HIV & Travelling Abroad &USA

So, you’ve been thinking about taking a holiday for sometime now. You’ve decided where to go. You’ve spoken to your doctor and he’s agreed that you are well enough to travel. You’ve got your passport, tickets and you’ve already packed. But, have you forgotten anything?

Health precautions
Your doctor will know if there is any need for special vaccinations you may need and which ones are safe for you to receive, taking into account your HIV status. Some countries insist that you have a Yellow Fever vaccination certificate if you have previously travelled to an infected area. They will not let you into the country without one. Your travel agent will know if this applies to your destination. Once you arrive at your destination there are a few sensible health precautions you can take to minimise the risk of becoming ill. Food and drink can sometimes be a source of infection abroad, most often in developing countries, and if you are in any doubt then follow these simple measures.

Only drink water that has been boiled, even bottled water, and avoid ice unless you are sure it has been made with boiled water. The same also applies to milk and ice cream. Food bought from street vendors should be avoided, as should raw seafood and other raw foods (except fruit and vegetables which you have peeled yourself) and salads. If you are going to be sunbathing, use high factor sunblocks and don't spend too long in the hot sun. Don't forget that some drugs can increase sensitivity to the sun, such as Septrin.

Medication
Make sure that you have enough of your regular medication to last you through your holiday, as well as any other drugs your doctor may have given you especially for the trip. It may be a good idea to take a few extra days of your anti-HIV medication to be on the safe side. Bags and cases can go missing when travelling so make your decision as to where to carry them, either in hand luggage or in your case. Unfortunately, many customs authorities around the world are wary of anyone carrying a substantial amount of medication. Always carry the drugs in their original packaging and it is probably safer to get a copy of your prescription and/or a letter from your doctor confirming that you have been prescribed the drugs, and they are essential for your well being. There are two other options you could consider:

* Sending your medication ahead. Check that it has arrived at your destination before you leave;
* Purchasing them in the country which you will be visiting. Check price and availability in advance as some of the drugs may be unavailable or very expensive;

Another factor to consider when travelling or going abroad with your anti-HIV medication is whether or not any of them need to be stored in the refrigerator. Will there be a fridge when you get there? This is not so much of a problem if you are staying with friends, but if you are staying in a hotel or other accommodation then you should check beforehand. If you have to travel with needles and syringes be aware that you may be stopped at customs and asked about them. It is also a good idea to take every-day preventative medications for things like headaches, insect bites and diarrhoea, that you are used to taking, as new medications can cause allergic reactions and you do not know how available your usual brand will be.

In some countries (e.g. USA) where HIV-positive tourists are generally unwelcome except in special circumstances, the posting of medication is not recommended. Please refer to ‘Travelling to the USA’ section below.

Travel insurance
If you’re thinking about travelling abroad without travel insurance then don't! If you are unlucky enough to have an accident abroad or need medical treatment while you are away, you will not have the luxury of free medical care which you get at home. Without medical insurance, how would you pay for any treatment you might need? There are special arrangements for treatment within the European Union, but you must have form E111, which you can get from your local post office. Even then, you may be asked to pay for some of your treatment.

If you have HIV you need to be aware that many insurance companies may not pay for the treatment of any HIV related illness or for the cancellation of a holiday due to an HIV related illness. There are some companies that do provide cover, however some may charge a higher premium and require you to answer some questions related to your condition. It must be noted though that insurance is sold on the basis of absolute trust between client and insurer. This means that you must declare all existing conditions of which you are aware, because your insurer will refuse to pay for your claim and cancel your policy if it becomes clear, in the process of making a claim, that you have not done so.

This is the case even if the condition that you did not declare is unrelated to your claim. We understand this might push the premium higher but it’s definitely worthwhile for peace of mind when travelling.

The following is a list of some companies that cover HIV. Shop around and get different quotes finding the one that is best for you.

Rothwell and Towler - 01404 41234
Easy Travel Insurance – 0845 222 2226
Freedom Travel Insurance – 0870 774 3760
Free Spirit – 023 9241 9080

Visas
If you are a British citizen and you are travelling within the European Community, you will not need a visa. If however, you are travelling further afield or do not hold a British Passport you should check with your travel agent about any visa requirements. Some countries even require that you produce the result of an HIV antibody test before they will issue a visa. Other countries retain the right to refuse entry to travellers who are HIV positive and among these is the United States of America. This power is only usually used however, when someone intends to settle in the country. It does not usually affect tourists. Although the USA no longer insists on a visa for holidays with a duration of less than 90 days, if you are British and are HIV+, you should apply for a ‘waiver of ineligibility’ under the Visa Waiver Program (VWP). If you have previously been refused a visa on health grounds, for further details see “Travelling to the USA” below. You are advised to contact the country’s tourist office or embassy to check on the latest visa requirements.

