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Zhou Q, Wu W, Yi M, Shen Y, Goldsamt L, Alkhatib A, Jiang W, Li X. HIV knowledge, sexual practices, condom use and its associated factors among international students in one province of China: a cross-sectional study. BMJ Open 2022; 12:e058108. [PMID: 36038170 PMCID: PMC9438073 DOI: 10.1136/bmjopen-2021-058108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE China has seen an increasing number of international students in recent years, mostly from Africa and Asia. However, little is known about these students' HIV knowledge, sexual practices and potential HIV risk. This study aimed to describe HIV-related risk among international students. DESIGN An online cross-sectional survey. SETTING 10 universities situated in one province of China. PARTICIPANTS 617 international students filled out the questionnaire and 607 international students were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Socio-demographic and programme-related characteristics, HIV-related knowledge, sexual practices and other HIV/sexually transmitted infection-related variables. Logistic regression analyses were performed to examine factors associated with inconsistent condom use among international students. RESULT The results showed that in total, only 51.6% (313/607) of international students had adequate HIV-related knowledge, and 64.9% (394/607) reported not receiving any HIV related education or training while studying in China. Moreover, 32.3% (196/607) reported having penetrative sex including oral, vaginal and anal sex during the period in which they studied in China and among them. The proportions of inconsistent condom use in vaginal and oral intercourse while studying in China were 52.6% (50/95) and 79.5% (35/44), respectively, with casual partners, and 60% (80/129) and 91.2% (52/57) with regular partners, respectively. Female gender, being married and having multiple sexual partners were associated with inconsistent condom use. CONCLUSION The present study indicated that international students in one province of China have suboptimal HIV-related knowledge, significant unprotected sex, less HIV testing and less safe sex education, which highlights an urgent need to provide HIV education and related health services to international students in China.
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Affiliation(s)
- Qidi Zhou
- Xiangya Shool of Nursing, Central South University, Changsha, Hunan, China
| | - Weizi Wu
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Mengyao Yi
- Xiangya Shool of Nursing, Central South University, Changsha, Hunan, China
| | - Yan Shen
- Xiangya Shool of Nursing, Central South University, Changsha, Hunan, China
| | - Lloyd Goldsamt
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Asem Alkhatib
- Central South University Xiangya School of Nursing, Syria, Syrian Arab Republic
| | - Wenjing Jiang
- Central South University Xiangya School of Nursing, Chengdu, Sichuan, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Knowledge of the Sexual Transmission of Zika Virus and Preventive Practices Against Zika Virus Among U.S. Travelers. J Community Health 2020; 44:377-386. [PMID: 30478625 DOI: 10.1007/s10900-018-0594-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Individuals are often at increased risk of acquiring infectious disease while traveling. We sought to understand knowledge, attitudes and practices (KAP) regarding Zika virus among travelers from the United States. A total of 1043 study participants were recruited from a probability-based internet panel. Participants self-reported their knowledge of Zika infection and modes of transmission, and identified actions they had taken to prevent Zika infection and transmission including actions to prevent unintentional pregnancy since becoming aware of the Zika virus. Logistic regression was used to model the odds of taking preventive actions against Zika infection with adjustment for potential confounding factors. Knowledge of the sexual transmissibility of Zika virus significantly increased the odds of taking a preventive action against Zika infection, especially condom use or sexual abstention. Participants reported preferences for receiving information about Zika from private doctors and from the Internet. Discrepancies between where travelers seek information about Zika and how they would like to receive information regarding Zika were also found. These findings suggest that improving targeted messaging through online media may increase awareness of the sexual transmissibility of Zika as well as improve health communications with U.S. travelers. Travelers who are unaware of potential disease risks are less likely to adopt personal protective measures to protect themselves and reduce disease spread. Thus, future work should focus on improving communication and providing education to adopt effective prevention strategies while traveling.
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Martins SL, Hellerstedt WL, Bowman SB, Brady SS, Mason SM. International Travel as a Context for Sexual and Contraceptive Behaviors: A Qualitative Study of Young Women Traveling Outside the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1039-1052. [PMID: 31243616 DOI: 10.1007/s10508-019-1400-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
International travel is popular worldwide, yet its implications for sexual and reproductive health are not fully understood. Few studies have examined the contextual factors that shape women's sexual and contraceptive behaviors-and thus, their risk of unintended pregnancy and sexually transmitted infections (STIs)-while traveling outside their home country. In this qualitative study, female university students with recent (n = 25) or upcoming (n = 19) travel outside the U.S. completed semi-structured interviews from October 2015 to March 2017. Transcripts were analyzed for themes related to contraceptive and sexual behaviors: (1) participants' pre-travel expectations of sex; (2) the circumstances surrounding sexual encounters with men while traveling; (3) negotiation about condom and contraception use with partners; and (4) factors affecting contraceptive adherence. Participants generally expected to be abstinent during travel, citing myriad rationales that included personal values, no perceived opportunities for sex, and the nature of the trip. Some travelers had unexpected sexual encounters, involving health-protecting behaviors and risk-taking (e.g., unprotected sex, substance use). New sexual partnerships were fueled by increased attention from men, situational disinhibition, and perceived heightened intimacy. International travel brought many contraceptive considerations (adequacy of supplies, access to refrigeration, time zone differences, etc.) as well as obstacles that triggered contraceptive lapses and discontinuation. Pill users described the most challenges, while travelers using intrauterine devices expressed appreciation for their maintenance-free contraception. This study suggests complex associations between international travel and young women's sexual and reproductive health. Some travelers were more vulnerable to situational risk factors, while others may have been more insulated. We identify potential intervention opportunities via clinical services, education, and policy to reduce young women's risk of adverse sexual and reproductive health outcomes while traveling abroad. We urge greater recognition of and conversations about contraceptive lapse and unintended pregnancy as potential health risks for female travelers of reproductive age, just as clinical guidelines acknowledge travel-associated STI.
