A study of the demographic characteristics of domestic tourists

"A sample survey was conducted [in China]: more than 6,000 questionnaires were submitted and retrieved from domestic tourists in Shanghai, Xi'ian, Huangshan, and Huashan in order to provide data for demographic analysis of the special fluid population of tourists. The paper looks at the relationship between tourists' gender, age, income, occupation, education, and family structure, as well as their tourist activity, selection of destinations, shopping, and other tourist behaviors."

Epidemic cholera in Latin America: spread and routes of transmission

In the most recent epidemic of cholera in Latin America, nearly a million cases were reported and almost 9000 people died between January 1991 and December 1993. The epidemic spread rapidly from country to country, affecting in three years all the countries of Latin America except Uruguay and the Caribbean. Case-control studies carried out in Peru showed a significant association between drinking water and risk of disease. Cholera was associated with the consumption of unwashed fruit and vegetables, with eating food from street vendors and with contaminated crabmeat transported in travellers' luggage. This article documents the spread of the epidemic and its routes of transmission and discusses whether the introduction of the epidemic to Peru and its subsequent spread throughout the continent could have been prevented.

AIDS knowledge, risk behaviors, and factors related to condom use among male commercial sex workers and male tourist clients in Bali, Indonesia

OBJECTIVES

To describe the AIDS/sexually transmitted diseases (STD) knowledge and risk behaviors, and to determine factors related to condom use among male commercial sex workers (CSW) and male tourist clients in Bali, Indonesia.

DESIGN

Individual survey interviews were conducted with a sample of 80 male CSW and 100 tourist clients in the Kuta area of Bali.

METHODS

Survey interviews included detailed questions on AIDS/STD knowledge, sexual behavior, and psychosocial measures related to risk taking.

RESULTS

Most of the male CSW had heard about AIDS and other STD, although some misconceptions about transmission and risks of different sexual practices remained. Both oral and anal intercourse with tourists were common and condom use was far from consistent. Factors related to condom use for anal intercourse with tourist clients were condom beliefs, self efficacy, susceptibility to STD infection, and STD knowledge. Tourist clients were mainly from Australia and Europe and many had paid for sex in other parts of Indonesia as well as in high prevalence countries. Knowledge of AIDS/STD was very good among the tourists and previous experience with STD was common. Factors related to condom use with male CSW were condom beliefs and self efficacy.

CONCLUSION

There is a very active and mobile group of male CSW and tourist clients present in Bali. Interventions with these men are needed due to the low level of knowledge about AIDS among CSW, their experience with STD and STD symptoms, and their level of risky sexual behavior.

HIV risk behavior among Peace Corps Volunteers

OBJECTIVE

To describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors.

METHOD

Cross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention.

RESULTS

Non-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use.

CONCLUSION

These data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

HIV and STD prevalence among bus and truck drivers in Cameroon

It is generally accepted that transport workers will have a higher level of seroprevalence than the general population--and that their employment means that they are at greater risk. There have been a few studies on this, primarily in east Africa. Among the studies reported in Yokohama was a 1993 survey of 128 truck drivers in Douala and 40 bus drivers in Ekok (on the Cameroon-Nigerian border). The survey found that drivers (whose mean age was 24.5 years) spent an average 14 days away from home on each trip. As might be expected there was a high incidence of seeking partners away from home, 62% had sex during the trip and 25% had sex every night they were away. The main partners were commercial sex workers, followed by girl friends. Drivers had high levels of STDs. 50% had had gonorrhea during the past six months, while 16% had had syphilis. As might be expected, the level of HIV prevalence were also high. 15% of drivers tested positive, the third highest prevalence in the country after commercial sex workers (35%) and prisoners (17%). The conclusion was that special prevention messages should be designed for drivers. The first need is to see the groups as a target who need to change their behavior, the second is to look at the determinants of this behavior and to seek to change the environment in which the drivers operate. For example, can the trips be shorter? Could drivers be encouraged to take partners with them? There is a need to move beyond the simple measuring of prevalence and identifying of the "risk groups" to looking at the socioeconomic setting in which they operate.

