Travel happens all during the year, especially in the summer and on holidays. When traveling, people living with HIV are well advised to start getting "appropriately neurotic" about food safety concerns. We do want you to get back home in good health, well fed, and without any travelers' diseases. Also, it's a bummer to find yourself sick and in bed during the vacation of your dreams -- just because bad food got to you before the fun started.

Here, then, are some reminders on how we really can have it all and still enjoy in good health. But it's like everything else in HIV-life; traveling and staying well is more of a job and much more tedious than for HIV-negatives. One trick that may be helpful is to behave as if your vacation dreamland is like a third-world country; all bets are off -- assume that most of the food you find there is suspicious, and act accordingly.

I often tell people to think of their water and ice cubes. Picture a fresh-water pond with lilies floating, crickets cricketing and birds singing. And algae. While some nutritionists encourage eating algae, I think that after you look at it live and in person, you won’t want to. Also, some nutritionists recommend taking algae in pill form. This is just a nice way of making algae appear to be healthy -- but -- pond or pill, it’s the same from either source: Slimy Scum. In a glass of water, even if it all looks crystal-clear, the water can be rife with hundreds of bacterial species. They’re small and don’t "show"; so what if that clear-looking, cooling sip of clear water turns out to be really clean-looking pond scum and you get diarrhea, often of the embarrassing volume and incontinence kind? As with everything else, looks aren’t everything; beauty can be deceptive. Don’t gamble unless you can afford to lose.

Prepared's first consideration, and a suggested travel-safety requirement, is a visit to your doctor. Tell this member of your healthcare team where you're planning to go, and discuss any prophylaxis that may be warranted to make sure you return home safely and, of course, to maintain your "personal best" health while you're away. This medical visit should occur, ideally, about six months prior to your planned excursion -- but ideal timing notwithstanding, always better late than never; even if you’re leaving next week, call today! And be persistent, keep calling until you get to speak to him or her in person to address your needs -- individually.

If your travel involves a foreign country (especially Mexico and other "south of the border" vacation sites) medical prophylaxis is almost always indicated. You may need preventive antibiotics for "travelers trots." Since many antibiotics can trigger allergic reactions, a "tolerance test" may be indicated. Often Bactrim/Septa is the preventive of choice, but many of us are already using this for PCP prophylaxis. There are non-Bactrim alternates to preventive options like Ciprofloxacin, Norfloxican, and others. If that’s the case, or you can't tolerate Bactrim, a different preventive antibiotic may be recommended. Call your doctor. Please don't assume that you're safe just because you're traveling to a familiar location -- the transportation experience itself may pose risks -- read on.

When traveling to some countries, vaccinations may be required. Included in this process you may need inactivated versions of polio and typhoid vaccines, hepatitis preventives and perhaps the "measles/mumps/rubella" triple-combo protection. Also, depending on your destination, protection from cholera, rabies, and plague, perhaps even extending to anti-encephalitis, and yellow fever may be warranted. Above all, don't tempt fate: Prevent any uninvited medical condition for which there is a safe vaccine. Call your doctor.

Your prescription medications should be going with you, and preferably in their original container (so as to avoid going to jail). Discretely pack your prescription bottles. If your destination is not an HIV-friendly locale, although we'd never encourage you to fib, you might use a creative success approach: Put meds into vitamin bottles and, of course, include the vitamins too (for that familiar unpleasant vitamin stench). Also, before you leave, get a list of medical services along your way and with luck, the names and numbers of HIV-savvy doctors at or near your destination. Call your doctor.

Other sources of information on vacation safety are available. You may wish to call the country's embassy in Washington, D.C. or its local consulate to find out their policy on immigration for HIV-positive travelers. The place you want to visit may have restrictive immigration policies, while other destinations may be more HIV-friendly. Another good information source is the Centers for Disease Control (CDC) in Atlanta. Calling them at (404) 332-4555 is another good safety idea.

Travel by plane may pose health problems. Airplane food is usually sufficiently awful such that not eating it shouldn't be a problem. However, if you do eat the air-fare, don't eat anything unless it's hot; cold airplane food poses very real safety risks -- regardless of HIV status. It's been reported on some flights that HIV-negative passengers who ate cold food got sick -- probably from neglected meats, lettuce, mayonnaise, or just plain sloppiness. Plain rolls and breads are usually OK, but don't trust the junk they send on it -- especially mayonnaise and other dressings. If you are offered a sandwich, ask for a few dry rolls, butter and jelly. Or simply, eat it plain on the plane. Otherwise, eat only hot food offerings.