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Affiliation(s)
- Summer L Martins
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1301 2nd Street S., Suite 300, Minneapolis, MN, 55455, USA.
| | - Wendy L Hellerstedt
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1301 2nd Street S., Suite 300, Minneapolis, MN, 55455, USA
| | - Sara B Bowman
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1301 2nd Street S., Suite 300, Minneapolis, MN, 55455, USA
| | - Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1301 2nd Street S., Suite 300, Minneapolis, MN, 55455, USA
| | - Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1301 2nd Street S., Suite 300, Minneapolis, MN, 55455, USA
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Sundbeck M, Agardh A, Östergren PO. Travel abroad increases sexual health risk-taking among Swedish youth: a population-based study using a case-crossover strategy. Glob Health Action 2018; 10:1330511. [PMID: 28598729 PMCID: PMC5496094 DOI: 10.1080/16549716.2017.1330511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The fact that youth take sexual risks when they are abroad have been shown in previous studies. However, it is not known if they increased their sexual risk-taking when travelling abroad, compared to the stay in their homeland. Objective: To assess whether Swedish youth increased their individual sexual risk behaviour, defined as having a casual sex partner, when travelling abroad and to examine possible factors that may be associated with increased risk-taking abroad. Design: In 2013, a population-based sample of 2189 Swedes, 18-29 years, was assessed by a questionnaire (45% response rate). Sexuality, duration of travel, parents’ country of origin, mental health, heavy episodic drinking (HED), use of illicit drugs, and socio-demographic background were assessed. Increased risk of casual sex in relation to time spent abroad vs. time spent in Sweden was analysed by a variant of case-crossover design. Factors that could be associated with increased risk of casual sex in Sweden and abroad, separately, were analysed by logistic regression.
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Affiliation(s)
- Mats Sundbeck
- a Social Medicine and Global Health , Lund University , Malmö , Sweden
| | - Anette Agardh
- a Social Medicine and Global Health , Lund University , Malmö , Sweden
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Trevis T, Gossé M, Santarossa N, Tabrizi S, Russell D, McBride WJ. Mycoplasma genitalium in the Far North Queensland backpacker population: An observational study of prevalence and azithromycin resistance. PLoS One 2018; 13:e0202428. [PMID: 30153259 PMCID: PMC6112622 DOI: 10.1371/journal.pone.0202428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Mycoplasma genitalium is a sexually transmitted infection (STI), and a common cause of non-gonococcal urethritis (NGU). There is concern regarding the rise in prevalence of M. genitalium and rates of resistance to macrolide antibiotics. International backpackers represent a unique population that may be at an increased risk of STIs. The purpose of this study was to determine the prevalence of M. genitalium and antibiotic resistance in international backpackers. Methods First void urine samples were obtained utilising opportunistic sampling from 294 non-treatment-seeking international backpackers at a variety of hostels in Cairns, Queensland Australia. Participants also answered a fixed-answer survey regarding sociodemographic characteristics and sexual risk behaviours. Samples were tested for M. genitalium, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction (PCR). Samples positive for M. genitalium were investigated for macrolide resistance-associated mutations in the 23S rRNA genome at positions A2058G, A2058C, A2058T, A2059G and A2059C (Escherichia coli numbering). Results Of the 294 samples, 23 failed the internal control. The prevalence of M. genitalium was 1.8% (5/271, 95% confidence interval [CI] ± 1.58), C. trachomatis was 4.1% (11/271, 95% CI ± 2.36) and N. gonorrhoeae was not detected. Macrolide resistance-associated mutations were identified in 40% (2/5) of M. genitalium-positive samples. M. genitalium infection was associated with reporting symptoms (odds ratio [OR] 14.36, 95% CI 2.17–94.94, p < 0.05). Conclusions M. genitalium and C. trachomatis are relatively common amongst non-treatment seeking international backpackers, but may not differ from Australian population prevalence. This article provides evidence to further support the increased utilisation of M. genitalium PCR in the diagnosis of NGU, and for macrolide resistance testing for all identified M. genitalium infections.
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Affiliation(s)
- Thomas Trevis
- James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia
- * E-mail:
| | - Marianne Gossé
- Norwegian University of Science and Technology, Faculty of Medicine, Trondheim, Norway
| | - Nicola Santarossa
- James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia
| | - Sepehr Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns North, Queensland, Australia
| | - William John McBride
- James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia
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Svensson P, Sundbeck M, Persson KI, Stafström M, Östergren PO, Mannheimer L, Agardh A. A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel. Travel Med Infect Dis 2018; 24:65-88. [PMID: 29567294 DOI: 10.1016/j.tmaid.2018.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND International travel facilitates global spread of sexually transmitted infections (STI). Travellers could contribute to onward transmission of pathogens rarely encountered at home and export new strains to the destination. The aim was to systematically examine evidence regarding determinants of travel-related sexual risk-taking and identify knowledge gaps and areas for targeted interventions. METHOD Articles published in peer-reviewed journals from 2000 to 2017 were screened in 6 databases and assessed for relevance against criteria. Data was extracted for factors associated with travel-related STI or proxies. Meta-analyses estimated pooled prevalence of casual sex and non-condom use. Adjusted odds ratios of predictors were pooled to generate a combined estimate. RESULT Forty-nine articles qualified for inclusion. A heterogeneity test indicated variation across studies. The pooled prevalence of casual travel sex was 35% and prevalence of non-condom use 17%. Expectations of casual sex strongly predicted sex with a new partner when travelling abroad. Planning to have sex indicated condom use. CONCLUSION The studies largely represented sub-groups of risk-taking populations from a European context, indicating substantial knowledge gaps. Studies investigating migrants travelling to visit friends and relatives, older travellers, and female travelers are needed. Post-travel harm reduction activities may serve as a focus for future interventions.
