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Vicente de la Cruz MDLM, Giesen C, Díaz-Menéndez M. International travels and transmission of multidrug resistant Neisseria gonorrhoeae in Europe: A systematic review. Travel Med Infect Dis 2022; 49:102401. [PMID: 35850441 DOI: 10.1016/j.tmaid.2022.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The increase of gonococcal infection cases in Europe and rises in Neisseria gonorrhoeae antibiotic resistance (AMR) have become an urgent concern globally. In the last few years international tourism has increased, which might contribute to the spread of different strains of multiresistant gonococcal infections. This study aimed at assessing the effect of international travel on the transmission of multidrug resistant N. gonorrhoeae in the European Union and associated European countries. METHOD We conducted a systematic review and searched PubMed, Scopus, Embase and CENTRAL between January 1, 2010 and June 30, 2021 for gonococcal infection, antibiotic resistance and international travel. Articles were screened in title, abstract and keywords. The quality of the articles was assessed using a pre-designed tool. Individual, travel related and susceptibility to antimicrobials data were collected. RESULTS A total of 18 studies met our criteria, of which 88.9% concluded that international travel directly influences the transmission of multidrug resistant N. gonorrhoeae from the country of travel to the country of return. Travelers mainly visited South East Asian countries (66.7%) and returned to the UK (38.9%). Half of the included studies reported ciprofloxacin resistant strains and the most frequently prescribed drug used for treatment was ceftriaxone. CONCLUSIONS International travels might be an important factor in the spread of multi-resistant sexually transmitted infections (STIs). There is a need to strengthen AMR surveillance in international travelers for prompt investigation and notification of drug resistance in STIs.
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Affiliation(s)
| | - Christine Giesen
- Preventive Medicine Unit, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), Spain.
| | - Marta Díaz-Menéndez
- National Referral Centre for Tropical Diseases. Hospital Universitario La Paz-Carlos III, Madrid, Spain, CIBERINFEC
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Díaz-Menéndez M, Arsuaga M. Pre-travel consultation: The exciting new mission for James Bond. Travel Med Infect Dis 2021; 44:102203. [PMID: 34775067 DOI: 10.1016/j.tmaid.2021.102203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Marta Díaz-Menéndez
- National Referral Centre for Tropical Diseases, Hospital Universitario La Paz-Carlos III, Madrid, Spain.
| | - Marta Arsuaga
- National Referral Centre for Tropical Diseases, Hospital Universitario La Paz-Carlos III, Madrid, Spain
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Vorakitphokatorn S, Pulerwitz J, Cash RA. HIV/AIDS Risk to Women Travelers in Thailand: Comparison of Japanese and Western Populations. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016. [DOI: 10.2190/2ln8-mdfj-efdv-7xxf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Heywood AE, Nothdurft H, Tessier D, Moodley M, Rombo L, Marano C, De Moerlooze L. Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†. J Travel Med 2016; 24:taw069. [PMID: 27738112 PMCID: PMC5063019 DOI: 10.1093/jtm/taw069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Knowledge about the travel-associated risks of hepatitis A and B, and the extent of pre-travel health-advice being sought may vary between countries. METHODS An online survey was undertaken to assess the awareness, advice-seeking behaviour, rates of vaccination against hepatitis A and B and adherence rates in Australia, Finland, Germany, Norway, Sweden, the UK and Canada between August and October 2014. Individuals aged 18-65 years were screened for eligibility based on: travel to hepatitis A and B endemic countries within the past 3 years, awareness of hepatitis A, and/or combined hepatitis A&B vaccines; awareness of their self-reported vaccination status and if vaccinated, vaccination within the last 3 years. Awareness and receipt of the vaccines, sources of advice, reasons for non-vaccination, adherence to recommended doses and the value of immunization reminders were analysed. RESULTS Of 27 386 screened travellers, 19 817 (72%) were aware of monovalent hepatitis A or combined A&B vaccines. Of these 13 857 (70%) had sought advice from a healthcare provider (HCP) regarding combined hepatitis A&B or monovalent hepatitis A vaccination, and 9328 (67%) were vaccinated. Of 5225 individuals eligible for the main survey (recently vaccinated = 3576; unvaccinated = 1649), 27% (841/3111) and 37% (174/465) of vaccinated travellers had adhered to the 3-dose combined hepatitis A&B or 2-dose monovalent hepatitis A vaccination schedules, respectively. Of travellers partially vaccinated against combined hepatitis A&B or hepatitis A, 84% and 61%, respectively, believed that they had received the recommended number of doses. CONCLUSIONS HCPs remain the main source of pre-travel health advice. The majority of travellers who received monovalent hepatitis A or combined hepatitis A&B vaccines did not complete the recommended course. These findings highlight the need for further training of HCPs and the provision of reminder services to improve traveller awareness and adherence to vaccination schedules.
