HIV travel restrictions and retreats

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Restrictions


 

Posting Medication

Some positive travellers post their medication ahead of them, to a friend in the country or the hotel where they will be staying. Remember however that international mail can be delayed or lost altogether, so you should post it well in advance to someone who can verify it has arrived.

Customs officials inspect posted items. If you do post medication ahead, you should fill out and include a customs declaration stating the parcel contains prescribed medication, for personal use only, without any commercial value. Enclose a letter from your doctor advising the medication is for personal use. The letter does not have to detail your condition.

Carrying Medication

If you are taking your medication with you, always carry your medication in your hand luggage, in case your checked luggage is lost or delayed.

Always carry a letter from your doctor stating that it is prescribed medication for personal use. The letter doesn’t have to say it’s for HIV. You might ask your doctor to list medications by name with daily doses, unless you are visiting a country with entry restrictions for people living with HIV/AIDS.

Bring enough meds for your trip, plus a few days’ extra in case you’re delayed or change your travel plans. But don’t bring an excessive amount, as customs and immigration officials may treat this as evidence of intention to overstay your visa.

Most medications should be kept at room temperature, and some require refrigeration. Keep this in mind if you’re planning to travel long distances by car or bus in summer! Ask your doctor or pharmacist for advice.

Airplane cargo compartments are unpressurised and unheated, so liquid medication may freeze or leak during the journey. Carry these medications in hand luggage with an appropriate letter to satisfy security restrictions.

Experienced travelers will tell you that nothing can be taken for granted once you leave home, but there’s one thing you can still count on: The airline will one day lose your luggage. Pack enough medicine in your carry-on to last until you can get replacements, and always carry two copies of your prescription — one with the medicine, one in your carry-on or fanny pack.

Injectable Medication(needles and syringes)

If you inject medication such as Fuzeon(R) (T-20) or insulin, contact your country’s consulate of any country you’re planning to visit and ask about their laws on needles and syringes. In some cases it may be easier to post them ahead and only carry what you will need to inject on your journey.

Check with your airline(s) ahead of time to find out their policy on carrying needles onboard an aircraft. For example, QANTAS allows you to carry as many needles as you will need during the flight, plus a small excess as a margin for error. The rest of your supply must be carried in your checked-in luggage. As usual a letter from your doctor is required as proof you need them for a medical condition.

Syringes should be sealed and needles should have caps on them. Remember to dispose of used needles carefully.If you’re carrying a syringe, bring a doctor’s note for that, as well.

Injecting Fuzeon (T-20) in Flight

Talk to your doctor before you leave about whether it is possible to schedule your inections so you don’t have to inject oboard. However, this may not always be possible, especially on longer flights, so you should make plans to inject while in flight.

You can prepare your Fuzeon solution before your flight and keep the liquid in a cold pack for up to 24 hours.If your drugs require refrigeration overnight, hotels in most developed countries have long experience handling such requests. A re-usable ice pack, and a hotel with a freezer, should be all you need. In developing areas, ask before you go, and be aware that power outages may thwart even the best-intentioned hotel.

Try to avoid injecting during moments of turbulence. These are more common just after take-off and during the final descent, as teh plane passes through the clouds. At cruising altitude the flight is normally smoother and you will find it easier to inject.

Find somewhere private to inject your medication. The airline you’re flying may recommend asking your flight attendant for assistance. Otherwise, this leaves the toilet cubicle.

Injecting in this space gets easier with practice. Sit down if possible and use your legs and thighs to lightly brace yourself in case or turbulence.

Before you fly, prepare a small kit with everything you will need to inject. A medium-sized toiletries bag is perfect.

Bring alcohol wipes and use them to wipe down the lids of your Fuzeon bottles and any surface you will touch during the process of injecting your medication.

Wash your hands thoroughly with soap, and do not touch anything other than your medication before injecting it.

Hiding the medication

There is no actual HIV test at the airport or border, says Vishal Trivedi, Immigration Project Coordinator at the Legal Services Department of Gay Men’s Health Crisis (GMHC) in New York City. But travelers carrying HIV-related literature or HIV medications may be turned over to an immigration official for further investigation.

People on ARVs use more or less crafty strategies to circumvent the regulations. We do not legally recommend any of those.