Worldwide pattern of mortality from motor vehicle accidents, 1950-1990

Trends in age-specific and age-standardized death certification rates from motor vehicle accidents over the period 1950-1990 were analyzed for 48 countries from four continents (2 from North America, 10 from Latin America, 8 from Asia, 26 from Europe, Australia and New Zealand) on the basis of data produced by the World Health Organization mortality database. In most developed western and Asiatic countries, mortality rates increased until the late 1960's or early 1970's, and declined thereafter to reach values often lower than those of the early 1950's, although the number of circulating vehicles has substantially increased over the same calendar period. The extent of the decline was, however, different in various countries, as well as in the two sexes and in various age groups, thus leading to complex cohort and period patterns. In general, countries (like the U.S.A. or U.K.), where the number of motor vehicles had increased earlier, have now comparatively higher rates at younger than at middle and older age, while the opposite is observed in countries with later spread of motor vehicles. Further, there were a few countries, including Kuwait, Venezuela and several other Latin American countries, Australia and New Zealand, and several southern and eastern European countries, with exceedingly high rates from motor vehicle accidents, and where comprehensive interventions on this important cause of death are therefore a public health priority.

Disseminated Penicillium marneffei infection as an imported disease in HIV-1 infected patients. Description of two cases and a review of the literature

Two cases of disseminated Penicillium marneffei infection, as an imported disease, in HIV-1-infected patients with a severe immunodeficiency are reported. These patients had a history of travel in Southeast Asia where P. marneffei is endemic. Fever, cough, malaise, hepatosplenomegaly, anaemia, skin lesions and mucosal ulcers are the main clinical characteristics. Differentiation from histoplasmosis and leishmaniasis might be difficult. Treatment with amphotericin B was successful. Anti-fungal maintenance therapy is most likely indicated.

Status of imported malaria in a control zone of the United Arab Emirates bordering an area of unstable malaria

A concerted malaria eradication programme in the United Arab Emirates has reduced local transmission to only a very few small foci in the country. The Al Ain district is now a consolidation zone. However, transmission across the undemarcated border with Oman continues. Malaria imported by the large immigrant work force from major disease endemic areas remains a large burden. An added threat is the appearance of chloroquine-resistant Plasmodium falciparum principally from Sudan and Pakistan but increasingly amongst Omani cases seen in the hospitals and clinics in Al Ain. The implications of re-introduction of malaria and the establishment of chloroquine resistance, particularly for non-immune residents and visitors, are emphasized.

Planned sexual behaviour of young Australian visitors to Thailand

OBJECTIVE

To research the knowledge of AIDS and other sexually transmitted diseases among young Australian tourists to Thailand, and their intended sexual behaviour.

DESIGN AND SETTING

A cross-sectional survey by anonymous, self-administered questionnaire, of persons seeking pre-travel medical advice in private clinics in five Australian cities.

PARTICIPANTS

213 consecutive patients travelling to Thailand without a spouse or partner.

RESULTS

Only 34% of the sample reported a definite intention not to have sex in Thailand. Regarding choice of potential partners: 24.5% more men than women said they would have sex with a Thai national; 13.7% of men said they would have sex with a "bar girl"; and 21.7% more women than men said they would choose a fellow Australian traveller. Eighty-two per cent of the sample reported that they would use condoms 100% of the time, and there was no significant difference between the number of men and women who expressed this intention.

CONCLUSIONS

Although not obviously "sex tourists", many young Australian travellers are likely to have sex while visiting Thailand. These data have important implications for education and prevention programs to control the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases.

Travel, migration and HIV

This is a review of recent publications on the subject of travel (taken in its widest sense) and HIV/AIDS. As with all epidemics caused by transmissible pathogens, AIDS has been seen in many countries as an imported problem. What this perspective fails to recognize is that with the explosion of international travel in the past thirty years it is virtually impossible to prevent the spread of infectious disease across international frontiers. Here we highlight the relative paucity of studies that describe or investigate the context in which sexual risk behaviour of travellers takes place, and suggest areas of further research which could increase understanding of the nature of sexual risk taking, and help in the design of health education programmes.

A history of sexually transmitted diseases in Thailand: policy and politics

This paper provides a brief history of sexually transmitted diseases (STDs) in Thailand. The presentation is divided into three main sections: the period up to the 1930s; the period from the 1930s until the end of the early 1980s; and the period from the early 1980s until the present, the so-called 'AIDS Era'. The discussion in each of these sections focuses, as far as sources permit, on the epidemiological picture, as well as describing public and official responses to these diseases. In the final part of the paper consideration is given to these findings in relation to the present situation in Thailand regarding the HIV/AIDS epidemic.

STDs and the overseas traveller

Although most HIV and STD patients acquire their infections in Australia there is an increase in the numbers diagnosed with these infections after international travel. Risks to the sexual health of the travellers and their subsequent partners are discussed and suggestions made for minimising risks.

The cost of the district hospital: a case study in Malawi

Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed.