Travel, migration and HIV

Differences in travel-related incidence of chlamydia by age groups, gender and destination: Sweden 2000-2013

BACKGROUND

The absolute number of travel-related Chlamydia cases in Sweden has consistently increased between 2000 and 2013. Given the growth in international travel, we aimed to study the trends of travel-related Chlamydia incidence to determine differences and identify high-risk groups and destinations.

METHODS

For 2000-2013 we calculated annual Chlamydia incidence per 100,000 travels by dividing the number of notified travel-related cases by the number of travels; the latter were collected from a yearly survey among Swedish residents. For specific destinations 95% confidence intervals were calculated and monotonic yearly trends tested.

RESULTS

The overall median annual travel-related Chlamydia incidence was higher for women than for men, but the opposite was true in age groups >25 years. For men, Thailand had the highest incidence, which was 3-7 times higher than the next highest destination in each age group. Spain, Turkey and Thailand had the highest incidence among women, but differences between countries were smaller than for men. For most destinations the yearly trends were stable.

CONCLUSIONS

We showed different profiles for men and women and age groups in terms of high incidence destinations. This specific information could allow to better tailor safe sex messages and advocate post-travel Chlamydia testing to target groups travelling to certain destinations.

HIV/AIDS Risk to Women Travelers in Thailand: Comparison of Japanese and Western Populations

Japanese and Western women travelers to Thailand were interviewed to determine factors associated with travel and risk of sexually transmitted HIV infection. Self-administered questionnaires ( n = 179) were collected at beach resort areas during July and August of 1995. Four travel attitude profiles were determined by a Principle Components Analysis. Japanese travelers reported attitudes consistent with “Relaxation/Romance,” and Western travelers attitudes consistent with “Sexual Adventure.” Both groups indicated that they would develop a sexual relationship with another traveler, as opposed to a local Thai. Japanese respondents were less likely to report carrying condoms, report the intention to use condoms, or report knowledge about AIDS in Thailand. They also reported less comfort with the open distribution of condoms and AIDS prevention information. Differing HIV risk beliefs and behaviors indicate that cultural factors should be taken into account when designing intervention messages and materials for any group.

The harm inside: injection during incarceration among male injection drug users in Tijuana, Mexico

Limited access to sterile syringes and condoms in correctional facilities make these settings high risk environments for HIV transmission. Although incarceration among injection drug users (IDUs) is common, there is limited information regarding specific IDU risk behaviors inside. We examined correlates of incarceration, injection inside and syringe sharing inside among male IDUs recruited in Tijuana, Mexico, using respondent driven sampling (RDS) (n=898). An interviewer administered survey collected data on sociodemographic, behavioral and contextual characteristics. Associations with (a) history of incarceration, (b) injection inside, and (c) syringe sharing inside were identified using univariate and multiple logistic regression models with RDS adjustment. Seventy-six percent of IDUs had been incarcerated, of whom 61% injected inside. Three quarters (75%) of those who injected shared syringes. U.S. deportation [adjusted odds ratio (AOR)=1.61; 95% confidence interval (CI): 1.07, 2.43] and migration (AOR=1.81; 95% CI: 1.12, 2.95) were independently associated with incarceration. Injection inside was independently associated with recent receptive syringe sharing (AOR=2.46; 95% CI: 1.75, 3.45) and having sex with a man while incarcerated (AOR=3.59; 95% CI: 1.65, 7.83). Sharing syringes inside was independently associated with having sex with a man while incarcerated (AOR=6.18; 95% CI: 1.78, 21.49). A majority of incarcerated IDUs reported injecting and syringe sharing during incarceration, and these IDUs were more likely to engage in sex with other men. Corrections-based interventions to reduce injection and syringe sharing are urgently needed, as are risk reduction interventions for male IDUs who have sex with men while incarcerated.

