One of the first overseas trips I took after being diagnosed with an AIDS-defining illness was to the USA. The ban on people with HIV entering the country was in full force at the time so, needless to say, I was nervous as the plane touched down in New York.
Not looking particularly well and tired and drawn after a long flight, I was visibly anxious as we lined up at Customs. A friend had been deported back to Australia after US officials discovered she was HIV positive, and I didn’t want the same fate to befall me.
Can they hear my pills rattling in my carry-on luggage? This is what I was thinking as a large Customs official made a beeline towards me. He raised his armhivnextsteps.org.au as if to remove me from the line . . . and then curiously lifted it again to let it rest on an older woman standing behind me.
Even today, many countries discriminate against the positive traveller. Some threaten immediate deportation if HIV status is declared or discovered. I don’t believe that these laws should stop you travelling to these countries, but I do believe that you should take adequate precautions to limit the chance of your status being discovered.
The website www.plwha.org suggests the following tactics to try to get through Customs in a country which may otherwise be problematic:
- Carry your prescriptions and a doctor’s letter with you. The letter should include a list of the medications and the words: "These medications have been prescribed for a medical condition", without mentioning HIV.
- Keep your HIV medications in their original bottles and do not attempt to hide the containers. If you do, Customs officials may think they contain contraband.
- Don’t advertise the fact that you are HIV positive. Even a red ribbon might alert a Customs official to follow up on a suspicion.
- Be discrete and polite. Don’t draw any attention to yourself that could cause Customs officials to pull you aside.
- If you are taking injectable medications (such as Fuzeon, insulin or testosterone), you must have the medication with you in order to carry any empty syringes.
- If you encounter problems, it can be worthwhile asking for a private screening to protect your confidentiality or to ask to speak to a supervisor.
- Take the attitude that it’s not really an issue unless it is presented as one.
The good news today is that an increasing number of countries are removing barriers to HIV-positive travellers.
When the USA lifted its travel ban early in 2010, China followed suit later in the year. One of the reasons it did so was probably to counteract the negative publicity it received when it refused a visa to HIV-positive Australian writer Robert Dessaix in March of that year. Advocacy efforts by the Australian government, writers’ groups and HIV- advocacy organisations were thought to have helped change the Chinese government’s attitude.
TRAVELLING WITH TREATMENT
We know that taking a break from treatment or missing doses is not a good idea, so always pack more pills than you’ll need in case you are held up.
For short trips, carry double the number of tablets. Put half in your carry-on luggage and checkin the other half, in case either bag goes missing.
Some people avoid carrying their drugs through borders by posting them to their destination ahead of time. This strategy can be problematic, as Customs have been known to intercept such packages; plus, mail can get delayed or not arrive at all.
Other people try to obtain medications in their destination country. This too can be fraught and, unless you are sure of the procedures, can also turn out to be very expensive.
The best idea is to take enough treatment with you. And remember to pack your doctor’s prescriptions as well. This will not only verify that your medications are bona fide, it will also make it easier to obtain more should the need arise.
Six months is the maximum amount your doctor can prescribe at any one time. But for this amount to be dispensed, you may need your doctor’s help to negotiate with your dispensing pharmacy. If you are away longer and are unable to return to Australia to refill your scripts, you may wish to purchase cheaper generics through a reputable online website such as www.aidsdrugsonline.net
Talk to your doctor about vaccinations or prophylactic medications if you are travelling to areas where malaria, yellow fever or other bugs may be prevalent. People with HIV should not take live vaccines, such as those offered by some clinics for yellow fever.
Anti-diarrhoeals are also a good idea, particularly if you are visiting developing countries.
TIME ZONE CHANGES
Most people like to take their HIV drugs at the same time every day and this can prove difficult when crossing time zones. You may want to set an alarm as a reminder.
If you are on a particularly complicated regimen, ask your doctor if it can be simplified.
While adherence is important, it is also true that missing one dose because of a time zone is unlikely to cause any problems.
Another tricky area is travel insurance. Fortunately, a few companies have caught up with the fact that people with HIV, particularly those on treatment, are unlikely to present with HIV-related conditions while travelling.
However, it is still common for travel companies to refuse to provide cover for HIV-related conditions, although some will provide cover if you pay an extra premium — usually a reasonably substantial one. A few will even refuse to pay out for anything if you have not declared your HIV status upfront — on the grounds that you have misled the company about the risk (even if you are not claiming for an HIV-related condition).