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Affiliation(s)
- Anita E Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Level 3, Samuels Building, Sydney 2052, Australia
| | | | - Dominique Tessier
- Family Medicine, Groupe Sante Voyage, Quebec, Canada Unité Hospitalière de Recherche, d'enseignement et de soins sur le sida, CHUM, University of Montreal, Montreal, Canada
| | | | - Lars Rombo
- Centre for Clinical Research, Sormland County Council and Uppsala University, Eskilstuna, Sweden
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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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Pedersini R, Marano C, De Moerlooze L, Chen L, Vietri J. HAV & HBV vaccination among travellers participating in the National Health and Wellness Survey in five European countries. Travel Med Infect Dis 2016; 14:221-32. [PMID: 27000975 DOI: 10.1016/j.tmaid.2016.03.008] [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: 07/02/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND A main cause of hepatitis A and B infections in European countries is travel to endemic countries. Most research on hepatitis vaccination among travellers from Europe has been conducted in airports or travel clinics, samples which potentially overrepresented frequent travellers. METHODS 2102 respondents across France, Germany, Italy, Spain, and UK completed an internet-based questionnaire. Vaccination status, travel to endemic countries, and other characteristics were compared across frequent, occasional, and non-travellers. Logistic regressions tested association between vaccination and travel adjusting for potential confounders. RESULTS Most respondents were occasional travellers (61%) and 24% were frequent travellers. Frequent travellers had 2.3-2.4 times the odds of being vaccinated relative to non-travellers, and odds of vaccination were 2.5-3.1 times higher among travellers to endemic areas relative to others (all p < .05). Frequent travellers were more aware of their vaccination status (HAV: 80% vs. 72%; HBV: 82% vs. 74%), though many who were vaccinated could not identify the number of injections to complete the series (47% vs. 29%) (all p < .05). CONCLUSION Travel frequency and destination endemicity are associated with increased hepatitis A and B vaccination. The number of unvaccinated travellers and the lack of recall for the dosing schedule suggest the need to improve travellers' awareness and adherence to recommendations.
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Affiliation(s)
| | - Cinzia Marano
- GSK Vaccines, 20 Avenue Fleming, 1300, Wavre, Belgium
| | | | - Lin Chen
- Mount Auburn Hospital and Harvard Medical School, Cambridge, MA, USA
| | - Jeffrey Vietri
- Kantar Health, 700 Dresher Road, Horsham, 19044, PA, USA.