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Affiliation(s)
- Pia Svensson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Mats Sundbeck
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kristina Ingemarsdotter Persson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Public Health Agency, Health and Sexuality, Stockholm, Sweden
| | - Martin Stafström
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Louise Mannheimer
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Public Health Agency, Health and Sexuality, Stockholm, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Chen LH, Leder K, Barbre KA, Schlagenhauf P, Libman M, Keystone J, Mendelson M, Gautret P, Schwartz E, Shaw M, MacDonald S, McCarthy A, Connor BA, Esposito DH, Hamer D, Wilson ME. Business travel-associated illness: a GeoSentinel analysis. J Travel Med 2018; 25:4841826. [PMID: 29462444 PMCID: PMC5824651 DOI: 10.1093/jtm/tax097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
Background Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers. Methods GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on ill business travelers, defined as persons traveling for work, evaluated after international travel 1 January 1997 through 31 December 2014. Results Among 12 203 business travelers seen 1997-2014 (14 045 eligible diagnoses), the majority (97%) were adults aged 20-64 years; most (74%) reported from Western Europe or North America; two-thirds were male. Most (86%) were outpatients. Fewer than half (45%) reported a pre-travel healthcare encounter. Frequent regions of exposure were sub-Saharan Africa (37%), Southeast Asia (15%) and South Central Asia (14%). The most frequent diagnoses were malaria (9%), acute unspecified diarrhea (8%), viral syndrome (6%), acute bacterial diarrhea (5%) and chronic diarrhea (4%). Species was reported for 973 (90%) of 1079 patients with malaria, predominantly Plasmodium falciparum acquired in sub-Saharan Africa. Of 584 (54%) with malaria chemoprophylaxis information, 92% took none or incomplete courses. Thirteen deaths were reported, over half of which were due to malaria; others succumbed to pneumonia, typhoid fever, rabies, melioidosis and pyogenic abscess. Conclusions Diarrheal illness was a major cause of morbidity. Malaria contributed substantial morbidity and mortality, particularly among business travelers to sub-Saharan Africa. Underuse or non-use of chemoprophylaxis contributed to malaria cases. Deaths in business travelers could be reduced by improving adherence to malaria chemoprophylaxis and targeted vaccination for vaccine-preventable diseases. Pre-travel advice is indicated for business travelers and is currently under-utilized and needs improvement.
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Affiliation(s)
- Lin H. Chen
- Mount Auburn Hospital, Cambridge, Massachusetts, and Harvard Medical School, Boston, MA, USA
| | - Karin Leder
- Royal Melbourne Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kira A. Barbre
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Michael Libman
- Montreal General Hospital and McGill University, Montreal, Quebec, Canada
| | - Jay Keystone
- Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Philippe Gautret
- Aix Marseille Université, IHU—Méditerranée Infection, Marseille, France
| | - Eli Schwartz
- The Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine Tel-Aviv University, Israel
| | - Marc Shaw
- Worldwise Travellers Health Centres New Zealand and James Cook University, Australia
| | - Sue MacDonald
- Medicine and Quality, Interior Health, and University of British Columbia, Kelowna, British Columbia, Canada
| | - Anne McCarthy
- Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Bradley A. Connor
- The New York Center for Travel and Tropical Medicine and Weill Medical College of Cornell University, New York, NY, USA
| | - Douglas H. Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Davidson Hamer
- Center for Global Health and Development, Boston University School of Public Health, and Boston University School of Medicine, Boston, MA, USA
| | - Mary E. Wilson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Crawford G, Lobo R, Brown G, Macri C, Smith H, Maycock B. HIV, Other Blood-Borne Viruses and Sexually Transmitted Infections amongst Expatriates and Travellers to Low- and Middle-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1249. [PMID: 27999275 PMCID: PMC5201390 DOI: 10.3390/ijerph13121249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
In some high-income countries, a proportion of human immunodeficiency virus (HIV), other blood-borne virus (BBV) or sexually transmitted infection (STI) diagnoses have been reported as acquired overseas in low- and middle-income countries. A review was conducted to explore HIV, other BBV or STI related knowledge, risk behavior and acquisition amongst expatriates and travelers, particularly males, travelling from high to low- and middle-income countries. Seven academic databases were searched for 26 peer reviewed articles that met inclusion criteria. Significant variability in the studies was noted, in age, travel duration and frequency and outcomes/risk factors measured and reported on. Risk factors described included longer duration of stay; being single; travel for romance or sex; alcohol and other drug use; lack of travel advice; being male; higher number of sexual partners; and inconsistent condom use. Vaccination, pre-travel health advice, and having fewer sexual partners were described as protective. Studies are needed focusing on the social context in which risk-taking occurs. Better collaboration is essential to deliver comprehensive health promotion interventions alongside more consistent pre- and post- travel testing and advice. Policy measures are crucial, including consistent evaluation indicators to assess impacts of HIV, other BBVs or STIs in the context of mobility. Risks and responses for these epidemics are shared globally.