The impact in the UK of the Central and Eastern European HIV epidemics

Despite increasing migration, the impact of HIV epidemics from Central and Eastern Europe (C&EE) on the UK HIV epidemic remains small. C&EE-born adults comprised 1.2% of adults newly diagnosed with HIV in the UK between 2000 and 2007. Most C&EE-born women probably acquired their infection heterosexually in C&EE. In contrast, 59% of C&EE-born men reported sex with men, half of whom probably acquired their infection in the UK. Previously undiagnosed HIV prevalence in C&EE-born sexual-health-clinic attendees was low (2007, 0.5%) as was overall HIV prevalence in C&EE-born women giving birth in England (2007, <0.1%). The high proportion of men who have sex with men (MSM) suggests under-reporting of this group in C&EE HIV statistics and/or migration of MSM to the UK. In addition to reducing HIV transmission in injecting drug users, preventative efforts aimed at C&EE-born MSM both within their country of origin and the UK are required.

Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico

HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and treatment programs. IDUs aged > or = 18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N = 898), factors independently associated with higher HIV prevalence were syphilis titers consistent with active infection, being arrested for having 'track-marks', having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in this region, and whether US immigration policies adversely affect HIV risk.

Individual, social, and environmental influences associated with HIV infection among injection drug users in Tijuana, Mexico

OBJECTIVE

We examined correlates of HIV infection among injection drug users (IDUs) in Tijuana, Mexico, a city bordering the United States, which is situated on major migration and drug trafficking routes.

METHODS

IDUs aged > or =18 years were recruited using respondent-driven sampling. Participants underwent antibody testing for HIV and syphilis and structured interviews. Weighted logistic regression identified correlates of HIV infection.

RESULTS

Of 1056 IDUs, the median age was 37 years, 86% were male, and 76% were migrants. HIV prevalence was higher in female participants than in male participants (8% vs. 3%; P = 0.01). Most IDUs testing HIV-positive were previously unaware of their serostatus (93%). IDUs reported injecting with a median of 2 people in the prior 6 months and had been arrested for having injection stigmata (ie, "track-marks") a median of 3 times. Factors independently associated with HIV infection were being female, syphilis titers consistent with active infection, larger numbers of recent injection partners, living in Tijuana for a shorter duration, and being arrested for having track-marks.

CONCLUSIONS

Individual, social, and environmental factors were independently associated with HIV infection among IDUs in Tijuana. These findings suggest the need to intervene not solely on individual risk behaviors but on social processes that drive these behaviors, including problematic policing practices.

Mobility and its liminal context: Exploring sexual partnering among truck drivers crossing the Southern Brazilian border

Mobile populations, including truck drivers, are at elevated risk of acquiring HIV and other sexually transmitted infections (STI). However, measures of mobility have been poorly operationalized and little research exists exploring the psychosocial context of mobility and sexual risk taking. A systematic sample of 1775 male truck drivers underwent interview at two customs stations on the Southern Brazilian international border in 2003. The psychosocial effect of being mobile was assessed by clustering truckers based on perceptions of the liminal environment, or being outside of one's normal social environment. The relationship between physical mobility (nights spent at home) and liminal cluster with sexual partnerships was assessed. The clustering procedure yielded three dispositions towards the liminal environment. Compared to truckers in the baseline cluster, those who perceive the environment as (1) very, or (2) moderately permissive had increased odds of reporting a commercial sex partner in the past six months and reported increased numbers of commercial partners. For each week slept at home, the odds of reporting a commercial partner decreased by a factor of 0.73 and the average number of commercial partners decreased by a rate of 0.76. Physical and psychosocial measures of mobility were associated independently with increased partnering on the road. Additional exploration of how the liminal environment shapes mobile populations' sexual decision making and vulnerability to STI is warranted.

Migration and transmission of blood-borne infections among injection drug users: understanding the epidemiologic bridge

Migration is one of many social factors contributing to the spread of HIV and other blood-borne or sexually transmitted infections (STI). Bringing together large numbers of people from diverse settings, the process of migration moves infected individuals to diverse geographic locations. Injection drug users (IDU) are a relatively mobile group, often moving between cities, smaller communities, and across international borders for reasons of work, security, or access to narcotics. This mobility indicates the potential for IDU who engage in risky behavior outside their home areas to transmit HIV infection to other IDU, their sex partners, and others in the population. The objectives of this review are to examine: (1) the influence of drug trafficking and the spread of drug use on the diffusion of HIV, (2) the influence of migration on drug use and HIV-related risk behaviors among migrants, and (3) the mobility patterns of IDU and its role in the spread of HIV. We also discuss the potential policy implications of addressing prevention and care issues in mobile drug using populations.

HIV and ethnicity in Canada: is the HIV risk-taking behaviour of young foreign-born MSM similar to Canadian born MSM?

There is a dearth of information on the HIV risk-taking behaviour of foreign-born men who have sex with men (MSM) in Canada. This study focused on identifying sexual risk behaviour among MSM who immigrated to Canada and compared them to MSM who were born in Canada. Baseline data from the Omega Cohort in Montreal and the Vanguard Project in Vancouver were combined to form four ethnicity/race analytical categories (n = 1,148): White born in Canada (WBIC), White born outside of Canada, non-White born in Canada (NBIC) and non-White born outside of Canada (NBOC). Psychological, demographic and sexual behaviour characteristics of the groups were similar except: NBOC were more likely to be unemployed, less likely to be tattooed, had fewer bisexual experiences and less likely worried of insufficient funds. WBOC were more likely to report unprotected sex with seropositives and more likely to have had unprotected sex while travelling. NBIC were more likely to have ever sold sex and to have had body piercing. WBOC are at high risk of acquiring as well as transmitting HIV. It is important to consider place of birth in addition to ethnicity when developing programmes to prevent the transmission of HIV.

'What happens in Tenerife stays in Tenerife': Understanding women's sexual behaviour on holiday

Recent research has drawn attention to the epidemiological importance of international travel in the spread of HIV. Drawing on data generated in focus groups and in depth interviews with women holiday travellers, this paper explores the context of sexual risk behaviour of women on holiday. These data suggest that freedom from the constraints and realities of domestic life is a crucial aspect of the holiday experience. It is argued that holidays are a 'liminoid period' in which norms of behaviour are temporarily abandoned. Furthermore, on holiday, time becomes 'compressed'. Thus relationships follow a similar pattern to that they would at home however over a much shorter time period. Time compression and liminality lead to the rapid establishment of trust in new relationships. This has implications for sexual risk: women have sexual intercourse more quickly with a new partner on holiday than they do at home. Unqualified trust in relative strangers also raises issues for women's general safety.

HIV and sexual health knowledge and sexual experience among Australian-born and overseas-born students in Sydney

PURPOSE

To examine differences between Australian-born and Asian-born first-year university students in Sydney in their sexual behavior and knowledge about the prevention and transmission of human immunodeficiency virus (HIV) and other sexually transmissible infections (STIs).

METHODS

Students were recruited from a stall during the student Orientation Week in both 2002 and 2003 at the University of New South Wales. A short questionnaire was completed and returned anonymously. Data on age, gender, country of birth, sexual behavior, and sexual health knowledge were collected. A score was calculated based on the sum of the correct answers given to 12 HIV/STI transmission and prevention questions. The students were then divided into three groups according to their country of birth (Australia, Asia, and elsewhere) and their knowledge scores were compared. Students born in certain Asian countries were also asked their perception of the HIV epidemic in their home country compared with Australia.

RESULTS

A total of 1185 first-year students completed the questionnaire. Although older on average, Asian-born students were less likely to have had sexual intercourse and had had fewer sexual partners. They also had consistently poorer HIV/STI knowledge scores than Australian-born students. Students born in China, Hong Kong, Indonesia, Malaysia, and Singapore but not Thailand underestimated the prevalence of HIV in their country of birth in comparison with Australia.

CONCLUSION

The combination of poorer knowledge, apparent misconception of the extent of HIV epidemic in their home country (or Australia), and potential later frequent travel indicates a potential risk for later transmission of HIV/STIs. The university is an underused setting for prevention health education.