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Croughs M, Remmen R, Van den Ende J. The effect of pre-travel advice on sexual risk behavior abroad: a systematic review. J Travel Med 2014; 21:45-51. [PMID: 24354921 DOI: 10.1111/jtm.12084] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Travelers often have casual sex abroad and the risk of acquiring a sexually transmitted infection (STI) associated with casual travel sex is considered to be threefold higher compared to the risk of casual sex in the home country. Consequently, international guidelines recommend including STI advice in the pre-travel consultation. We performed a systematic review on the effect of a pre-travel STI intervention on sexual risk behavior abroad. METHODS In September 2012, a systematic analysis and meta-analysis of peer reviewed literature were performed on the relation between pre-travel STI advice for travelers and sexual risk behavior abroad. Primary outcome measure consisted of the number of travelers with a new sexual partner abroad; secondary outcome measure entailed the proportion of consistent condom use. RESULTS Six studies were identified for inclusion in the review, of which three clinical trials on the effect of a motivational intervention compared to standard pre-travel STI advice qualified for the meta-analysis. Two of these trials were performed in US marines deployed abroad and one in visitors of a travel clinic. The extensive motivational training program of the marines led to a reduction in sexual risk behavior, while the brief motivational intervention in the travel clinic was not superior to standard advice. The meta-analysis established no overall effect on risk behavior abroad. No clinical trials on the effect of a standard pre-travel STI discussion were found, but a cohort study reported that no relation was found between the recall of a nonstructured pre-travel STI discussion and sexual risk behavior, while the recall of reading the STI information appeared to be related to more consistent condom use. CONCLUSIONS Motivational pre-travel STI intervention was not found to be superior to standard STI advice, while no clinical trials on the effect of standard pre-travel STI advice were found.
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Affiliation(s)
- Mieke Croughs
- Department of General Health, GGD Hart voor Brabant,'s-, Hertogenbosch, The Netherlands; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Johnson DF, Leder K, Torresi J. Hepatitis B and C infection in international travelers. J Travel Med 2013; 20:194-202. [PMID: 23577866 DOI: 10.1111/jtm.12026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/10/2013] [Accepted: 01/14/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hepatitis B and C virus (HBV and HCV) cause significant morbidity and mortality worldwide. With the rise in international travel over the last three decades, many travelers are at risk of HBV and HCV infection. METHODS This review focuses on the epidemiology of HBV and HCV in international travelers, the modes of transmission, and the prevention of infection in travelers. RESULTS The risk of HBV and HCV infection varies widely and depends on the prevalence of the destination country, the duration of travel, and the activities undertaken while abroad. Travelers commonly undertake high-risk activities that place them at risk of both HBV and HCV infection. Poor uptake of preventative health measures and poor adherence to health recommendations are also common. The monthly incidence of HBV infection for long-term travelers to endemic countries ranges from 25 to 420 per 100,000 travelers. HBV infection can be prevented through timely vaccination of travelers. HBV vaccination is safe and efficacious with protective levels of antibodies achieved in >90% of recipients. Information regarding the risk of HCV acquisition is scarce and until recently was limited to case reports following medical interventions. CONCLUSIONS This review demonstrates international travelers are at risk of HBV and HCV infection and provides evidence-based information enabling health practitioners to provide more appropriate pre-travel advice. HBV vaccination should be considered in all travelers to countries with a moderate to high HBV prevalence (HBsAg ≥ 2%) and the risk and benefits discussed with the individuals in consultation with the health practitioner. There is no duration of travel without risk of HBV infection. However, it is apparent that those travelers with a longer duration of travel are at greatest risk of HBV infection (ie, expatriates). Travelers should also receive advice regarding the modes of transmission and the activities that place them at risk of both HBV and HCV infection.
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Affiliation(s)
- Douglas F Johnson
- Department of Infectious Diseases, Austin Hospital, University of Melbourne, Heidelberg, Victoria, Australia
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10
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Fricker M, Steffen R. Travel and public health. J Infect Public Health 2008; 1:72-7. [PMID: 20701848 PMCID: PMC7102744 DOI: 10.1016/j.jiph.2008.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 10/23/2008] [Accepted: 10/24/2008] [Indexed: 12/01/2022] Open
Abstract
Increasing international travel and migration can interfere with public health in both the country of destination and back home. The revised International Health Regulations (IHR) and travel disease sentinel networks are means to protect public and individual health. Public health risks related to infectious disease are higher in mass gatherings, in travellers visiting friends and relatives and in sexual encounters away from home. In contrast, in-flight transmission of infections plays only a limited role.
