title: Knowledge, attitudes and health outcomes in HIV-infected travellers to the USA.
abstract: BACKGROUND
  The USA bans entry to non-citizens unless they obtain a waiver visa.
  
  
  OBJECTIVE
  To establish how many people with HIV infection travelled to the USA, whether they were aware of the travel restriction, whether they travelled with a waiver visa and HIV inclusive medical insurance and how they managed with their antiretroviral medication (ARV).
  
  
  METHODS
  Collation of data from cross-sectional studies conducted independently at three different medical centres, Manchester, Brighton and London, using a structured self-completion questionnaire.
  
  
  RESULTS
  The overall response rate was 66.6% (1113 respondents). 349 (31%) had travelled to the USA since testing HIV positive, of whom only 14.3% travelled with a waiver visa. 64% and 62% of the respondents at Manchester and Brighton were aware of the need of a waiver visa. 68.5% (212) were on ARV medication at the time of travel and, of these, 11.3% stopped their medication. Of those taking ARV medication, only 25% took a doctors' letter, 11.7% posted their medication in advance. Of those discontinuing treatment (n=27), 55.5% sought medical advice before stopping, 11 were on NNRTI-based regimen and one developed NNRTI-based mutation. Only 27% took up HIV inclusive medical insurance. Many patients reported negative practical and emotional experiences resulting from travel restrictions.
  
  
  CONCLUSIONS
  The majority of HIV patients travel to the USA without the waiver visa, with nearly half doing so with insufficient planning and advice. A significant minority (11.3%) stop their medication in an unplanned manner, risking the development of drug resistance.
authors.forename: M
authors.initials: M
authors.lastname: Mahto
authors.forename: K
authors.initials: K
authors.lastname: Ponnusamy
authors.forename: M
authors.initials: M
authors.lastname: Schuhwerk
authors.forename: J
authors.initials: J
authors.lastname: Richens
authors.forename: N
authors.initials: N
authors.lastname: Lambert
authors.forename: E
authors.initials: E
authors.lastname: Wilkins
authors.forename: D R
authors.initials: DR
authors.lastname: Churchill
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
authors.forename: R H
authors.initials: RH
authors.lastname: Behrens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013315:Stress, Psychological / Q000523:psychology; D014195:Travel / Q000331:legislation & jurisprudence*; D014481:United States
chemical_list: D044966:Anti-Retroviral Agents; D018894:Reverse Transcriptase Inhibitors