Another important consideration about air travel is air quality, which may pose health risks. Suppose you're seated near a coughing person. You may never know why the person is coughing, but if he or she has anything from a cold to pneumonia to tuberculosis, the germ-spread can extend five-to-seven rows -- in all directions. Should you find yourself in such a situation, request reseating. If getting this done means you need to explain a health condition, and if you don't want to disclose your HIV status, you could claim that you're going through chemotherapy or organ transplantation -- there's less stigma around those conditions and the possibly homophobic and AIDS-phobic crew and passengers won't be as likely to discriminate. Though these days compassionate people are easier to find than ever; always be careful; use your best judgement.

It's your call; say what they need to hear! Maintain your anonymity if you feel more comfortable that way. More than likely, your sky host or hostess will be happy to oblige your request. Did I say demand to be reseated? Take it to the cock-pit crew if you must. You do want to return from your travels unharmed?

Being prepared here is inspired! We can always take safe food along for the ride. It's not highly expensive to get a large cooler (whatever suits your needs and space -- from very small to quite large). Between cooler, thermos, ice stops and distilled water purchases, you can arrange things so that you never need a restaurant for your trip -- unless you need a "comfort stop" at a clean-looking gas station. The ubiquitous Denny’s restaurants have never asked me not to use their restrooms, and I’ve done just this for many years! They’re clean and handy -- but the food can be a little, shall we say, "lacking?"

Taking your food with you saves quite a lot: Money for one -- from fine restaurants to roadside diners, any food you buy is more expensive than your "bring-along" fare. Your major expense may be buying ice -- good advice -- lots of ice. Don’t eat the ice.

Nice things to keep on ice might include sandwich fixings. Breads and rolls are usually safe for a day or two with or without ice, but what goes into the sandwich may not be. Tuna sandwiches can be great -- and are a good health choice too. Keep everything but the tuna in your cooler. Canned foods are germ-proof by definition; the canning process uses intense heat. So, a small 3 1/2 ounce tuna can is a nearly-perfect sandwich size container (fish-oil power!). Add mayonnaise, maybe some chopped up hard-boiled eggs (protein power!), tomato slices (vitamin C and Lycopene power!), avocados (calorie/nutrient power!), onions (flavor power!), and maybe even some water chestnuts (crunch power!). Have it with a little trail mix (nut power!).

Other nice ice things to include are potato/pasta salads, yogurt, peanut butter, carrot sticks, cottage cheese, Cole-slaw, avocadoes, grapes, apples, oranges, peaches, nectarines, pears bananas and other assorted fruits and vegetables -- etc! If you have diarrhea, leave out most of the vegetables and peel the fruits if you can (a multi-purpose knife for peeling, etc. is an easy-to-pack tool). If your produce has seeds (eg. grapes, berries, tomatoes) this might not work too well on your food-bringing list because of the fiber they have -- the kind that makes diarrhea worse.

Canned fruits are even better than fresh -- they don't need ice and they won't rot on you. Since you may not be able to buy fresh produce during your "dream" trip, packing in some canned goods may be just the thing for this vacation. Also, their fiber is less effective at making diarrhea worse -- the canning and soaking combo does this. Your multi-purpose knife probably has a can opener built into it (convenience is everything).

Yogurt and multi-packs of chips (with dips from the cooler) can be good snacks, and trail mix can come in handy too. Pureed foods often work well; already pre-packaged and safe, they can be found in the baby-food aisle of your market. If the aisle also has some Infalyte, pick up a bottle or two -- just in case diarrhea happens, or happens to get worse. Or, if you can pre-prepare, get some Cera Lyte; it’s cheaper and easier to pack, but harder to find. Cera Lyte’s an excellent choice because it’s a powder (much less weight); enough to make a quart. And because it costs just over a dollar a packet; far lower than supermarket fare. Call (800) 507-2250 -- mention my name for the best price! (Nobody pays me to say things like this; that would be unethical.)

