What Travelers Need to Know About AIDS

While AIDS probably is not uppermost in travelers’ minds as they ready for vacation, a reminder of the connection between AIDS and sexual activity, blood transfusions and unsterilized needles is not out of place.

As of April of this year, at least 8 to 10 million people were infected with the AIDS virus in at least 162 countries, according to the World Health Organization. And WHO currently projects 10 to 20 million new infections during the 1990s, mostly in the developing world and most of them among heterosexuals.

As frightening as they are, these figures need not cause alarm to international travelers who have only everyday contact with the people of the countries they visit. And there is no evidence that insect bites, handshakes, food, water, toilets and swimming pools increase a traveler’s risk of infection from the AIDS virus. As with the United States, the presence of people infected with the AIDS virus is no reason to avoid the pleasures of ordinary social behavior.

But sexual contact is a different matter. During the early 1980s, when AIDS cases seemed to be confined to a few cities here and in Europe and several African countries, a false notion arose that some regions of the world were AIDS-free. In the early years of the pandemic, when only a handful of cases were being reported in Asia and parts of Latin America, some people even speculated that Asians possessed a special immunity protecting them from the disease.

This idea was based, in part, on the fact that by the end of 1989, only about 500 AIDS cases had been reported in all of Asia and those cases were clustered in only a few places. The notion by some that AIDS had somehow missed this part of the world helped business at massage parlors and bars in Southeast Asian countries such as Thailand, a nation with a reputation for offering easy access to sex.

According to an article in American Medical News, a publication of the American Medical Assn., group tour operators in some countries even offered vacations that were focused on sex. It is well known that large numbers of men from Western Europe, Australia, Asia and the United States engage in sex with prostitutes while visiting Thailand.

Today the AIDS virus is spreading at an alarming rate throughout South and Southeast Asia. That region may now have at least 1 to 1.5 million infected, the vast majority of them in Thailand and India, according to WHO estimates.

Researchers speculate that the potential for spread in Southeast Asia is greater than it was in Central Africa during the early 1980s. The reason is that the adult population is double that of Central Africa, which now has more than 7 million HIV-infected people, including children, and 1.3 million AIDS cases. (The U.S. total of AIDS cases is about 175,000.)

The official Thai policy (which in the past has been seen as deficient in providing public education on AIDS prevention) has been much-criticized by international health agencies. Fear of jeopardizing its lucrative tourist industry is seen as the government’s reason for soft-pedaling the AIDS problem, according to Dr. Prawase Wasi, head of Thailand’s National Epidemeology Board. In March, however, government officials described prostitution and AIDS as Thailand’s biggest social problem, and declared war on the country’s “sex tourists.”

Marked increases in infection are occurring also in Latin America and the Caribbean, especially among women. In Central America, there has been a 40-fold increase in the rate of reported clinical AIDS cases in women in the last four years. One study in Costa Rica suggests that the typical woman with AIDS became infected as a result of her partner’s high-risk behavior--behavior of which she was probably unaware.

Unlike the United States and Western Europe, where most AIDS cases result from homosexual practices, about 70% of all global AIDS infections are estimated to have been spread by intercourse between men and women. By the year 2000, it is projected that 80% of all infections of the AIDS virus will result from heterosexual intercourse.

Tourists who play AIDS roulette in Bangkok or Rio de Janeiro endanger not just themselves, but others at home.

While transmission of the virus through infected blood transfusions has now been virtually eliminated in industrial countries--and developing countries are improving their laboratory screening of blood--it is still risky to have a transfusion. Because of the potential for inadequate needle sterilization, vaccinations or injections of any kind are also to be avoided.

Many health experts recommend that people who may need them carry sterilized needles when visiting high-risk countries where needle sterilization and blood screening is not up to U.S. standards.

About 28 countries require that visitors entering for an extended period (businessmen and students, for example) receive a test for the AIDS virus. The definition of extended stay varies from country to country. The best policy is to telephone the Washington embassy of the country to be visited to learn its restrictions. Some, but not all of those countries, accept a test done in the United States. Countries with requirements include:

Belize, Bulgaria, China, Costa Rica, Cuba, Cyprus, Ecuador, Egypt, Germany (Bavaria only), Greece, India, Iraq, South Korea, Kuwait, Liberia, Libya, Marshall Islands, Mongolia, Pakistan, Papua, Philippines, Qatar, Saudi Arabia, South Africa, Soviet Union, Syria, Thailand and United Arab Republics. The U.S. State Department operates the Overseas Citizens’ Emergency Center in Washington (202-647-5226) where information and advice on disease, crime, visa requirements and similar matters in various countries may be obtained.