Unprotected sexual activity overseas even during short holidays, places an individual at risk of transmission of sexually transmitted infections including human immunodeficiency virus (HIV) and hepatitis B. Sexually transmitted infections are endemic world-wide, but much more prevalent in certain overseas destinations. Prevalence of HIV in the UK is highest in gay/bisexual men. However, in 1999 for the first time, newly reported HIV infections acquired heterosexually exceeded those in gay/bisexual men. Most of these heterosexually acquired infections were acquired whilst living abroad, mainly in sub-Saharan African countries.

AIDS cases have been reported from every country in the world, including those in Europe (in 1998 thirteen countries in Europe had incidence levels of HIV infection higher than the UK). In general, the prevalence of HIV infection is highest in groups with high levels of risk behaviour for infection (eg homosexual men, persons with many sexual partners, sex workers, injecting drug users) who are usually to be found in urban areas. In some cities in the highest risk countries of the world, most of which are in sub-Saharan Africa and South East Asia, as many as one in four young and middle-aged adults in the general population may be infected with the virus.

Hepatitis B infection exists world-wide. Countries of low prevalence include north and Westren Europe, North America, Australia and New Zealand, although prevalence is higher in groups with high risk behaviour. Intermediate prevalence areas include Eastern Europe, North Africa, the Indian subcontinent and parts of Central and South America. High prevalence areas include most of sub-Saharan Africa, the Far East and the Pacific Islands. The risk of infection for short term travellers is generally low, provided they do not put themselves at risk by their behaviour or unless blood transfusion is required.

Hepatitis C is endemic in every continent, with a higher prevalence in some countries in Africa, the Middle East, South East Asia and the Western Pacific. In developed countries, routine screening of blood for transfusion (and blood products and organ tissues) has virtually eliminated this route of transmission, sharing contaminated needles now being the most common route. Many developing countries still use unscreened blood and blood products.

9.2  Prevention

9.2.1  Sexual intercourse

It is imperative that travellers

•   are aware that a person infected with an STI, HIV or hepatitis B may appear to be perfectly healthy and may not even know they are infected

•   avoid unprotected sexual intercourse with anyone other than a regular partner

•   always use good quality condoms - this will reduce the likelihood of acquiring other STIs as well as HIV (condoms purchased abroad may be of poor quality)

•   carry condoms rather than try to obtain them at the last minute

•   appreciate that sex tourism (travel to a country with the explicit intention of having sex, commercial or otherwise, with men or women in that country) is hazardous. It has particularly been a source of infection with HIV and other STIs among UK residents travelling to Thailand

•   remember that alcohol weakens inhibitions and makes precautions more easily forgotten

9.2.2  Intravenous drug abuse and body piercing

Travellers should also be aware of;

•   the risk of sharing equipment for administering drugs

•   the dangers of any procedure which punctures the skin (eg tattooing, ear-piercing) as the sterility of instruments cannot be guaranteed

Using or carrying illicit drugs abroad can also attract very severe penalties.

9.2.3  Medical care

Injections: Standards of infection control in some countries may be inadequate to prevent the spread of blood-borne infections such as hepatitis B and C and HIV. Instruments may not be sterilised between patients and needles and syringes may be re-used. It may be helpful for travellers to carry a clearly labelled medical kit containing sterile sutures, syringes and needles for use in an emergency. Those on group expeditions should consider including a plasma expander in the kit.

Blood transfusions: Not all countries screen all blood donated for transfusion. Travellers should avoid transfusion unless absolutely required and ensure as far as possible that blood they are given has been screened for HIV antibodies. The nearest British Consulate may be able to give advice.

Insurance: Medical insurance should cover the cost of all contingencies, including evacuation in an emergency.

9.2.4  Hepatitis B vaccine

Hepatitis B vaccine may be indicated in addition to the above precautions, in particular for longer stay travellers and shorter term travellers who may place themselves at risk from their behaviour.