lecture 11 travel medicine and hiv positive traveler

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    Travel Medicine and HIVpositive Traveler

    Tuti Parwati MeratiDivision of Tropical and Infectious

    Disease, Department of InternalMedicine,Faculty of Medicine, Udayana

    University, Bali

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    Demographics of InternationalTravel in

    HIV Infected PatientsPre-HAART

    (Kemper et. al. 1992-93)

    Survey in hospital-ased HIVclinic! "alifornia

    #$% had traveled &ithin 'S(

    )*% &ith foreign travel &ithin )years

    +edian "D#,)*.mm/

    Reason for travel0

    /*% thought last chance to travel

    hi

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    Post-HAART(Sherrard 1997-2007)

    International Health "linic! 1tta&a! "anada

    23% foreign orn0 travel to visit friends and

    relatives #/% "anadian orn0 travel for vacation and

    usiness

    +edian "D# , ##*.mm/

    Destinations0 4in order5 Su-Saharan Africa

    "ariean

    "entral America

    South Asia

    S6 Asia

    Sherrard and McCarthy. Travel Medicine and Infectious Disease 2009;

    7:29129!."e#$er et. al. % Travel Med 199!; 2: &!&&.

    Demographicsof InternationalTravel in HIV

    Infected Patients

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    Te purpose of tispresentation

    !urrent "lo#al $ID% %ituation and HIVInfection

    &is' of ac(uirin) HIV infection durin)international travel

    $ddresses te issues of HIV screenin) ofinternational travelers

    *ffers advice to prevent HIV infection

    durin) international travel &ecommendation provided for medicalcounselin) of te prospective travelerwo is HIV positive + on ealt precaution,propylactic medication andimmuniation-

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    t t t

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    at s t e tr gger o ep em c nAsia 8

    FemaleMale

    75 million

    Men in Asia had sexWith CSW

    (2-20% adult male)

    50 millionWomen married

    With men who had

    sex with CWS

    10 millionMale !"

    10 millionMSM

    10 millionWomen sell

    sex

    n#ant $

    Children

    Asia population 0 /9 illion

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    1.6

    7

    8.8 8.5

    12.414.5

    15.2

    20.5

    22.5

    0.25 0.24

    2 24 4.1

    6.1 7.2

    0

    5

    10

    15

    20

    25

    2000 2001 2004 2005 2006 2007 2008 2009 2010

    TR6:D 1; HIV PR6VA

    71R?6RS

    I:DIR6"T S7

    %ource. Bali HealtDepartment

    %

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    F$!T*&% *0 P/&I*D% *F TIM/ I0

    I0D*0/%I$

    Sumber : Laporan Triwulan Pengidap infeksi HI dan !asus "I#$ $ep%e&'er 2008

    64.7

    43.2

    17.6

    53.7

    72.5

    36.6

    50.5

    17.6

    39.5

    11.8

    1.3

    3.47.7

    3.4

    02.1

    53.3

    2.61.05 2.2 4.0

    5.5

    5.90 00

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100

    87-90 91-95 96-2000 2001- 2005 2006-skrg

    Ta(un

    Perse

    n

    Homosex Heterosex ID !"#$-%"#$ &"k '#ket"(u#

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    6)

    71

    6158

    64

    0

    10

    20

    )0

    40

    50

    60

    70

    80

    2000 200) 2004 2005 2007

    HIV PR6VA

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    )8)4

    4)

    66

    7)

    0

    10

    20

    )0

    40

    50

    60

    70

    80

    2007 2009 2010

    TR6:D 1; "1:D1+ 'S64I:T6RVI67 7ITH S6> 71R?6RS5

    Percent al&ays use condom &ith clients in thelast &ee

    Percent condom use last seB

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    "HA

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    SW

    Children

    Clients

    Children

    Clients

    Clientswife

    Sex workers/or

    IDU

    as the epicentrum

    of HIVtransmission

    Clients

    wifeID

    8

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    "ountry HIV Positive Rateof ;S7 4%5

    ID's 4%5

    U%$ +Florida-U%$ +Miami and0ewar'-3ondon

    Paris"ermanyItaly%witerland0eterlands

    !entral, /astern,%outern$frica

    4est $frica

    $sia 5 Pacific

    6 5 768

    659659

    :76 ; ; ?6

    @ ; 7?

    6 ; >

    65