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Up, Up and Away!

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There are two things that mark the end of fall in my clinic: Flu shots arrive, and men start coming to see me for travel vaccination advice. I’m a huge fan of travel, and although high-quality research on the health benefits of globetrotting is lacking, there’s a general understanding that it promotes physical and mental well-being.

Challenging yourself with a new language or life experience can be unsettling, but the value they bring you is immeasurable. Yet even the most luxurious holiday can come with risk, so it’s important to prepare well in advance of your trip to ensure you stay as healthy as possible while you’re away.

One common pitfall many guys encounter while on holiday is running out of prescription medication. I’ve had frantic phone calls from all over the world from patients who simply miscounted their pills before leaving. I understand, preparing for a holiday can be stressful, but this has to be a priority. Believe me, blood-pressure pills are just as important when you’re lying on the beach as they are in the city. When you see your doctor about travel vaccines, take the opportunity to make sure your prescriptions will last for the entire time you’re away.

Speaking of vaccines, check out www.cdc.gov/travel for up-to-date information on outbreaks and required vaccinations for your destination.  This is the site I use when I’m giving travel advice. It’s user-friendly and can help make a visit to your doctor more useful if you’ve clearly outlined all of the countries and regions you plan to visit.

I’m often asked about the traveller’s-diarrhea vaccine advertised on TV called Dukoral. The big problem with this vaccine is that it protects against only two of countless bugs that can make you sick. I worry that taking it gives people a false sense of security. If you prefer to be aggressive with vaccination, then by all means take it—it’s actually available without a prescription—but continue to be careful with food handling and water safety while you’re away. I would still carry a short course of antibiotics for severe traveller’s diarrhea lasting longer than three days (two if you see blood).

The type of antibiotic actually depends on where you’re going. Old reliable ciprofloxacin, for example, is no longer effective in Asia due to overuse. Ask your doctor to consider azithromycin instead for that region.

Malaria, yellow fever and, more recently, chikungunya and dengue are severe mosquito-borne maladies that will seriously interfere with your vacation. Even in tourist-friendly places like the Dominican Republic, malaria is a small but real risk. Wherever you plan on going, check the CDC website to see if you’ll need malaria prophylaxis, and remember mosquito safety. Wear repellent and long pants at sunrise and sunset. And try to stay in air-conditioned accommodations: Malaria mosquitoes can’t tolerate the cold. For more nuanced travel advice, consider visiting a travel clinic. It will have expertise and vaccines that aren’t available in most doctors’ offices and pharmacies.

Unfortunately, as gay travellers we often have more to worry about than just travel bugs. Personal safety is a real concern if you want to go out and be out in certain countries. The international lesbian, gay, bisexual, trans and intersex association website www.ilga.org provides a clear summary of the local laws on homosexual activity around the world. I encourage you to take a look even if you don’t plan on travelling. It’s a fascinating visual representation of those who are still struggling for the acceptance we take for granted in Canada.

The picture is even more complicated for those travelling while living with HIV. A fabulous resource is the global database on HIV-specific travel and residence restrictions, www.hivtravel.org. As a general rule I recommend that HIV-positive men travel with their antiretroviral medication in their carry-on in generic pharmacy bottles with the medication name listed. Don’t carry your medication in original pharmaceutical bottles; they often identify that the medication is used for HIV treatment and will disclose your status. That’s your business and not that of a customs agent. Carry a letter from your doctor listing all of your current medications, so it’s very clear that the pills you are carrying belong to you and are important.

For HIV-negative travellers, if you know that holidays are a time when you tend to party more and perhaps have more sex, consider speaking to your doctor about HIV pre-exposure prophylaxis. It works exceptionally well but is not a substitute for safer sex. There are plenty of other sexually transmitted infections from which it won’t protect you. That means keeping your senses intact. Overusing alcohol and drugs can be dangerous at the best of times but particularly when you’re away from your social supports and a reliably familiar medical system. Consider a vacation from partying on your next getaway: You might feel much better for it.

While many of us will be staying home with our limp Canadian dollars in hand, a lucky few will be off to sunny beaches and desert palms. The next time you travel, plan ahead. Take some time to visit the websites noted here to get some medical background on your destination. You don’t want to return home like so many others do—needing a vacation to recover from the one you just had.

Dr. Malcolm Hedgcock is a Toronto-trained family doctor living and working in Vancouver. He has a special interest in gay men’s health issues, including the primary care of those living with HIV and AIDS.

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