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Affiliation(s)
- Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
| | - Graham Brown
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne 3083, Australia.
| | - Chloe Macri
- School of Public Health, Curtin University, Perth 6845, Australia.
| | - Hannah Smith
- School of Public Health, Curtin University, Perth 6845, Australia.
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
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Sexual risk-taking during travel abroad - a cross-sectional survey among youth in Sweden. Travel Med Infect Dis 2016; 14:233-41. [PMID: 27083687 DOI: 10.1016/j.tmaid.2016.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 03/09/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim was to assess sexual risk-taking behaviour in a sample of Swedish youth who were sexually active while travelling abroad and to examine possible associations with sexual risk-taking behaviour during such travel. METHODS From a population-based sample of 2189 Swedes 18-29 years, 768 who were sexually active while abroad, were assessed by a questionnaire concerning socio-demographic background, life-style, travel duration, sexuality, mental health, heavy episodic drinking (HED) and drug-use. RESULTS Approximately 1/4 reported intercourse with a casual partner abroad. Casual sex was associated with HED, 18-24 years, and drug use in both sexes, and for women, also with ≥one month of travel. Among youth with casual partners, 48% reported non-condom use. Non-condom use with a casual partner was associated with 18-24 years, ≥one month of travel for women, and poor self-rated mental health for men. About 10% had ≥2 partners abroad. Having ≥2 partners abroad was associated with ≥one month of travel, and for men also with HED. CONCLUSION Male sex, 18-24 years of age, ≥1 month of travel, HED, and drug use were significantly associated with sexual risk-taking during travel abroad. Poor self-rated mental health and foreign-born parentage might also constitute risk factors for men.
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Simkhada PP, Sharma A, van Teijlingen ER, Beanland RL. Factors Influencing Sexual Behaviour Between Tourists and Tourism Employees: A Systematic Review. Nepal J Epidemiol 2016; 6:530-8. [PMID: 27152234 PMCID: PMC4850236 DOI: 10.3126/nje.v6i1.14735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Increased travel abroad has a significant impact on the incidence and prevalence of Sexually Transmitted Infections (STIs). Previous reviews have focused on the knowledge, attitudes and behaviour of tourists and acquisition of STIs. Less is known about the impact on tourism operators in countries visited by tourists. The aim of this review is to ascertain factors influencing sexual behaviour between workers in the tourism industry and tourists; exploring the prevalence of sexual behaviour between the two populations, their perceptions of sexual risk while engaging in sexual activities and the knowledge of tourism operators regarding STIs. Methods: A systematic review was conducted. Database searches were performed in Medline/Ovid, EMBASE, Cochrane library and CINAHL for studies published between 2000 and March 2016. Grey literature searches were completed in the NHS database and Google Scholar between 2000 and December 2013. Papers were independently selected by two researchers. Data were extracted and critically appraised using a pre-designed extraction form and adapted CASP checklist. Results: The search identified 1,602 studies and 16 were included after review of the full text. Studies were conducted in nine countries. Findings suggest that STI knowledge, attitude and practice were fairly good among tourists and tourism workers, but there is a need for pre-travel advice for travellers, especially those travelling to low and middle-income countries. Greater importance was given to tourists than to tourism operators and locals interacting with tourists. Studies suggest that as a group both tourist and tourist workers were likely to engage in sexual activities. Overall, both condom use and STI screening were low, among tourists as well as tourism operators. Furthermore, studies reported links between drug and alcohol use and sexual behaviour and risk taking. Conclusion: Although less research appeared to have been conducted among tourism workers than tourists, it does demonstrate the need for education, training and promotion of travel medicine. STI screening, pre-travel advice, travel history in terms of contracting STIs and safe-sex awareness-raising are needed. More and better sexual health education and relevant tourism policies are needed globally.
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Alcedo S, Kossuth-Cabrejos S, Piscoya A, Mayta-Tristán P. Factors associated with non-use of condoms in an online community of frequent travellers. Travel Med Infect Dis 2015; 12:750-6. [PMID: 25457304 DOI: 10.1016/j.tmaid.2014.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 08/01/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. METHODS Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). RESULTS Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. CONCLUSION An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience.
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12
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The 2014 FIFA World Cup: communicable disease risks and advice for visitors to Brazil--a review from the Latin American Society for Travel Medicine (SLAMVI). Travel Med Infect Dis 2014; 12:208-18. [PMID: 24821081 DOI: 10.1016/j.tmaid.2014.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 11/21/2022]
Abstract
The next FIFA World Cup will be held in Brazil in June-July 2014. Around 600,000 international visitors and participants (as well over 3 million domestic travelers) are expected. This event will take place in twelve cities. This event poses specific challenges, given its size and the diversity of attendees, including the potential for the transmission of imported or endemic communicable diseases, especially those that have an increased transmission rate as a result of close human proximity, eg, seasonal influenza, measles but also tropical endemic diseases. In anticipation of increased travel, a panel of experts from the Latin American Society for Travel Medicine (SLAMVI) developed the current recommendations regarding the epidemiology and risks of the main communicable diseases in the major potential destinations, recommended immunizations and other preventives measures to be used as a basis for advice for travelers and travel medicine practitioners. Mosquito-borne infections also pose a challenge. Dengue poses a significant risk in all states, including the host cities. Vaccination against yellow fever is recommended except for travelers who will only visit coastal areas. Travelers visiting high-risk areas for malaria (Amazon) should be assessed regarding the need for chemoprophylaxis. Chikunguya fever may be a threat for Brazil, given the presence of Aedes aegypti, vector of dengue, and the possibility of travelers bringing the virus with them when attending the event. Advice on the correct timing and use of repellents and other personal protection measures is key to preventing these vector-borne infections. Other important recommendations for travelers should focus on preventing water and food-borne diseases such as hepatitis A, typhoid fever, giardiasis and traveler's diarrhea. Sexually transmitted diseases (STD) should be also mentioned and the use of condoms advocated. This review addresses pre-travel, preventive strategies to reduce the risk of acquiring communicable diseases during a mass gathering such as the World Cup and also reviews the spectrum of endemic infections in Brazil to facilitate the recognition and management of infectious diseases in travelers returning to their countries of origin.