It might well be that some of the bypassing strategies below would also be a violation of  immigration laws or other laws. We don’t know what the consequences of such violations might be. It could be that they, too, result in a permanent ban on entry. That might not make much difference to someone, since once they’re found out, they’re found out and barred from re-entry anyway.

1. The probably safest strategy

• Rebottle medications with non-prescription packaging

• Have a letter from a clinician on you

Get the meds rebottled in neutral packaging and properly labeled by your pharmacy (which means without mentioning the nature or brand name of the drugs). To comply with US law, you need to carry a letter from a clinician which states that your drugs are prescribed for a personal medical condition. This letter should not mention HIV. Be ready to answer the question why you need these meds without hesitation (blood pressure, coronary problems, etc.).

“There is no legal requirement that you keep your pills in the original, labeled bottle in which they came,” says Ronda Goldfein, executive director of the Philadelphia-based AIDS Law Project.

Risk:
Small, especially with today’s therapies (reduced number of pills). Plan well ahead to have everything ready.

Advice:
You should carry the drugs in your hand luggage. Checked luggage is sometimes late or can get lost completely. However, be aware that the drugs can be detected more easily that way.

2. Carry the needed drugs on you, or in your luggage

This is, as the Brighton study shows below, what most people do.

Risk:
There is a certain risk of being detected, by immigration officials, or by customs. Since September 11 2001, luggage is checked more frequently and more thoroughly. If this happens, you may face deportation by the next available flight.

Advice:

• HIV-positives are advised to take enough medication to cover delays.

• To comply with the law, you need to carry a letter from a clinician which states that your drugs are prescribed for a personal medical condition. This letter should not mention HIV. Be ready to answer the question why you need these meds without hesitation (blood pressure, coronary problems, etc.).

• You should carry the drugs in your hand luggage. Checked luggage is sometimes late or can get lost completely. However, be aware that the drugs can be detected more easily that way.

• Take a last dose to be safe during travel, before checking in, eliminate remaining meds and ensure to have drugs available when needed after arrival. However, there is a small risk in case of delayed departure.

Tips for Travelers

Police

If you are arrested overseas, you are generally entitled to receive a visit from local consular staff.  However, consular assistance is very limited.

This may include visiting the person regularly in detention, providing general information about the country’s legal system and local prison system, offering a list of local English-speaking lawyers, helping them to contact their family, and attending their trial as an observer (if approved by the local authorities).

Consular officers can approach local authorities to request that the detainee’s basic needs are met and that humanitarian standards of treatment are respected. However, they cannot organise better treatment than that provided to the host country’s own citizens.

If you use recreational drugs, remember the laws related to illicit drugs vary enormously from country to country.  In Singapore airport, posters announce ‘the penalty for drugs is death’.  Elsewhere, dealers may ‘value add’ their sales by informing on overseas purchasers to local police in exchange for a cut of the bribe.

Bribes are a taken-for-granted part of life in some countries. However it may be unwise to offer a bribe unless you are certain it is expected, as you may end up facing criminal charges, either real or contrived to jack up the bribe amount.

Recreational Drugs

If you drink or take party drugs, remember your normal judgments of risk might rely on having friends around, or at least security guards who speak your own language!  If you’re alone or in new company, drink or dose in smaller amounts, spaced apart, and keep aware of your surroundings.

Taking recreational drugs alongside some antiretroviral drugs can be dangerous. Certain HIV drugs can boost the amount of recreational drugs in the bloodstream, especially the drug ritonavir (Norvir – also in Kaletra) which ‘boosts’ both the level of other protease inhibitors – and a lot of recreational drugs including ecstasy, GHB, methamphetamine and Viagra. People have died from ecstasy, methamphetamine and GHB overdoses because of interactions with their HIV drugs, so take care. In contrast some antiretroviral drugs can lower methadone levels.

If you are going to take recreational drugs you should start with a lower amount than HIV-negative friends, keeping in mind you never know how much you are going to get. Don’t be scared to speak to your consultant about any recreational drugs you are taking as they will be best placed to advise you as to how they may affect you.