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Affiliation(s)
- Manuel Fricker
- Division of Epidemiology and Prevention of Communicable Diseases, WHO Centre for Travellers Health, cc Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland
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Keystone JS, Hershey JH. The underestimated risk of hepatitis A and hepatitis B: benefits of an accelerated vaccination schedule. Int J Infect Dis 2008; 12:3-11. [PMID: 17643334 DOI: 10.1016/j.ijid.2007.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 04/23/2007] [Accepted: 04/24/2007] [Indexed: 01/10/2023] Open
Abstract
Hepatitis A virus (HAV) and hepatitis B virus (HBV) are vaccine-preventable. Current recommendations advocate vaccination of non-immune adults at risk of exposure, including travelers to HAV or HBV endemic areas, individuals with high risk of contracting a sexually transmitted infection, and some correctional facility inmates. We review the use of an accelerated schedule to administer the combination hepatitis A and hepatitis B vaccine (Twinrix). Administering three doses over three weeks and a fourth at 12 months provides rapid initial protection of most individuals for whom the standard 6-month vaccination schedule would not be suitable, including last-minute travelers and short-term correctional facility inmates. Furthermore, we consider the role of a universal vaccination strategy in preventing the spread of HAV and HBV.
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Affiliation(s)
- Jay S Keystone
- Division of Infectious Disease, Department of Medicine, Tropical Disease Unit, Toronto General Hospital, University of Toronto, Toronto, Ontario M5G 2C4, Canada.
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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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Abstract
BACKGROUND European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure. METHOD A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition. RESULTS In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B. CONCLUSIONS The results have implications for the individual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.
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Affiliation(s)
- Catherine L Streeton
- Clinical R&D and Medical Affairs, GlaxoSmithKline Biologicals, Australia/New Zealand/Oceania, Melbourne, Victoria, Australia.
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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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Ragsdale K, Difranceisco W, Pinkerton SD. Where the boys are: sexual expectations and behaviour among young women on holiday. CULTURE, HEALTH & SEXUALITY 2006; 8:85-98. [PMID: 16641059 DOI: 10.1080/13691050600569570] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The main objectives of this study were to examine relationships between vacation sex expectations and travelling companionship type (solo, paired, or group), and behavioural outcomes such as engaging in a relationship while on vacation, procuring condoms, and initiating condom use with vacation sex partners among tourist women in Costa Rica. A brief interview was used to assess sociodemographic characteristics, vacation sex expectations and relationships, casual sex variables, and alcohol use among a convenience sample of 128 single female tourists 18 years of age or older. Univariate and multivariate analysis were used to examine relationships among variables of interest. Women who travelled solo or with a single female companion and women who anticipated having sex on holiday were more likely than other tourist women to report one or more vacation relationships, to have procured condoms, and to have initiated condom use with a vacation sex partner. Women who engage in unanticipated vacation relationships may be at increased risk of participating in unsafe sex with a partner met on holiday due to lack of condom procurement and/or initiation of condom use. The findings point to the importance of public health efforts to educate women regarding safer sex precautions when travelling on holiday.
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Affiliation(s)
- Kathleen Ragsdale
- Medical and Health Research Association of New York City, Inc., NY 10010, USA.
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Abstract
International travelers engaging in casual sex are at risk for acquiring sexually transmitted diseases (STDs), including HIV. The frequency of international travel emphasizes the need for a travel sexual activity history to be included in the clinical assessment of any returned traveler. When formulating a differential diagnosis, the STD prevalence rates at the travel destination and the risk profile of the traveler and the sexual partner need to be considered. Casual sex with host country nationals residing in tropical and subtropical areas of the developing world increases the traveler's risk for acquiring STDs rarely seen in industrialized countries, particularly bacterial genital ulcer diseases. Pretravel counseling needs to include education on STD prevention. A post-travel STD diagnostic evaluation is indicated when casual sexual activity has occurred during travel, regardless of whether symptoms are present.
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Affiliation(s)
- Noreen A Hynes
- Johns Hopkins University, School of Medicine, Division of Infectious Diseases, 1830 East Monument Street, 4th Floor, Baltimore, MD 21205, USA.