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Zimmermann R, Hattendorf J, Blum J, Nüesch R, Hatz C. Risk perception of travelers to tropical and subtropical countries visiting a swiss travel health center. J Travel Med 2013; 20:3-10. [PMID: 23279224 DOI: 10.1111/j.1708-8305.2012.00671.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 07/15/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study assessed the risk perception ratings of travelers pre- and post-travel and in comparison to the ratings by travel health experts. While most surveys on travel health knowledge, attitudes, and practices focus on malaria and vaccine-preventable diseases, noninfectious travel risks were included in this study. METHODS Pre- and post-travel perception of nine travel-associated health risks was recorded among 314 travelers to tropical and subtropical destinations. All travelers sought pre-travel health advice at the Travel Clinic of the Swiss Tropical and Public Health Institute in 2008 and 2009. In addition, 18 Swiss travel health experts provided an assessment of the respective risks. A validated visual psychometric measuring instrument was used [pictorial representation of illness and self measure (PRISM)]. RESULTS Travelers and experts rated most risks similarly, except for accidents and sexually transmitted infections (STIs) which experts rated higher. Compared to other risks, accidents ranked highly in both groups and were the only risk perceived higher after travel. Pre- and post-travel perceptions of all other risks were similar with a tendency to be lower after travel. Travelers perceived mosquitoes to be the highest risk before travel and accidents after travel. CONCLUSION Travelers' risk perception appears to be accurate for most risks stated in this study. However, travel health professionals should be aware that some perception patterns among travelers regarding travel-related health risks may be different from professional risk assessment. Important but insufficiently perceived health risks, such as sexual behavior/STIs and accidents, should be considered to be part of any pre-travel health advice package.
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Affiliation(s)
- Rosalie Zimmermann
- Departments of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Cabada MM, Mozo K, Pantenburg B, Gotuzzo E. Excessive alcohol consumption increases risk taking behaviour in travellers to Cusco, Peru. Travel Med Infect Dis 2011; 9:75-81. [DOI: 10.1016/j.tmaid.2011.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 11/15/2022]
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Talbot EA, Chen LH, Sanford C, McCarthy A, Leder K. Travel medicine research priorities: establishing an evidence base. J Travel Med 2010; 17:410-5. [PMID: 21050323 DOI: 10.1111/j.1708-8305.2010.00466.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Travel medicine is the medical subspecialty which promotes healthy and safe travel. Numerous studies have been published that provide evidence for the practice of travel medicine, but gaps exist. METHODS The Research Committee of the International Society of Travel Medicine (ISTM) established a Writing Group which reviewed the existing evidence base and identified an initial list of research priorities through an interactive process that included e-mails, phone calls, and smaller meetings. The list was presented to a broader group of travel medicine experts, then was presented and discussed at the Annual ISTM Meeting, and further revised by the Writing Group. Each research question was then subject to literature search to ensure that adequate research had not already been conducted. RESULTS Twenty-five research priorities were identified and categorized as intended to inform pre-travel encounters, safety during travel, and post-travel management. CONCLUSION We have described the research priorities that will help to expand the evidence base in travel medicine. This discussion of research priorities serves to highlight the commitment that the ISTM has in promoting quality travel-related research.
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Affiliation(s)
- Elizabeth A Talbot
- Infectious Disease and International Health, Dartmouth Medical School, Lebanon, NH 03756, USA.
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Cabada MM, Maldonado F, Mozo K, Dziuba N, Gotuzzo E. Pre-travel preparation for Cusco, Peru: a comparison between European and North American travelers. J Travel Med 2010; 17:382-6. [PMID: 21050317 DOI: 10.1111/j.1708-8305.2010.00461.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Demographics, preferences on health care, and regional differences in pre-travel advice guidelines may influence the preparation of travelers to developing countries. METHODS A secondary data analysis of the database of a travelers' health survey conducted in Cusco in 2002 was performed. Data from those whose place of residence was North America or Western Europe were selected. Illness rates, vaccinations, prophylactic medication use, and general recommendations on disease prevention were compared between the two groups. RESULTS Data from 1,612 North Americans (NAM) and 3,590 Western Europeans (EUR) were analyzed. NAM were older, stayed longer in Cusco, and had less experience traveling to developing countries (p < 0.01). They reported being ill more often than EUR (58% vs 42%, p < 0.01). Diarrhea was more frequent among EUR (55.6% vs 46.7%, p < 0.01), and acute mountain sickness (AMS) was more frequent among NAM (52.8% vs 35.2%, p < 0.01). EUR sought advice from health care professionals (67.1% vs 52.0%, p < 0.01) and travel medicine practitioners (45.8% vs 37%, p < 0.01) more often. NAM used prophylactic medications more often (53% vs 48.6%, p = 0.00) and received a lower mean number of vaccines (1.97 ± 1.68 vs 2.63 ± 1.49; t-test 14.02, p < 0.01). Advice on safe sex and alcohol consumption was low in both groups, especially among NAM. CONCLUSIONS Pre-travel preparation and travel-related illnesses varied between NAM and EUR. Improving consistency of pre-travel preparation based on the best evidence should become a priority among different national bodies providing travel medicine recommendations.