Whether in the Third World or the Great Plains, water safety is a must! If you don't have access to distilled water, boil your own. A lot of fluids are available packaged in "tetra-brik" boxes. This is a very user-friendly and packing-friendly container type. Risk of spillage is very minimal, the packaging is safe enough to not require refrigeration, so you'll always have "safe fluids" to drink. If in a restaurant, you may want to drink this beverage from a glass -- just request a "no-ice" clean glass. Most of the time, I carry my own soda to movies and restaurants. All canned sodas are safe -- remember, canning means safety (because of the heat factor). Heat kills germs.

A Positive friend recently took off for a backpacking trip with plans for campfire-based water-boiling and lots of powdered supplements, including single-serving size mixes such as Met-RX, (available in many pharmacies), cheap and easy instant breakfast, and dehydrated soups. Instant oatmeal and other single-serving packets are easy to pack, lightweight, and safe when made with hot water. Clintec Nutrition Company recently introduced the "New Basics" product line including soups (tomato and chicken), and really good-tasting chocolate bars. And coffee! Right, a nutraceutical, high-protein coffee. Also, NCI has NuBars in coffee crunch and vanilla caramel flavors. Pre-packaged individually these meal augmentations can help with fatigue prevention and weight-loss protection.

For a trekking-type of vacation trip, insect repellant is an important provision. Dr. Jeffery Karaban, a dermatologist, warns that people with HIV get bigger, more itchy bites -- and these, in turn, may require hi-potency medications plus cortisone treatments. He adds that we're also more sensitive to sun exposure, especially if taking Bactrim or other antibiotics. Decreases in CD4 counts have been noted after significant sun exposure.

On the trail, be sure to notice things. A mosquito bite can give you malaria. It can also give you diphtheria ( a deadly, vaccination-avoidable disease). A tick bite can give you everything from Valley Fever to Rocky Mountain Spotted Fever to encephalitis and erlichiosis. These are seriously bad conditions for Negatives; Positives might not be able to launch the immune force to survive. The best common symptoms to watch for are severe headache and any combination of fever, diarrhea, nausea, vomiting, and intense pain. If you get bit or stung, and you get a headache and/or fever, get to a doctor at once. No, not tomorrow morning -- these diseases move too fast to await the dawn; get to a doctor now-- immediately -- whatever it takes; it could save your life.

Dining away from home, well done is the request of choice, taking advantage of the health fact that heat kills germs. If the meat is well-cooked, the bugs are dead. If the meat is overly rare, send it back -- tell them you just love well-done meats. Only the thinnest little bit of red is allowed for a steak or prime rib. But be especially careful about ground meat like in hamburgers. Here, the meat cannot have even the tiniest bit of pink; E. coli from undercooked meat has caused far too many deaths -- in the hundreds -- as well as a lot of pain and suffering to HIV-negatives. For Positive People, the risk is even greater.

If something from the fish menu is for you, double your demands for doneness. Just knowing about our globe's polluted waters may be enough to cause seafood avoidance behavior, but if you do eat fish, it must be flaky. If there's even one little "soft-spot" (mushy) it's too suspicious to eat -- send it back for better cooking. It’ll taste better that way anyhow. Also, say no to raw oysters and clams, Sushi, Ceviche and other raw-fish preparations.

The same applies to poultry. Even in the US, poultry cooked at home can be hazardous to our health; away from home, the risk goes up the further into the Third World you get. From Mexico to Morocco, you may assume (usually correctly) that poultry has been stored and/or prepared un-hygienically, If there's the tiniest bit of pink near the bone (check this out before you begin to eat), send it back. Contaminated food that you don't eat won't hurt you.

Don't be afraid to demand safety; you'll probably be happier spending your travel time enjoying the vacation paradise of your dreams than just being able to look at it through your hospital window. By the way, no matter where in the world you are, a hospital is not a germ-free environment -- just being in one can add to your risk of contracting bacteria, parasites and other germfare.

Have a great trip! Stay safe, enjoy your vacation, and return home with your "best health" still intact. Personally, I usually work all year ‘round, so have one on me!

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As always, first do no harm. If this advice is unclear or seems to be related to any adverse consequences, consult your nutritionist. Call your doctor. And, have fun!

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Nutrition Power is a Registered Trademark of Health and Nutrition Awareness. Copyright 1996, Jennifer Jensen, MS, MBA, RD.

All Rights Reserved.

Other versions of this article have appeared with permission in Being Alive Newsletter, Arts & Understanding Magazine,and other newsletters.