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Porter JFH, Knill-Jones RP. Quality of travel health advice in higher-education establishments in the United Kingdom and its relationship to the demographic background of the provider. J Travel Med 2004; 11:347-53. [PMID: 15569570 DOI: 10.2310/7060.2004.19202] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of international trips undertaken by residents of the United Kingdom has risen dramatically over the past 50 years. Likewise, the numbers studying in higher education have also shown a huge increase. This study aimed to assess the appropriateness of advice given to traveling students by higher education-based health services and to relate this to the demography and experience of the professionals involved. METHODS A postal questionnaire describing three hypothetical groups of students traveling to different parts of the world was sent to 335 doctors and nurses. These clinicians belonged to the British Association of Health Services in Higher Education. They worked in 105 practices that serve higher-educational establishments in the United Kingdom. Main outcome measures included whether appropriate immunizations were advised and given correctly through the National Health Service (NHS) or privately, and whether appropriate advice was given regarding malaria, human immunodeficiency virus (HIV), and miscellaneous risks. The sources of information used to advise travelers were also asked, and the effect of demographic characteristics of the respondents on the quality of advice was investigated. RESULTS Two hundred fifteen (64%) questionnaires were returned. The mean score for whether the correct immunizations were advised was 77%, and for whether these were given correctly through the NHS or privately was 79.6%. For malaria, HIV, and miscellaneous risks, the scores were lower at 65%, 38%, and 32%, respectively. The score for correct immunizations was significantly affected by sex, with females respondents scoring higher (p = .036). Previous training in travel medicine improved scores for immunizations (p = .034) and for the correct choice being given through the NHS or privately (p = .006). Age, hours worked, role, and size of practice had no influence on scores. Charts in the general practice free newspapers were the most popular source of information. CONCLUSIONS Practices serving higher-education establishments usually give appropriate advice to travelers in terms of the immunizations required, whether these are available through the NHS or privately, and about reducing risks of malaria. This is not the case regarding advice pertaining to HIV and miscellaneous risks. Previous training in travel medicine seems to correlate with the giving of more appropriate advice.
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Affiliation(s)
- J F Hugh Porter
- The University of Nottingham Health Service, Cripps Health Centre, University Park, Nottingham, UK
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Abdullah ASM, Ebrahim SH, Fielding R, Morisky DE. Sexually transmitted infections in travelers: implications for prevention and control. Clin Infect Dis 2004; 39:533-8. [PMID: 15356817 DOI: 10.1086/422721] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Accepted: 04/20/2004] [Indexed: 11/04/2022] Open
Abstract
Sexually transmissible diseases (STDs), the most common notifiable infectious conditions, remain major threats to reproductive and public health worldwide. Travelers are particularly vulnerable to STDs, because of voluntary or involuntary sexual behavior while abroad, and are significant vectors who introduce new pathogens and resistant strains to unaffected parts of the world. This article outlines some key issues that travel medicine specialists and other clinicians should revisit when providing services to travelers. We discuss obstacles to promoting sexual health, including the diversity of the target group, unanticipated opportunities for sexual risk, ambivalent cooperation by the travel and tourism industries, poorly developed travel health sectors, illegal migration and sex tourism, and lack of research about the association between travel and STDs. We also outlined some programmatic aspects of public health that should be identified and addressed for the promotion of sexual health among travelers.
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Affiliation(s)
- Abu Saleh M Abdullah
- Department of Community Medicine, Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region.
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Cabada MM, Echevarria JI, Seas CR, Narvarte G, Samalvides F, Freedman DO, Gotuzzo E. Sexual behavior of international travelers visiting Peru. Sex Transm Dis 2002; 29:510-3. [PMID: 12218841 DOI: 10.1097/00007435-200209000-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual behavior of travelers to Latin America and the sexual behavior of US travelers in general are poorly characterized. GOAL The goal of the study was to evaluate sexual risk factors of travelers to Peru. STUDY DESIGN Anonymous written questionnaires were administered to 442/507 (87%) of the individuals approached in the international departures area of the Lima airport. RESULTS Of the 442 respondents, 54 (12.2%) had new sex partners during their stay. Sex with a local partner (35/52; 67.3%) was more frequent than sex with other travelers (18/52; 34.6%) or with sex workers (4/52; 7.7%). Risk factors for a new sex partner included male sex (relative risk, 1.94), single marital status (relative risk, 2.59), duration of stay longer than 30 days (relative risk, 5.05), traveling alone or with friends (relative risk, 2.88), and bisexual orientation (relative risk, 4.94). Frequency of sexual activity among US travelers was greater than that among travelers from other countries (15.2% [22/145] versus 10.6% [30/282]; NS). Condoms were consistently used by 12/50 (24%) and sometimes used by 10/50 (20%), including 8/20 United States travelers and 13/29 travelers from other countries. CONCLUSION Behaviors and risk factors are similar to those described for travelers to Africa, Asia, and Eastern Europe. Behavior of US travelers did not differ from that of other travelers.