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Affiliation(s)
- Miguel M Cabada
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Vivancos R, Abubakar I, Hunter P. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis 2010; 14:e842-51. [DOI: 10.1016/j.ijid.2010.02.2251] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 10/31/2008] [Accepted: 02/15/2010] [Indexed: 10/19/2022] Open
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Vivancos R, Abubakar I, Hunter PR. Foreign travel associated with increased sexual risk-taking, alcohol and drug use among UK university students: a cohort study. Int J STD AIDS 2010; 21:46-51. [DOI: 10.1258/ijsa.2009.008501] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a prospective cohort study to assess sexual behaviour of students at a British University during the summer break, to explore the role of foreign travel as a risk factor of sexually transmitted infections acquisition and to determine characteristics associated with casual sex. We found that those who travelled abroad were more likely to use alcohol (RR 1.59, 95% CI 1.17–2.16) and cannabis (RR 1.35, 95% CI 1.13–1.62) and to have casual sex during holidays. They also reported more sexual relationships after holidays (RR 1.26, 95% CI 1.09–1.53). New partnerships during holidays were associated with being single, foreign travel, drinking alcohol and having previously had large number of sexual partners. The adjusted relative risk of developing new sexual partnerships with foreign travel was 2.70 (95% CI 1.11–6.61). People who travel abroad during holidays are more likely to engage in risk taking behaviour and have casual sex. They are also more sexually active after holidays.
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Affiliation(s)
- R Vivancos
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - I Abubakar
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - P R Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
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Bauer IL. Sex education for local tourism/hospitality employees: addressing a local health need. Travel Med Infect Dis 2009; 7:371-4. [PMID: 19945015 DOI: 10.1016/j.tmaid.2009.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 10/22/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
Abstract
Health concerns arising from sexual relationships between tourists and locals usually focus on the travelling public. The local sex partners' health, and their impact on their communities' health, seem far less acknowledged. This paper describes a local health education session which implemented recommendations based on a study in Cuzco/Peru on tourists' and locals' views, knowledge, attitudes and experiences relating to sexual relationships between them. On location, fifteen discotheque employees received a health education session at the establishment's owner's request. Concluding from the positive experience, it is argued that researchers should, where possible, respond to requests to deliver ad hoc health education sessions while on location to address an identified local health need.
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Affiliation(s)
- Irmgard L Bauer
- Faculty of Medicine, Health, and Molecular Sciences, James Cook University, Townsville QLD 4811, Australia.
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Relationships between female tourists and male locals in Cuzco/Peru: implications for travel health education. Travel Med Infect Dis 2009; 7:350-8. [PMID: 19945012 DOI: 10.1016/j.tmaid.2009.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/31/2009] [Accepted: 09/02/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health concerns regarding casual sexual encounters during travel have been recognized for some time. The perception that female travellers' motivations are more romantic rather than sexual when entering a relationship with local men may exclude them from receiving appropriate travel health advice. This may pose even greater health risks, not only to themselves but also to their local partners. METHOD This paper presents 11 Western female tourists' perceptions of their relationships with local men in Cuzco/Peru, based on in-depth interviews, observations, and informal discussions. RESULTS Relationships with local men were often triggered by their physical appearance. Other themes identified were: methods and location of first contact, benefits for the local men, safe sex/condom use, and travel health advice received. CONCLUSIONS The findings support calls for more emphasis on sexual health in travel health education. Three aspects should be included: 1) an awareness that unfamiliar environment can cause 'out of character' behaviour, 2) an emphasis on not only to use but to not stop using condoms, and 3) the need to acquire negotiation skills.
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Cabada MM, Maldonado F, Mozo K, Seas C, Gotuzzo E. Self-reported health problems among travelers visiting Cuzco: A Peruvian Airport survey. Travel Med Infect Dis 2009; 7:25-9. [DOI: 10.1016/j.tmaid.2008.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 09/25/2008] [Accepted: 09/29/2008] [Indexed: 11/26/2022]
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Kaufman MR, Fuhrel-Forbis AR, Kalichman SC, Eaton LA, Cain D, Cherry C, Pope HL. On holiday: a risk behavior profile for men who have vacationed at gay resorts. JOURNAL OF HOMOSEXUALITY 2009; 56:1134-1144. [PMID: 19882431 DOI: 10.1080/00918360903275534] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sexual risk behavior is higher when people vacation as compared to when they are at home. The current study uses survey data to compare sexual risk behavior of gay men who vacation at gay resorts to those who do not. Independent predictors of vacationing at gay resorts included income level, relationship status, ever having attended a circuit party, and HIV serostatus. For men who visit resorts to meet sex partners, independent predictors included relationship status, ever having attended a circuit party, HIV serostatus, number of male sex partners in the past six months, and number of anal insertive male partners using a condom. These results show a need for the development of structural interventions in the gay resort and hotel setting.
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Abstract
Travel and trade have grown immensely. Travelers interact with people and microbes during their journeys, and can introduce infectious agents to new areas and populations. Studying illnesses in travelers is a source of knowledge into diseases of resource-poor regions and the control of these diseases. Travel-associated illnesses also serve to detect emerging infections.
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Affiliation(s)
- Lin H Chen
- Travel Medicine Center, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02238, USA.