Many of the travel companies I spoke to, in preparation for this article, were prepared to offer travel insurance at normal rates, even if you disclosed your HIV status to them — provided you did not intend to claim for HIV-related conditions. A consultant from Columbus Direct Insurance suggested that there would be no problem granting insurance cover if you disclosed your HIV status over the phone, but you would not be covered for anything related to it.
Another company I spoke to, Covermore (associated with Flight Centre), said that it did not need you to disclose pre-existing illnesses as long as you didn’t want to claim for them. The exception to this was if you were travelling to the Americas or Africa, where you must disclose any reduced immunity (present or past) or cover may be denied.
The company also said it could usually provide extra premium cover for people with HIV with a phone call to their medical consultants — and that if the HIV was well controlled, coverage would not be a problem.
Other companies require an assessment form to be filled out by your doctor regarding your current state of health and treatment before they will provide extra cover for HIV-related conditions.
There may still be a risk with some of the promises given above.
One policy, for example, states that the company does not automatically cover claims arising from, or exacerbated by, some existing medical conditions.
If I did not apply for HIV-specific cover and was to suffer a heart attack while overseas, could an insurance company regard my higher risk of that happening to be ‘exacerbated’ by my HIV medications or the virus itself? If I was to suffer a fall and break a leg, could the insurance company argue that the HIV-wasting in my legs was a contributing factor in my accident?
It’s difficult to say and would probably rely on a treating doctor’s report. However, many insurance companies have a history of avoiding payments if they can get out of them on a legal technicality.
Here is one salutary lesson about an insurance company which shows they are not always your best friend when things get tough.
Bruce was travelling through South America when he was struck down with a respiratory illness so severe that he needed to be hospitalised. He was diagnosed with PCP and the doctors asked if they could test him for HIV. To his surprise, the results came back positive.
Although the standard of medical care was excellent, Bruce knew he had to get back to Australia as quickly as possible to start HIV treatment.
"Don’t worry about the hospital bills," one of the doctors assured him. "You have travel insurance."
But it was not to be so simple.
The insurance company was quiet for the first few days after it was established that it was dealing with an HIV-related illness. It then took over a week to decide if it would cover the substantial cost of Bruce’s return to Australia. The company’s online product disclosure stated no cover for anything HIV/AIDS related — which didn’t bother Bruce when taking out the policy, as he was unaware of his status — but he was reassured by medical staff that he would be covered because it was not a pre-existing condition.
Bruce was devastated when the insurance company told him it would not cover his expenses. The only support it offered was contact with an Australian Embassy in another country 4,000 kilometres away.
"I was at the lowest ebb I had been physically in my life," he says.
Feeling alone and very sick, he spent his holiday savings on a long series of connecting flights back to Australia.
Back home, Bruce put the insurance company in contact with all his doctors over recent years. He wanted to prove that he didn’t know his HIV status before taking out the policy.
"I considered their behaviour to be negligent and failing in their duty of care to me as an insured client," he says.
Bruce considered taking legal action and even talking to the media, but eventually he was refunded his costs.
"It was a highly traumatic experience," he says.
The lesson from this story and from others I’ve heard is to read the fine print of insurance policies and ask questions if you are uncertain. Ring up their customer service lines and ask the hard questions. There is no need to disclose your personal details.
RECIPROCAL HEALTH AGREEMENTS
The Australian Government has Reciprocal Health Agreements with the following countries: New Zealand, the United Kingdom, the Republic of Ireland, Sweden, the Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway.
This means that Australian residents can receive help with the cost of essential medical treatment while visiting these countries and visitors from these countries will receive the same service if they visit Australia.
You need to show your passport and your Medicare card to medical staff in the country you are visiting and tell them you want to be treated under the Reciprocal Medical Agreement with Australia.
If you are travelling to the Netherlands, you need to apply for an eligibility form before you travel there.
Doctors in the United Kingdom do not have to accept a patient for treatment under their National Health Scheme (NHS) and can request a private consultation fee. However, coverage in the UK includes treatment in a hospital (as an inpatient or outpatient), ambulance and NHS prescription medicine if your doctor treats you as an NHS patient.
To check HIV travel and residence restrictions for particular countries plus treatment information and support services, we recommend the search engine at www.hivrestrictions.org
The travel tips available at www.smartraveller.gov.au are also useful.
Finally . . . please don’t let all these considerations put you off your overseas trip. With a little pre-planning and a dash of adventurous spirit, travel can do wonders for your health and wellbeing.