An agenda for future research on HIV and sexual behaviour among African migrant communities in the UK

The epidemiology of the recent rise in HIV cases in Britain highlights the need for more research among the heterosexual African migrant population. New research should not, however, only extend the limited number of studies that describe observable patterns in sexual health but should also seek to determine their underlying social causation. To achieve this, both methodological and ontological shifts are necessary in the existing research paradigm; we advocate that a broad range of qualitative techniques be deployed both to uncover the empirical details of specifically African sexual behaviours and to highlight and explore the 'relational' nature of sexual decision-making. Rather than fixing on individuals, analysis must situate them within the broader discursive and material frames that structure the boundaries of decision-making. In addition, researchers need to utilise the parallel literature on the social embeddedness of HIV in Africa to inform analysis of the British context. It would then be possible to address the crucial question of whether the social conditions known to cause high-risk behaviours and facilitate transmission in Africa persist, or are transformed, after migration to the UK. A key, and neglected, dimension of this is the role of spatial context in relational sexual decision-making and the constitution of social relationships in particular arenas. This needs further thought, particularly in relation to domestic space and gender identities. We believe that the research agenda proposed herein has much to contribute to interventions and service provision. Nevertheless, we are mindful of the need for self-reflexivity about our role in the production of powerful knowledges about sex. Our final proposal is that researchers seek ways to work with, not on, African communities in order to facilitate their own informed management of sexual health.

Sexual behavior in travelers visiting Cuzco

BACKGROUND

In South America, little is known about sexual behavior and risk factors for acquiring sexually transmitted diseases (STDs) among travelers and among local people sexually interacting with travelers. There is evidence that, in Peru, significant sexual interaction between these groups exists.

METHOD

An anonymous written questionnaire was administered to travelers in the airport and bus stations before they left Cuzco.

RESULTS

Of the travelers,5.6% engaged in sexual activity with a new partner during their stay in Cuzco. Sexual intercourse with other travelers was most common (76/140, 54.3%), followed by sex with local partners (57/140, 40.7%), and with commercial sex workers (3/140, 2.15%). Consistent condom use was reported by 97/140 (69.3%). In the multivariate analysis, the following variables were independently associated with casual sex: male gender, single marital status, age between 15 and 35 years, non-United States travelers (NUSTs), traveling alone or with friends, length of stay more than 30 days, homosexual or bisexual orientation, and expectation of having sex before traveling. Homosexual and bisexual travelers had 3 or more new sexual partners more frequently than heterosexual travelers (4/8, 18/129, OR=6.17 (1.16<OR<33.5)). NUSTs received more pretravel advice (698/1587, 210/718, OR=1.86 (1.54<OR<2.24)) and engaged in more sexual activity (100/1,587, 25/722, OR=1.86 (1.20<OR<2.93)) than United States travelers (USTs).

CONCLUSION

Travelers visiting Cuzco engage in sexual activities that put them at risk of acquiring STD and transmitting it, both in their home country and in Peru. We recommend the inclusion of Peru and possibly other Latin American countries in the list of destinations where there is substantial risk of transmission of STD and the provision of pretravel advice regarding this issue to travelers to Peru.

Travel, tourism, and HIV risk among older adults

Although the importance of human mobility in the spread of infectious disease has been recognized for quite some time, surprisingly little attention has been given to older adults' travel-related HIV risk behavior. This essay discusses the importance of studying the role travel and tourism play in the spread of HIV infection in older adults, reviewing select research on travel/tourism and HIV risk and highlighting the theoretical and methodological challenges confronting researchers in this area.

The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clients

OBJECTIVE

This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions.

DESIGN AND METHODS

Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information.

RESULTS

Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05).

CONCLUSION

The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.

HIV infection among foreign transsexual sex workers in Rome: prevalence, behavior patterns, and seroconversion rates

BACKGROUND

The Azienda Sanitaria Locale Roma E (ASL-RME) outpatient clinic is the main reference center in Rome for HIV testing of foreign people.

GOAL

To define the prevalence and incidence of HIV infection among foreign transsexual sex workers attending the center.

STUDY DESIGN

A cross-sectional, follow-up study was conducted.

RESULTS

Between 1993 and 1999, 353 transsexuals attended the ASL-RME. They were from Colombia (n = 208), Brazil (n = 122), and other countries (n = 23). Most of these transsexuals reported having 5 to 10 partners per day. The overall HIV prevalence was 38.2%, which multivariate analysis found to be associated with origin from Brazil and a higher number of sex partners. The observed HIV seroconversion rate was 4.1 per 100 person-years, and non-regular condom use was the only factor related to seroconversion.

CONCLUSIONS

The data from this study suggest that promotion of safer sex practices and regular condom use still is the main priority among marginalized population subgroups, such as foreign prostitutes, involved in sex activities that put them at risk for HIV infection.

HIV surveillance in complex emergencies

Many studies have shown a positive association between both migration and temporary expatriation and HIV risk. This association is likely to be similar or even more pronounced for forced migrants. In general, HIV transmission in host-migrant or host-forced-migrant interactions depends on the maturity of the HIV epidemic in both the host and the migrant population, the relative seroprevalence of HIV in the host and the migrant population, the prevalence of other sexually transmitted infections (STIs) that may facilitate transmission, and the level of sexual interaction between the two communities. Complex emergencies are the major cause of mass population movement today. In complex emergencies, additional factors such as sexual interaction between forced-migrant populations and the military; sexual violence; increasing commercial sex work; psychological trauma; and disruption of preventive and curative health services may increase the risk for HIV transmission. Despite recent success in preventing HIV infection in stable populations in selected developing countries, internally displaced persons and refugees (or forced migrants) have not been systematically included in HIV surveillance systems, nor consequently in prevention activities. Standard surveillance systems that rely on functioning health services may not provide useful data in many complex emergency settings. Secondary sources can provide some information in these settings. Little attempt has been made, however, to develop innovative HIV surveillance systems in countries affected by complex emergencies. Consequently, data on the HIV epidemic in these countries are scarce and HIV prevention programs are either not implemented or interventions are not effectively targeted. Second generation surveillance methods such as cross-sectional, population-based surveys can provide rapid information on HIV, STIs, and sexual behavior. The risks for stigmatization and breaches of confidentiality must be recognized. Surveillance, however, is a key component of HIV and STI prevention services for forced migrants. It is required to define the high risk groups, target interventions, and ultimately decrease HIV and STI transmission within countries facing complex emergencies. It is also required to facilitate regional control of HIV epidemics.

Epidemiology and clinical profile of HIV/AIDS in Pakistan

This study reviews available data on HIV/AIDS in Pakistan and is the first to analyse a clinical series of HIV-infected patients thus giving a wider perspective of the epidemic in Pakistan. A retrospective analysis of all medical records of patients with HIV/AIDS since 1986 was conducted in March 1998 at a Karachi hospital. There were 67 patients. Twenty-two were overseas (Middle East) contract workers. None were sex workers or drug users. Fifty-four had travelled or lived abroad. High risk sexual behaviour was reported in 35 patients of whom 26 men reported contact with commercial sex workers, mostly in the Middle East (21). The most common AIDS indicator condition was chronic diarrhoea. HIV in Pakistan is currently a disease of those Pakistanis (and their sexual partners) who have travelled abroad, overseas contract workers and those who, prior to 1989, were transfused abroad or received imported blood products.

Factors associated with gay men's sexual behaviours and risk on holiday

Findings are presented from a questionnaire survey of 562 gay men resident in southern England on their sexual behaviour in the context of holidays. Data were gathered during summer 1996 by means of a self-completion questionnaire; 395 men reported at least one holiday undertaken in 1996 and the analysis focuses on the first or only holiday described. Of 391 men giving details of sexual activity, 187 reported sex with a new partner, 113 men reported penetrative sex and 17 reported penetration without consistent use of condoms. Sexual activity on holiday was predicted by: being on holiday alone or with friends, taking condoms, being motivated by 'gay social life and sex' in planning a holiday, higher expectations of sexual activity/risk and a higher number of new partners at home. Penetrative sex was predicted by: more sexual partners on holiday, taking condoms and higher expectations of sexual activity/risk. Unprotected sex was predicted by: not taking condoms, higher expectations of sexual activity/risk and positive HIV status. Survey findings are discussed in relation to previous research, and implications for travel-related HIV prevention initiatives targeting gay men are explored.

Are preventive HIV interventions at airports effective?

BACKGROUND

Few empirical data exist on the impact of preventive human immunodeficiency virus (HIV) interventions on intended and actual sexual behavior of international tourists. The present cross-sectional study is based on a 2 3 2 design.