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von Sadovszky V. Preventing women's sexual risk behaviors during travel. J Obstet Gynecol Neonatal Nurs 2008; 37:516-24. [PMID: 18811771 DOI: 10.1111/j.1552-6909.2008.00274.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Sexually transmitted infections (STIs) are a global concern. Although several countries have tracked the incidence of STIs acquired during travel to foreign countries, the United States lags behind in this practice. Nevertheless, there is evidence from the US and several countries that women engage in sexual risk behaviors during travel whether domestic or foreign, thereby placing themselves at risk for contracting STIs. Guidelines for assessment, prevention, and travel-related supplies and resources are discussed.
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Risk and Burden Associated With the Acquisition of Viral Hepatitis A and B in the Corporate Traveler. J Occup Environ Med 2008; 50:935-44. [DOI: 10.1097/jom.0b013e3181808096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Travel. THE SOCIAL ECOLOGY OF INFECTIOUS DISEASES 2008. [PMCID: PMC7155445 DOI: 10.1016/b978-012370466-5.50006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Croughs M, Van Gompel A, de Boer E, Van Den Ende J. Sexual risk behavior of travelers who consulted a pretravel clinic. J Travel Med 2008; 15:6-12. [PMID: 18217863 DOI: 10.1111/j.1708-8305.2007.00160.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to determine to which degree travelers who received pretravel advice at a travel clinic have protected or unprotected sexual contact with a new partner and what factors influence this behavior. METHOD An anonymous questionnaire was sent to travelers who came to a pretravel clinic between June 1 and August 31, 2005. Risk factors for casual travel sex and predictors of protected sex were studied in a multivariate model. RESULTS A total of 1,907 travelers were included (response rate 55%) in the study. Only 4.7% of the respondents had sexual contact with a new partner, and 63.1% of these new partners were from the country of destination. Of those who had casual travel sex, 52.4% did not expect this (women 75%), 30.9% did not always use condoms, and 41% were not protected against hepatitis B. Independent risk factors for casual travel sex were traveling without steady partner (OR 14.4), expecting casual travel sex (OR 9.2), having casual sexual contacts in the home country (OR 2.4), non-tourist journeys (OR 2.2), being male (OR 2.1), the fact that the information on sexually transmitted infections (STI) had been read (OR 2.0), and traveling to South and Central America (OR 2.0). Taking condoms along (OR 5.4) and reading the information on STI (OR 3.3) were identified as independent predictors of protected sex. CONCLUSIONS Travelers have substantial sexual risk behavior. Casual sex is usually not expected, and the most important predictor is traveling without a steady partner. We would advice every client of a travel clinic who will travel without a steady partner to read the STI information, to take condoms along, and to be vaccinated against hepatitis B.
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Affiliation(s)
- Mieke Croughs
- Department of General Health Care, STI Clinic and Travel Clinic, GGD Hart voor Brabant, 's-Hertogenbosch, The Netherlands.
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Bauer I. Understanding sexual relationships between tourists and locals in Cuzco/Peru. Travel Med Infect Dis 2007; 5:287-94. [PMID: 17870633 DOI: 10.1016/j.tmaid.2007.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/25/2007] [Accepted: 06/28/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Casual sexual encounters between tourists and locals have been increasingly discussed. The city of Cuzco/Peru is well known for an increased availability of such sexual opportunities. The objective of this study was to explore tourists' and locals' knowledge, attitudes, and reasoning for engaging in casual sexual relationships. METHOD In this qualitative study, 10 locals and 13 tourists were in-depth interviewed (15 women, 8 men, aged 19-50+). Participant and non-participant observations, and informal discussions provided supporting evidence. RESULTS For tourists, the relationships with locals ranged from one-night-stands as part of the travel experience and having fun, to commitment for the term of a longer stay, to marriage. From the locals' point of view, these encounters ranged from sexual adventures to increase self-esteem and high standing in their circle of friends, to serious long-term commitments. In both cases, the difference in the physical appearance played a main part in the perceived attraction that had triggered the encounter. Lack of consistent condom use remains a concern along with the locals' profound lack of knowledge of STIs. CONCLUSIONS Travel health advisors should place more emphasis on sexual health in pre-travel consultations. The use of condoms cannot be stressed enough. Local health professionals should aggressively increase safe sex health promotion, specifically targeting people related to the tourism industry.
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Affiliation(s)
- Irmgard Bauer
- School of Nursing, Midwifery and Nutrition, James Cook University, Townsville QLD 4811, Australia.
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Cabada MM, Maldonado F, Bauer I, Verdonck K, Seas C, Gotuzzo E. Sexual behavior, knowledge of STI prevention, and prevalence of serum markers for STI among tour guides in Cuzco/Peru. J Travel Med 2007; 14:151-7. [PMID: 17437470 DOI: 10.1111/j.1708-8305.2007.00110.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sexual behavior during travel has increasingly become a focus of travel medicine research. The perceived freedom when away from home can lead to increased casual sexual activities, often unprotected. Local sexual partners, particularly those who are in close contact with tourists due to their occupation, need to be considered more in research. The purpose of this study was to explore the sexual behavior, knowledge of STI prevention, and prevalence of serum markers of selected STIs in tour guides in Cuzco/Peru. METHODS In this cross-sectional study, 161 tour guides completed a questionnaire consisting of information on demographics, sexual behavior, and knowledge about STI prevention. Blood samples of the participants were tested for antibodies against HSV2, Chlamydia trachomatis, and Treponema pallidum using commercial enzyme-linked immunosorbent assay kits. RESULTS The majority of guides (65%) were sexually active during the year prior to the study and 10% had foreign partners. Consistent condom use was reported by 38.1%, but almost 42% did not use condoms. In total, 27.6% reported symptoms compatible with STI. Three quarters of the participants had previously received information on STI prevention, predominantly from health professionals. In total, 22% considered themselves at high risk for STI. Antibodies against C trachomatis were prevalent in 15%, while 88.2% were against HSV2. None had antibodies against T pallidum. CONCLUSIONS There is an inconsistency in reported sexual behavior and reported knowledge about STI prevention. Because of the tour guides' bridging position between potential STI carriers in tourists and the local population, the reported nonuse of condoms is of concern. The prevalence of serum markers supports this concern, which is aggravated by the potential of noncurable infections. Current sexual health education strategies seem unsatisfactory, and major modifications are highly recommended.