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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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20
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Correia JD, Shafer RT, Patel V, Kain KC, Tessier D, MacPherson D, Keystone JS. Blood and body fluid exposure as a health risk for international travelers. J Travel Med 2001; 8:263-6. [PMID: 11703910 DOI: 10.2310/7060.2001.24033] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J D Correia
- Tropical Disease Unit, The Toronto Hospital, University of Toronto, Ontario, Canada
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21
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Morrissey CO, Woolley IJ, Mijch A, Wesselingh SL, Spelman D. Febrile illness in a returned traveller: could it be primary HIV? Med J Aust 2001; 175:172. [PMID: 11548088 DOI: 10.5694/j.1326-5377.2001.tb143075.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Matteelli A, Carosi G. Sexually transmitted diseases in travelers. Clin Infect Dis 2001; 32:1063-7. [PMID: 11264035 DOI: 10.1086/319607] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2000] [Revised: 10/20/2000] [Indexed: 11/03/2022] Open
Abstract
Prevention of sexually transmitted diseases (STDs) is a low priority among travel clinic services, despite increasing evidence that travelers have an increased risk of acquiring such infections. A proportion of 5%-50% of short-term travelers engage in casual sex while abroad, and this rate is even higher among long-term travelers. Few publications are available on STD preventive interventions among travelers. Education and counseling are recognized as key components of risk reduction. New efforts should be put forth with regard to identifying effective tools to promote safer sexual behaviors and to reduce the spread of infection by promoting condom use. Travelers at increased risk should be identified for targeted interventions; research to validate proposed markers of increased risk is prospectively needed. Hepatitis B infection is the only STD that is preventable by vaccination. The feasibility and cost-effectiveness of STD screening in travelers after exposure is a virtually unexplored field, though it may represent an important component of STD control strategies in developed countries.
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Affiliation(s)
- A Matteelli
- Clinic of Infectious and Tropical Diseases, Brescia, Italy.
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23
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Abstract
BACKGROUND Our objective was to determine the risks of infection with hepatitis B among European travelers and to compare this with the immunization status in various risk groups. METHODS A cross-sectional telephone questionnaire survey of randomly selected subjects, in nine European study populations was used. A total of 9, 008 individuals were involved, with approximately 1,000 interviews conducted in each country in the native languages. Situations with a high risk of hepatitis B infection, such as invasive medical procedures, attending to a bleeding person, and skin perforating cosmetic practices, particularly when performed in countries with medium/high transmission risk, and vaccination status of travelers, were the main outcome measures. RESULTS Depending upon the destination, 6.6-11.2% of travelers were classified as at high risk of hepatitis B, with 24.4% vaccinated; between 60.8-75.8% of travelers at potential risk, with 19.2% vaccinated; and 33.4% of travelers where no hepatitis B risk was identified. Significantly more travelers who only visited medium/high endemicity regions exposed themselves to a high risk of contracting hepatitis B, (40, 10.5%) compared to travelers who only visited low endemicity regions (225, 6.6%; p <.01). CONCLUSIONS A significant proportion of travelers surveyed unwittingly exposed themselves to the risk of hepatitis B infection while at medium/high risk destinations. The majority of at-risk travelers had not been vaccinated, regardless of their destination. Improved advice and clear recommendations to avoid transmission are needed.
