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Preparations for travel outside the country include the following subjects (click on the link to learn about each subject)::

• Medical.
• Health insurance.
• Arrange access to western style medicine.
• Update your passport.
• How Tto pack for your new normal.
• Make arrangements if you are traveling with a guide or service dog.
• Vaccinations if you are HIV positive.

NOTE:

• To avoid lengthy delays at customs on your return to the United States: Preapproved travelers can pass through U.S. Customs by swiping their passports at a kiosk, posing for a photo, scanning their fingerprints and answering some basic questions on a touch screen. To learn more about the Global Entry Program, including application, cost and participating airports, see: http://www.cbp.gov/global-entry/about.
• Sign up with the U.S. government in case there is an emergency abroad while you are there so you'll learn about it without delay. You can signup at https://step.state.gov/step/
• There are several apps to help adjust faster to jet lag. They analyze your trip's time zones and offer ways to alter your sleep cycle. See: Entrain, JetLag rooster and JetLag Genie.

Try to visit your doctor at least eight weeks before departure so that any negative reactions to inoculations or treatments for any problems found can managed before you leave.

Get a large enough supply of your medications to last the entire trip, plus a few extra days in case you get delayed returnig. (Take the medications in the prescription bottle. Also carry a copy of the prescription).

Ask your doctor for the generic name and for the names in the countries to which you will be traveling. Drug names are uniform throughout the United States but many drugs have different names outside the US. The information will be useful if you develop allergic reactions, or need an emergency supply. Even with the generic name, the FDA cautions against filling prescriptions abroad. An FDA investigation has found that many foreign medications, although marketed under the same or similar-sounding brand names as those in the, contain different active ingredients than in the United States.

Consider diseases that are prevalent in your proposed areas of travel and the inoculations required for your trip. This must be discussed in detail with your doctor taking your own physical condition into consideration. Some diseases to consider are:

• Cholera: No country requires inoculation against cholera since it does not prevent its introduction into an area. Two new oral cholera vaccines provide much better protection than the previously used parenteral cholera vaccine.
• Yellow Fever: This vaccination certificate is the only one ever required of international travelers, and even then only in limited cases.
• Malaria: This serious and common tropical disease is a problem in many areas. It's prevalence varies from country to country, from urban to rural areas, from season to season. The World Health Organization keeps track of malaria-infested areas. Your doctor should be able to advise you on your risk of exposure. Preventive prophylactic anti-malarial regimens should be started a week prior to departure, continued religiously for the duration of your stay in the malaria risk area and for four more weeks after leaving the area.

To determine the health risks at your proposed destination:  Check with your doctor, a local hospital with a travel clinic or one of the following:

• Centers for Disease Control (CDC) and Prevention's International Traveler's Hotline wwwn.cdc.gov/travel/default.aspx or tel. 877.394.8747. (The CDC publishes a book on travel related infections and diseases in each region of the world, including immunization recommendation. The publication is free on line at www.cdc.gov (click on Traveler's Health) 
• The Public Health Service, tel. 404..639.3311. The Public Health Service provides a person-to-person consultation with a travel advisor.
• The Department of State's Consular Information Sheets, available by phone (202-647-5225) or Internet (www.travel.state.gov ).

For information on vaccinations required for a particular country, contact The World Health Organization at www.who.int/ith

Some local Public Health offices offer vaccines for a traveler at a fraction of what you would pay at a doctor's office. To find your local county office of health, look in your telephone book or contact your state Department of Health listed in the blue pages of your phone book.

When you return from your trip, discuss with your doctor any symptoms your experience while abroad. They could be early warning signs of trouble and guide the doctor to prescribe appropriate medication and treatment.Discuss any symptoms with your traveling companion as well.

In order to assure access to western style medical care, consider joining one of the following organizations before you go:

• The International Association for Medical Assistance to Travelers (IAMAT). IAMAT members are guaranteed treatment by English-speaking doctors should you need medical aide during your trip. IAMAT's Western-trained doctors are available in 125 countries. IAMAT is located at 317 Center Street, Lewiston, NY 14092 or www.iamat.org tel. 716.754.4883.

• International SOS Assistance (ISOSA) offers medical assistance to its members including screening foreign doctors, medical supervision and medical evacuation. ISOSA also offers travel insurance. Contact tel. 800.523.8662 or www.internationalsos.com/en/index.htm?CFID=12845304&CFTOKEN=97443628

• TravelMed provides hotel house call service, oxygen and medical equipment in 826 cities in 82 foreign countries. (tel. 800-878-3627) or http://www.travmed.com/ .

Consider purchasing travel insurance. See Travel Insurance Post Diagnosis

The preparation required depends on the type of health insurance you have. No matter what type you have, look for provisions about medical care outside the U.S. as well as emergency care. For instance, will your insurance pay for a medical evacuation from a remote, resource-poor area to a hospital where you can receive adequate treatment or a flight back home? If ther are gaps, consider travel health insurance.

