Protection against HIV infection for medical trainees outside the United States

The increase in HIV infection rates around the world has created concern among medical educators for the safety of students and residents taking overseas electives. In some areas, the HIV adult positivity rate is 15%-20% or higher. Medical schools and residency programs need to make policies to protect their trainees serving abroad. This paper provides background for such policies. A key element is communication among the student, his/her advisor, and the overseas faculty. The student needs a knowledge of universal precautions and will need to have protective equipment that is often not available in developing countries. Which equipment and medication are available and which are needed will vary and must be clarified in advance. Sexual contact with the local populace must be avoided. In case of an emergency, the student must have adequate evacuation insurance. Centers for Disease Control and Prevention recommendations for determining the need for postexposure prophylaxis should be followed. Before the scheduled trip, students should assure themselves that enough medication will be available in the event of a mishap. If necessary, several days' worth of prophylactic medication should accompany each student. Having these medicines will allow the student to begin treatment immediately in the event of a high-risk exposure and then return to the United States for completion of workup and therapy. With proper planning and education, a student or resident can have a safe and rewarding experience in the developing world.