which the illness or injury initiated.
Needless to say, benefits vary from policy to policy; however, the majority cover hospitalization or emergency room treatment. Some cover air ambulance transport costs. Some will even pay for another person's travel costs to join you in case a long hospitalization is involved. Careful reading of such policies is very important. If you do purchase a policy and need to make use of it, it's best to contact the insurance carrier to make the special arrangements necessary (e.g., the air transport) rather than arranging it yourself and looking for reimbursement afterwards. Of course, this isn't always possible in an emergency, but if you're able, it's the best way to handle it.
Another issue is "pre-existing conditions." In some cases, HIV-related illness may be considered pre-existing if, for some specified time prior to the purchase of the policy, the condition is not deemed "stable." Of course, the definition of "stable" varies. Be wary. The good news is that many travel insurers have recently dropped most of their pre-existing condition clauses.
Best advice: If you choose the option of travel health insurance, have a qualified professional review the policy before you put your money into it. A few of the major companies offering travel insurance are Mutual of Omaha [(800) 228-9792], International Trip Assist [(800) 866-3042], Carefree [(800) 323-3149], and Travel Guard [(800) 826-1300].
Another way to deal with health emergencies during a vacation is to use the plastic. Many credit cards offer assistance and medical referral programs automatically and free of charge, with no need to register for these benefits. Usually, though, these services are offered only to high-end cardholders. Some examples:
MasterCard [(800) 622-7747 in the States, or call collect international number (303) 278-8000] extends its Master Assist Travel Medical Program to its gold and platinum members. Typical benefits include emergency medical referral service, legal referral service, emergency transportation help, and prescription assistance. The cardholder is responsible for the costs, but when you're in a foreign location and can't speak the language, referrals are worth their weight in gold (or platinum).
Diners Club [(800) 234-6377 in the States, international call-collect number (303) 799-1504] offers a program called Club Assistance, similar to the Mastercard program. It also includes emergency cash advances.
American Express [(800) 554-2639, collect number for international travelers (301) 214-8228] has the Global Assist Program for regular, gold, and platinum customers. Physician referrals and assistance in prescription refills are included in their services.
There are some other commonsense vacation dos and don'ts that, although particularly important to persons living with HIV, apply to all travelers:
Being sensible about sun exposure is one of them. A bad sunburn can ruin a vacation (not to mention that it's just not good for the skin -- after all, there is always vanity!).
Wash your hands frequently when in a foreign country. You can't be sure what the culture around "cleanliness" is, so whatever you touch may be a carrier of disease. It's a good idea to bring an anti-bacterial hand gel for this purpose.
Take extra precautions against mosquito bites. Insect repellent is a basic that should be packed.
Use rolling luggage for convenience, and to save your strength for sightseeing or other vacation activities that are more fun than lugging suitcases around. A few weeks before your trip, check the wheels on your luggage to make sure they work properly; if not, they're easily replaceable.
While you're away, get plenty of rest. Yes, some vacations are meant to be a whirlwind of fun, but build in the time for a good night's sleep, and a nap, if possible.
While you'll want to sample different foods and drinks, don't overindulge. Even if a food passes the minimum requirements (well done, served hot), you don't know for certain how your system will react to it. A tummy ache is always unpleasant, even if it doesn't lead to anything more serious. Of course, if you drink alcohol, always do it in moderation.
Some good things to pack for your trip:
Sunscreen, and plenty of it, if you'll be at the beach. Even if you'll just be walking around during the prime sunlight hours in a nonbeach environment, use sunscreen.
Lip balm is also good to bring.
Pack condoms and lubricants if visions of sex figure in your plans.
Women should bring extra tampons; you don't know what their availability will be where you're going.
A pair of comfortable shoes is always important on vacation; save the stylish foot-killers for those fancy occasions at home.
Don't forget to bring all your prescription medications!
A basic medical kit is also a good idea. What should go into it? That depends on your general health and your personal need for security. Again, consultation with a physician makes sense, but some staples, aside from those already mentioned (antiseptic hand gel, sunscreen), include bandages, antibiotic ointment, painkiller containing ibuprofin (Advil, Motrin) or acetominophen (Tylenol), and remedies for indigestion, constipation, diarrhea, sunburn, cough, sore throat, and nasal congestion.
There are many things to consider if you're living with HIV and going away on vacation. But don't dwell too much on the hassle of making the necessary preparations. Focus instead on the joy of the trip, the excitement of seeing and doing new things and meeting new people, the restorative balm of getting away from life's daily cares. The point of this article has been to clear the way for you to have a fabulous vacation by helping you make sure that nothing preventable gets in the way. Go. Have a fine time.
One last thing: Bring the spirit of vacation home with you, and take steps to make it last. Photos help to keep the memories alive, and I also enjoy keeping a journal while I'm away. It's a good way to relax and spend some meditative time each day of my vacation, and I get an unparalleled joy in reading my entries months, years, even decades later. Try it, if you've never done so before. You don't have to be Hemingway; you're only writing this for yourself, so let go and document all your impressions and feelings. It's therapeutic while you're doing it, and it will extend your vacation for a long time into the future.
Have a safe, fun journey, fellow wanderers.
Ronald Russo is a Training Director for a large corporation and a freelance writer.
Back to the June 1999 Issue of Body Positive Magazine.