• Managed Care If you have an HMO or other managed care coverage, check your policy to learn what you should do if you have a medical problem while you're abroad. If there are questions, call the insurance company.
• Indemnity Policy (Fee For Service type policy): If you have an indemnity policy, check it to learn what you should do if you have a medical problem while you' are outside the U.S. 
  • Expect that you will have to pay the bill rather than have it billed directly to the insurance company. 
  • Be sure to obtain proof from the medical provider which shows that your use of a foreign medical system was a medical necessity.
  • If there are questions, call the insurance company.
• Medicare: 
  • Traditional Medicare does not provide any coverage outside the U.S. (except in very limited circumstances near the borders in Canada and Mexico).
  • Medigap policies C through J cover travel emergency coverage outside the U.S. for the first 60 days of any trip. The Medigap benefit covers 80% of emergency care administered outside the country. A $250 deductible and $50,000 lifetime maximum for foreign-travel emergency care apply.
• Medicare managed care: If you have a Medicare Advantage managed care plan:
  • The plan must pay for emergency care whenever and wherever you need it. An emergency is when you believe that your health is in serious danger. For example, when you have severe pain, a bad injury, or a sudden worsening of illness. 
  • Medicare also requires managed care plans to pay for "urgent care" if you are outside your plan's service area. Urgent care is care you need for a sudden illness or injury that is not a medical emergency.
  • If there are questions, call the insurance company.
• Medicaid: Medicaid does not provide coverage outside the U.S.

If your health insurance covers outside the United States

At least ask your insurer the following questions. If possible, get the answers in writing.

• Does this insurance policy cover emergency expenses abroad such as returning me to the United States for treatment if I become seriously ill?
• Does this insurance cover high-risk activities such as parasailing, mountain climbing, scuba diving and off-roading?
• Does this policy cover pre-existing conditions?
• Does the insurance company require pre-authorizations or second opinions before emergency treatment can begin?
• Does the insurance company guarantee medical payments abroad?
• Will the insurance company pay foreign hospitals and foreign doctors directly?

If your health insurance does not cover outside of the United States or for the period of time you will be away, consider obtaining health coverage while you travel by one of the following means:

• Purchase a supplemental health insurance policy which will cover outside the United States. For example, through a company such as International Medical Group, see: www.imglobal.com
• Obtain coverage through travel insurance which does not exclude pre-existing health conditions. As a general matter, such policies need to be purchased within a few weeks after obtaining your ticket.
  • The Bureau of Consular Affairs includes a list of companies that offer travel medical insurance on its web site: http://bit.ly/2WniOm
  • For information about travel insurance post diagnosis, click here.

International SOS operates 21 health clinics and 24 help centers overseas that you can visit. The company also offers online profiles of over 150 countries. It alerts travelers to problems by e-mail or mobile phone. See: www.internationalsos.com/en/index.htm?CFID=12845304&CFTOKEN=97443628 .

Passport

• For information on obtaining or renewing your passport, see www.travel.state.gov
• For a list of services to expedite receipt of a passport, see www.astanet.com , the website of The American Society of Travel Agents.

Preclearance

TSA has set up a pre clearance program that provides a means of avoiding delays when going through security checks. Saving time can be important, particularly when you are not feeling well. For information about the program, including the application process, see: www.tsa.gov/tsa-precheck

Follow the guidelines for packing for any travel. In addition:

Don't jumble your medications together. Keep them in bottles with prescription name and date on the labels. It will help avoid problems with customs officials when you cross international borders.

Carry your medications with you in case your suitcase gets delayed or lost. Given high security today, it couldn't hurt to also take a copy of your prescriptions.

If you are traveling to a country whose main language you don't speak, include a phrase book that includes medical phrases in your carry-on luggage.

An interesting substitute for a phrase book is a small book with photographs called Point It, Traveller's Language Kit, published by Graf Editions, available through bookstores such as Fotofolio in New York City (212.26.0923) or at www.grafeditions.de . The book -- which is smaller than a passport-- contains photos of items and needs a traveler is likely to encounter so you don't even have to worry about mispronouncing words in a foreign language.

Many airlines no longer supply pillows. If they do, they can spread disease because they are freshened at most once a day. Bring your own inflatable pillow.

Check to see about other countries restrictions on traveling with a seeing-eye dog. Some countries severely restrict the entry of animals. Your dog may be subject to quarantine.

Write for the pamphlet "Traveling with Your Pet" from TravelPort, Air Cargo Center, Kennedy International Airport, NY 11430.

Because of an immunodeficiency, people living with HIV with lowered immune systems are at increased risk for complications of vaccine-preventable diseases.

Scientists have found that people with HIV do not experience more adverse reactions to inactivated vaccines that people who are not HIV+. However, live-organism vaccines may be more likely to cause and adverse reaction. Plus, depending on the degree to which your immune system is compromised (if at all), your immune system may be less likely to respond to a vaccine -- possibly rendering it ineffective.

Taking the risks and benefits into consideration, standard advice is usually in favor of vaccination for people with HIV. Consult your doctor if you have a question.

If you do decide to receive a vaccine, still try to avoid infections whenever possible. For example, avoid mosquito bites in yellow fever areas and exposure to people with measles or chickenpox. To learn more about how to avoid infections, click here.