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Affiliation(s)
- J N Zuckerman
- Academic Unit of Travel Medicine and Vaccines, Royal Free and University College Medical School, University College, London, United Kingdom
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25
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Abstract
Sex and travel do not infrequently coincide as pleasurable occupations. This articles explores the possible risks of unsafe sexual activity in a travel-related context, gives guidelines on how to decrease risks for both partners, and outlines how to manage the exposed or infected traveler on his or her return home. Both sexually transmitted infections and contraception are covered.
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Affiliation(s)
- S Hawkes
- Reproductive Tract Infection Project, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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de Graaf R, van Zessen G, Houweling H, Ligthelm RJ, van den Akker R. Sexual risk of HIV infection among expatriates posted in AIDS endemic areas. AIDS 1997; 11:1173-81. [PMID: 9233466 DOI: 10.1097/00002030-199709000-00014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- R de Graaf
- The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Abstract
Travel and tourism is a major industry in Australia, employing 6.9% of the nation's workforce (535,600 persons) and generating AUS$46.9 billion in 1993-94.1 While economic and marketing analyses have traditionally dominated the field of tourism research in Australia, health and safety issues that impact on the business of tourism are now emerging.2 Travel medicine is still a small specialty area, though it has established a legitimate role within the tourism industry by providing services in prevention and treatment. To date, little attention has been given to empirical research, even though field studies are a critical component in the provision of accurate medical advice for patients. This paper reviews the Australian research that is available and identifies areas where further work should be conducted.
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Affiliation(s)
- J Wilks
- Psychologist and Attwood Marshall Fellow in the School of Law, Bond University, Gold Coast, Australia
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28
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Abstract
OBJECTIVE To examine and compare specialised services for patients with sexually transmitted diseases (STDs) in Australia and New Zealand. DESIGN Postal questionnaire survey. PARTICIPANTS AND SETTING All STD facilities in Australia and New Zealand in 1993. MAIN OUTCOME MEASURES Patient numbers and demography; staffing levels; the role of nurses; diagnostic and treatment protocols; contact-tracing policies; and the availability of specialist medical services and community and education programs. RESULTS 83 of 100 clinics responded; 52 were urban, 21 rural, and nine remote. 95% were open to men and women. Staffing levels were similar in Australia and New Zealand and there was considerable consistency in diagnostic techniques and treatment among clinics. Australian clinics more often used ciprofloxacin or ceftriaxone as the treatment of first choice for gonorrhoea; New Zealand clinics were more likely to test for Chlamydia using direct immunofluorescence; and Australian clinics were more likely to test for hepatitis A and offer hepatitis B vaccination to a broader range of patients. 88% of clinics always traced contacts for gonorrhoea, 86% for syphilis and 77% for Chlamydia. 98% of clinics offered HIV test counselling, and 78% STD health education. CONCLUSIONS The number of sexual health services has increased over the past decade. Other improvements include most clinics being open to both men and women, and consistency in the diagnosis, treatment and contact tracing of STDs. However, given the lack of adequate comparative data and the variable quality of national surveillance data, it is difficult to determine whether current facilities are meeting service needs.
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Affiliation(s)
- C Marks
- Academic Unit of Sexual Health Medicine, Sydney Hospital, NSW.
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Mårdh PA, Arvidson M, Hellberg D. Sexually Transmitted Diseases and Reproductive History in Women with Experience of Casual Travel Sex Abroad. J Travel Med 1996; 3:138-142. [PMID: 9815441 DOI: 10.1111/j.1708-8305.1996.tb00727.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: The objective of this study was to determine whether the frequency of sexually transmitted diseases (STDs) and some reproductive events in women with experience of casual travel sex (CTS) abroad with previously unknown male partners differed when compared to women lacking such experience. Methods: Nine hundred and ninety-six women seeking contraceptive advice from two family planning clinics and a youth clinic were studied. Two hundred and seventy-six of these women (27.7%) admitted experience of CTS. Results: Among current STDs, only the prevalence of cervical human papilloma virus infection was significantly higher in women with a history of CTS when compared to the comparison (COMP) group (11.2% vs. 0.7%). A history of gonorrhea, genital chlamydial infection, and genital warts was reported significantly more often in women with, rather than without, CTS (p=0-.005). Women who had experienced CTS had a lower rate of childbirth, but higher rates of legal abortion and pelvic inflammatory disease than did females in the COMP group. Conclusion: The study shows that women with experience of CTS belong to a group at high risk for acquisition of STDs. This increased risk, with the exception of genital warts, was attributed to sexual risk taking in general, not merely to traveling abroad.