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Affiliation(s)
- Miguel M Cabada
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Abstract
Increasing population mobility and increasing frequency and variety of sexually transmitted infections (STI) are closely linked around the globe. Although all mobile populations are at increased risk for acquiring STIs, international travelers are the focus of this review. Several aspects of travel such as opportunity, isolation, and the desire for unique experiences all enhance the likelihood of casual sexual experiences while abroad. The situational loss of inhibition of travel can be markedly enhanced by alcohol and drugs. Several of the most important elements of the complex interaction between travel and STIs are discussed.
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Affiliation(s)
- Brian J Ward
- McGill University Tropical Diseases Centre, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.
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Thomas M. 'What happens in Tenerife stays in Tenerife': Understanding women's sexual behaviour on holiday. CULTURE, HEALTH & SEXUALITY 2005; 7:571-84. [PMID: 16864223 DOI: 10.1080/13691050500256807] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
- Michelle Thomas
- Seafarers International Research Centre, Cardiff University, UK.
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Cabada MM, Maldonado F, Quispe W, Serrano E, Mozo K, Gonzales E, Seas C, Verdonck K, Echevarria JI, Gotuzzo E. Pretravel health advice among international travelers visiting Cuzco, Peru. J Travel Med 2005; 12:61-5. [PMID: 15996449 DOI: 10.2310/7060.2005.12201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cuzco, a Peruvian city of historical interest located 3,326 m above sea level, is a frequent destination for tourists. We conducted a descriptive study to assess the extent and sources of pretravel health advice received by international travelers before their arrival to Cuzco. METHODS Data were collected as part of a health survey among travelers. Between August and November 2002, travelers between 15 and 65 years old were invited to fill out a questionnaire in the departing area of Cuzco's international airport. RESULTS A total of 5,988 travelers participated. The mean age was 35.4 years (SD 11.4 yr); 50.6% were female and 50.8% were single. Tourism was the reason for traveling in 90.2% of the participants, and 89.3% of them were traveling with companions. Pretravel health information was received by 93.6%. The median number of information sources was two, with books (41.5%), travel medicine clinics (38.8%), the Internet (23.3%), and general practitioners (22.7%) as the main sources. Most frequently received recommendations were about safe food and water consumption (85%), use of insect repellents (66.0%), sunburn protection (64.4%), and condom use (22%). Only 16.5% took medication to prevent altitude sickness, and 14.2% took medication to prevent traveler's diarrhea. Variables independently associated with receiving pretravel health information from a health care professional were female gender, country of residence other than the United States, length of stay in Cuzco > 7 days, length of stay in other Peruvian cities > 7 days, tourism as the main reason for visiting Cuzco, traveling with companions, and consulting of more than one source of information. CONCLUSIONS Most travelers arriving to Cuzco had received pretravel health information, and the majority obtained it from more than one source. Recommendations addressed for specific health risks, such as altitude sickness prophylaxis, were received by few travelers.
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Cáceres CF, Mendoza W. Monitoring trends in sexual behaviour and HIV/STIs in Peru: are available data sufficient? Sex Transm Infect 2005; 80 Suppl 2:ii80-4. [PMID: 15572646 PMCID: PMC1765845 DOI: 10.1136/sti.2004.012021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To review and summarise various types of Peruvian evidence on sexual behaviour, HIV/STI exposure and risk, and discuss how to increase its usefulness for HIV/STI risk trend monitoring in Peru. METHODS Review HIV sentinel surveillance conducted by the Ministry of Health; data from the Demographic and Health Surveys (DHS); and academic publications on sexual behaviour in combination with biological markers. Changes over time, quality of data, size of studies, and intended audience are discussed. RESULTS Data from HIV sentinel surveillance showed very high (8-23%) HIV seroprevalence among men having sex with men, but stable, relatively low figures among female sex workers (1%) and antenatal clinic patients (under 0.5%). DHS data suggest that single women increased their sexual activity throughout the 1990s but did not raise their contraceptive use accordingly, resulting in increased early conceptions. The contribution of condoms to overall contraceptive protection increased threefold in 1992-2000. According to the 1996 survey, men become sexually active 2.5 years earlier than women, but marry or cohabit four years later than women; women marry or cohabit 1.5-2.5 years after first sex, whereas men take eight years to do so. Finally, published studies confirmed dramatic differences in HIV prevalence between men who have sex with men and other populations, and also suggested patterns of bridging from men to women. CONCLUSIONS Data available from the three sources are numerous, although limitations of each approach reduce their monitoring utility: Ministry of Health studies should select better sentinel populations and timely process behavioural data. Future demographic surveys should incorporate an AIDS risk perspective and include men.
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Affiliation(s)
- C F Cáceres
- School of Public Health, Cayetano Heredia University, Lima, Peru.
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