From 26 October 2004, all British passport holders, including children, travelling to the USA under the VWP will need their own machinereadable passports (MRP). From 26 October 2004, anyone without a MRP, including children who are currently on a parent's passport, will need a visa to travel to the USA. For further details on entry requirements for the USA telephone 020 7499 9000, option 1.

Sex
If you plan to have sex while you are on holiday then take your own supply of condoms, femidoms, lubricant and or spermicide. Not all countries provide as easy access to them as the UK and quality standards that apply here may not apply elsewhere. In other EC countries check that the condoms have the EC mark.

What if I become ill on holiday?
Assuming that you will have the appropriate travel insurance, the choice you will have to make will be whether or not you wish to be treated there or return home. The extent of your illness will obviously influence your decision as will the availability of the treatment that you need.

Travelling to the USA
Non-US citizens who are HIV-positive are ineligible for the Visa Waiver Program under current US law. However, the Immigration and Naturalization Service (INS) can waive the ineligibility under certain circumstances for non-immigrant (i.e., temporary) visa applicants. Since the passage of the new Immigration Act of 1990, this ineligibility has been under review. The US Embassy in London will continue to process applications as before with the required HIV Waiver of Ineligibility until it receives guidelines to the contrary. Generally such visas will be granted only for stays of thirty days or less, and only for visits where public benefit outweighs public risk. Public benefit is broadly defined and may include family visits, medical treatment and business travel.

However, for individuals who have stopped medical treatment and wish to travel to the US, it is considered immigration fraud for those who fail to declare their HIV status on the green I94-W form whilst knowing that they may be barred from entry. The I94-W form allows citizens of EU countries to enter the US for up to 90 days without any visa, as long as they are not terrorists, communists, convicts or ‘afflicted with a communicable disease’. If such an individual is identified at the border, the Bureau of Citizenship and Immigration Services (BCIS) has the authority to detain the individual indefinitely, without any right to release on bail. The individual has no right to counsel and may not be permitted to communicate with others who may be able to help the individual.

Medication
Discovery of non-declared drugs may result in questioning and a referral for a medical examination. Un-marked containers of drugs do not comply to US custom laws and should be accompanied by a written prescription pertaining to the medication. Posting of medication to the US is also not recommended, as post offices and courier firms now require in detail the contents of any package sent to the US, with full details of the sender as well as the addressee. For individuals deciding to stop HIV medication it is imperative that you consult with either HIV clinician or pharmacist before doing so, otherwise you run the risk of acquiring new or further resistance that could have significant future health risks.

Should you wish to apply for a visa, the embassy will consider your application for possible recommendation to the INS. Your application must include:

* A letter from your doctor addressing your current state of health, the risk to US public health and the risk of spread of infection. If you suffer from haemophilia, this should include a statement that you will be carrying, and can administer an adequate supply of Factor VIII;
* A letter from you outlining the purpose of the trip, your anticipated arrival date in the US, the date by which you need to confirm your travel arrangements, and your anticipated length of stay in the US. You also need to indicate that you will be covered by medical insurance during your stay in the US;
* Your current passport;
* One photograph. If you do not wish to have the visa stamped in the passport an extra photograph will be needed - please state this in your letter;
* A fully completed application form, copies of which are available directly from the embassy;

Your application package should be sent to the embassy:

For the attention The Visa and Immigration Department
5 Upper Street
London
W1A 2JB

You must be aware that approval of waiver recommendations can take several months to process, and will not be granted more than thirty days before the date of travel to the US. Therefore, you should apply for the visa and waiver well before (3 months) your anticipated date of travel. You should not purchase tickets or make non-changeable travel arrangements until you have been advised that the waiver has been approved. The US Embassy promises to give full and discreet consideration to any visa application.

For further information provided by the US embassy on visa applications, visit www.usembassy.org.uk or contact the 24 hr Visa Information Line: 09068 200 290 (calls to this line @ 60p/minute) or 09042 450 100 (£1.20/minute).