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Affiliation(s)
- PA Mårdh
- Institute of Clinical Bacteriology, Uppsala University, Uppsala
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Abstract
Background: Travelers to the tropics have been reported to comply poorly with recommendations regarding malaria and AIDS. This study addresses the problem of influencing travelers' behavior through different approaches to conveying advice. Method: 3509 people attending a large travel clinic were randomly allocated to different interventions, including brochures about the implications of "sex tourism" and the possibility of participating in a contest assessing knowledge of malaria and AIDS. A comparison group (n = 607) of travelers to Kenya was contacted at an airport. Anonymous, self-administered questionnaires were sent to all travelers after their return. Results: Compliance with chemosuppressive regimen for malaria was 87%. Well-informed travelers did not protect themselves more efficiently against malaria. The efficacy of a given intervention was found to vary according to the age, sex, or travel experience of the participants. Of travelers, 51% reported casual sex abroad (M/F: 69/31). Thirty-eight percent of these contacts were unprotected. Casual sex abroad and condom use were correlated with a history of casual sex in the home country. Condom use was especially low in young women, who were also more likely to have casual sex with fellow travelers than with local partners. Eight percent of the "sex tourism" brochure readers had engaged in casual sex with local partners (all travelers, 4%). Conclusions: Lack of knowledge does not appear to be the problem. Travelers need to be motivated to put their knowledge into practice. Our results suggest that risks relating to malaria and AIDS are perceived in a different manner and that counseling should be individualized. Contest questions can help start a discussion on ethical and health-responsible behavior. The target group of the "sex tourism" brochure was reached, but their behavior appears not to have changed. Objective criteria can help physicians recognize "high-risk" travelers. Travelers need to be made aware that they may encounter environments conducive to risky behavior and that, while abroad, they may react in unexpected ways.
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Affiliation(s)
- OP Gagneux
- Swiss Tropical Institute, Department of Public Health & Epidemiology, Basel, Switzerland
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Abstract
In many European countries, foreigners constitute the majority of certain groups of prostitutes, e.g., approximately 90% of the window prostitutes in the red light district of Amsterdam are not native to the Netherlands. The same is true for prostitutes working in bars in Vienna. In cities where registered prostitution is legal, unregistered prostitutes, most of whom are foreigners, often outnumber the registered ones. Central European countries often receive "sex workers" from eastern Europe, e.g., from Bulgaria, the Czech Republic, Slovakia, Hungary, and Romania, whereas the majority of migratory prostitutes in Great Britain and continental western Europe come from Africa, the Caribbean, and South America. In northern Europe, women from Russia, the Czech Republic, Slovakia, Poland, and the Baltic states are prostituting themselves in increasing numbers. Scandinavia has so far been affected relatively less by this mobility. In Spain, France, and Italy, women from Arabic and subSaharan countries are common among prostitutes. Foreign prostitutes move into Turkey along two main routes: women from the Balkan countries come to the western part of the country, whereas those from the former Soviet Union cross the border from Georgia, where they usually operate at resorts along the eastern Black Sea coast. Prostitutes are also mobile within the former communist bloc. For instance, women from Russia prostitute themselves in Lithuania, the Czech Republic, Slovakia, and Hungary. the customers are locals, particularly those with "hard currency", such as businessmen and "sex tourists" from the West. Following the outbreak of civil war in the former Yugoslavia, women from that country are now more frequently seen among the population of migratory prostitutes in Europe.
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Affiliation(s)
- PA M&oring;rdh
- Uppsala University Centre for STD Research, Uppsala University, Uppsala, Sweden
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