Play Safe

In some countries, including Thailand, police raid nightclubs on a semi-regular basis.  Hotel staff and tour guides may know which clubs are safest to visit.

If you experience sexual assault, remember there may not be the same support structures you’d expect to find.  First ensure you’re physically safe, then contact the embassy or consulate.  They can advise you what to expect and how best to proceed if you want to make a police report.

In some countries there is a thriving trade in commercial sex work, targeting overseas visitors.  If someone young and attractive comes on strong, it’s not impolite to ask ‘are you working?’ to avoid misunderstandings later.

If visiting someone new, such as someone you met in the chat rooms, it maybe better to raise the subject of your HIV status before a visit, rather than place yourself in possible danger in a strange place away from home. You never know what someone’s reaction will be until you tell them.

Remember the age of consent may vary overseas and sex between men is outright illegal in some countries.  Do your research before you travel.

Condoms can be difficult to purchase in some countries so bring your own personal supply.  Don’t take too many – in some countries, possession of a very large number of condoms can be taken to mean you are a sex worker.

Consular Assistance

Embassies and consulates can help you locate medical assistance, normally by helping you make contact with an English-speaking healthcare provider.  They can facilitate communication between the traveller and local doctors/hospitals, monitor the welfare of the traveller in hospital, and communicate with their next-of-kin back home.

In a worst-case scenario they can assist in coordinating a medical evacuation (medivac).  However, quite strict limits apply to the kind of assistance a consulate/embassy can provide.

Overseas PLWHA Organisations

The Internet is your friend!  Before you travel, use it to find PLWHA organisations in the countries you’re planning to visit.  The laws in each country are different, and it may not be possible to find them out in advance.  Local PLWHA organisations can provide advice and support in the event of a legal crisis or health emergency.
See:  http://www.thebody.com/hotlines/internat.html.

Next of Kin

There are steps you can take before you leave to ensure a swift response is possible if you need emergency assistance while travelling overseas.

• Arrange an Enduring Power of (Medical) Attorney for your partner, next of kin or a trusted friend, endorsed with their contact details on it, and give them a copy of this.

• Also give them copies of your vaccination certificates, relevant health documentation, insurance policy, identification documents– anything they might need to fax overseas in an emergency.

• For your safety and their peace of mind, agree on a schedule for phone calls, e-mail &/ blog updates while you’re away.

• Leave any medication you don’t take overseas with your next of kin or a trusted friend, so they can post it to you if you lose your baggage or medication overseas.  They will need to include a letter from your doctor and a customs declaration. Advise them to send no more than a month’s supply at a time, as it may be confiscated by customs if they send more.

KNOW YOUR RIGHTS
Immigration border agents are not supposed to make medical determinations and a noncitizen’s own admission to having HIV is not sufficient proof to deny entry. The noncitizen should be paroled in for deferred inspection for admission and undergo an HIV antibody test administered by a doctor of the Public Health Service (a doctor approved by immigration.) The doctor will notify immigration of the HIV test results. DHS may detain (jail) the noncitizen during this process or give them an appointment to return.

If a noncitizen is eligible to apply for a waiver, he or she may ask immigration for the waiver. If the noncitizen is not eligible or is later denied a waiver by immigration, he or she will then go before an immigration judge.

Things to know before traveling

Avoid starting a new treatment combination within a month of your trip, as your doctor may need to monitor and adjust your treatment in case of side-effects or allergic reactions.  (And you don’t want these to ruin your trip!)

In the past, some positive travellers have chosen to take a treatment break while they travel, but a recent study shows treatment breaks are more harmful than we previously realised. This is an important decision to make in consultation with your doctor.

Your doctor, nurse or treatments officer can suggest some tips and tricks to help you stick to your dosage schedule when you’re travelling across time zones and wrestling with your body clock.

We know from research that posting meds can result in unexpected treatment breaks, as they do not always arrive as expected.  The same risk applies to packing your meds in checked luggage.  Discuss this possibility with your doctor, and maybe carry a week of meds in a pill box in case this happens.

If you really can’t take them with you, contact a local AIDS agency before you leave and through them, make an appointment with a local physician to score a prescription for 2-3 weeks of the drugs you need.  You can expect to pay quite a lot of money, but it may be worth it for peace of mind.

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