METHODS

The sample consisted of departing and arriving passengers (n = 3100) at Zurich Airport with destinations in countries where heterosexual HIV transmission is dominant. While 41% of the tourists obtained information about safer sex, the remaining 59% without such intervention served as control group. Departing passengers completed a short questionnaire focusing on their planned sexual behavior. Arriving passengers were asked about their actual behavior during the journey. Subjects of the intervention group also evaluated the impact of the consultation.

RESULTS

Most travelers appreciated the intervention and reported that they received important information. Members of the intervention group were better informed than those of the control group about the risk of heterosexually transmitted HIV infection (p <.01). They also indicated more often that they could imagine having casual sex abroad (23% vs 16%, p <.01). However, the two groups did not differ with regard to planned condom use or actual sexual behavior. Whereas most of departing passengers indicated that they would use condoms consistently, only half of the passengers who reported casual sex actually did so. Subjects who refused to participate in the intervention tended to consider it as irrelevant and reported less consistent condom use.

CONCLUSIONS

Although travel health interventions focusing on casual sex are appreciated and increase the knowledge, they failed to result in significant behavior modification. Future projects should attempt to approach possible risk groups more specifically and to have more impact.

Sexual risk of HIV infection among expatriates posted in AIDS endemic areas

OBJECTIVE

To assess the prevalence of HIV infection and related risk factors among Dutch expatriates returning from assignment in sub-Saharan Africa, Latin America, and South and South-east Asia.

METHODS

From July 1994 to January 1996, a questionnaire on the risks of sexual exposure was completed by 864 respondents, and blood samples were taken.

RESULTS

Of the 634 men, 41% reported having sex with casual or steady local partners and 11% with casual or steady expatriate partners, during an average stay of 26 months in the previous 3 years. Of the 230 women, these figures were 31 and 24%, respectively. Of the men with local casual partners (29%), 59% paid for sex at least once. For men as well as women, having sexual contacts abroad was associated with younger age, positive intention prior to departure to have sex abroad, being single at departure, and, only for the men, working for a commercial organization, and feelings of loneliness and boredom. Among men, consistent condom use with casual local partners was 69%, and with casual expatriate partners 63%. Among women, these figures were 64 and 48%, respectively. Consistent condom use with steady local or expatriate partners was much lower. Among men, non-consistent condom use with casual partners was more prevalent if they had been abroad for a longer time, condoms were not taken along from The Netherlands, the country where they were posted was Asian, and the estimated HIV prevalence among the local population was lower. Among the women, non-consistent condom use was more prevalent if condoms were not taken along, and if they did not have the intention before departure to have sex abroad. Of the persons from whom blood could be obtained, one man was HIV-positive. Another man who refused to participate in the study indicated that he was HIV-positive.

CONCLUSIONS

Although 23% of the expatriates had unprotected sex with partners from endemic areas, very few HIV infections were found. In comparison with a previous study among this population carried out in 1987-1989, which found five out of 1968 expatriates to be HIV-infected, consistent condom use with casual local partners did increase considerably (from 21 to 67%). However, health education is needed to reduce the risk of HIV infection, which should emphasize the sociocultural differences in sexual practices.

Risk behaviour and STD acquisition in genitourinary clinic attenders who have travelled

OBJECTIVE

To investigate the travel history of clients presenting at a genitourinary medicine (GUM) clinic in order to assess the contribution made by sexual partnerships abroad to STD transmission in the UK.

SUBJECTS

386 old and new clients who attended during a 3-month period and who had travelled abroad in the 3 months preceding their visit.

METHODS

All participating clients self-completed a confidential questionnaire, the results of which were then linked to their clinical diagnosis (if any).

RESULTS

25% of participants reported a new sexual partner during their most recent trip abroad. In comparison to those not reporting a new partner, they were more likely to be male, travelling alone, to have visited the clinic previously and to have no regular sexual partner. Two-thirds reported never or inconsistently using condoms with these new partners. A total of 11.6% of the STDs diagnosed in the study participants may have been acquired abroad.

CONCLUSION

We have found a high rate of new sexual relationships reported by attendees at our GUM clinic, and a low rate of reported condom use. With high HIV incidence rates in many tourist regions, the need for further studies to establish the true extent of imported STDs in the UK is a priority, and primary prevention campaigns to inform travellers are of paramount importance.