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Advance Planning Reduces Major Health Risks : Despite sobering statistics, the risk of AIDS should not in itself be a reason to keep most people from traveling.

April 11, 1993|KATHLEEN DOHENY

When travelers preparing for foreign trips visit Dr. Victor Kovner, a Studio City physician specializing in travel medicine, they expect to hear about needed vaccinations and other health precautions.

Most aren't ready for his frank discourse on the risk of acquiring the human immuno deficiency (HIV) virus and AIDS while traveling in foreign lands.

If sexual abstinence with foreign partners isn't an option, Kovner tells the patient to "buy condoms before leaving the U.S. Assume anyone you have sex with (while abroad) has AIDS."

In addition, if the patient is traveling with a large group, such as a movie crew, Kovner might suggest that members their blood typed and cross-matched before departure in the event someone needs a blood transfusion overseas. (He acknowledges, though, that even this approach is not risk-free.)

Patients are intially taken aback by Kovner's straightforward talk. "It is pretty sobering," he said.

So, too, is the risk of acquiring HIV through bad blood or unprotected sex while vacationing or working outside the United States. So fearful are some travelers that they are either considering taking along their own supply of blood or avoiding certain countries altogether. Both approaches are unnecessary, say public health officials, because common sense and advance planning can reduce risks substantially.

The number of AIDS cases worldwide is expected to increase rapidly during the 1990s. As of early 1991, there were about 2 million cases, according to "The Global AIDS Disaster: Implications for the 1990s," a U.S. Department of State publication issued in July, 1992. By the end of the century, the cumulative total is expected to top 10 million.

"The epidemic is at its worst in sub-Saharan Africa," said Bob Howard, spokesman for the federal Centers for Disease Control, Atlanta. At least 7 million Africans have already been infected, according to the Department of State report, and by the mid-1990s, the total will probably exceed 20 million.

Another AIDS "hot spot" country, according to the World Health Organization, is Thailand. Because of prostitution and intravenous drug use, WHO calls it the "most AIDS-prone country in Southeast Asia." An estimated 1 million to 3 million could be infected by the turn of the century, experts say.

Also expected to be hard hit in this decade are the Caribbean countries and Brazil. Public health officials predict the epidemic may proceed in those locations "on a scale comparable to that in Africa."

AIDS is also a "major threat on the horizon" in India, according to the State Department report, "with the potential for a repetition of the African experience in 10 or 15 years."

In comparison, certain other areas probably pose no greater risk than does living in the United States, said Rosamond Dewart, chief of the Travelers' Health Section for the CDC. Among them, she said are Western Europe, Japan, Australia and New Zealand.

But travelers shouldn't consider some areas safe and others not, Dewart emphasized. There is probably gross underreporting of cases, she said, and the situation in any country can either worsen or improve rapidly. The best approach, concurred Dewart and other public health experts, is to minimize risk as much as possible regardless of location.

To that end, the CDC advises travelers to avoid sex with HIV-infected persons or with persons whose HIV-infection status is unknown. Travelers who do engage in sex with foreigners are advised to use latex condoms and to consider also using spermicides, believed to provide additional protection.

Blood supplies overseas are getting safer, some public health experts say. "Every country in the world has made vigorous efforts to screen blood supplies, although there is always some degree of risk," said Dan Epstein, spokesman for the Pan American Health Organization in Washington, D.C.

Even so, the CDC advises travelers to avoid blood transfusions overseas if at all possible. If the need arises, advised Dewart, "Try to get air-evacuated out." Several travel health insurance policies include the evacuation benefit with their policies.

The need for an emergency blood transfusion is rare for international travelers, according to the World Health Organization. If a transfusion is unavoidable, WHO guidelines suggest travelers ask about the possible use of "plasma expanders" rather than blood as a stop-gap measure and then arrange emergency evacuation home.

"If you are in an underdeveloped country, large hospitals and capital city hospitals are generally less risky and more apt to carry out screening," Dewart said. But, of course, travelers often don't have the luxury of picking their transfusion site.

Those traveling in a group might turn to colleagues to donate blood, as Kovner sometimes advises. And travelers concerned about minimizing their odds of having a blood transfusion should pay particular attention, experts suggest, to good preventive health practices like wearing seat belts and not drinking and driving.

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