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Javadivala Z, Najafi A, Shirzadi S, Najafi S, Nadrian H, Mansuri P, Pirehbabi K, Fathi B, Bhalla D. Development of a HIV Prevention Program to Promote Condom Use Among Iranian Female Sex Workers: Application of An Intervention Mapping Approach. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02878-6. [PMID: 38902491 DOI: 10.1007/s10508-024-02878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based "HIV Prevention and Awareness Program (HIV-PAP)" on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50-65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R2 = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (β = 0.331), perceived norms (β = 0.945), and perceived barriers (β = 0.258)], condom use negotiation (β = 1.386), and environmental factors (β = 0.333). Our IM-based framework had an adequate fit index (χ2 = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) - .38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI - 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI - 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI - 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program.
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Affiliation(s)
- Zeinab Javadivala
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, 14711, Iran
| | - Athareh Najafi
- School of Nursing and Midwifery, Islamic Azad University-Sanandaj Branch, Sanadaj, Iran
| | - Shayesteh Shirzadi
- Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Sarisa Najafi
- Graduate Student in Psychology, Islamic Azad University-Sanandaj Branch, Sanandaj, Iran
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, 5165665931, Iran.
| | - Parvin Mansuri
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamyar Pirehbabi
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrouz Fathi
- Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Devender Bhalla
- Pôle Universitaire Euclide Intergovernmental UN Treaty, Bangui, Central African Republic
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Santaolaya C, Malhotra J, Fowler JA, Warzywoda S, Debattista J, Mills DJ, Lau C, Furuya-Kanamori L, Durham J, Mullens AB, Istiko SN, Dean JA. Integrating sexual and reproductive health into pre-travel consultations. J Travel Med 2024; 31:taae024. [PMID: 38340322 PMCID: PMC11149722 DOI: 10.1093/jtm/taae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Casual sex during travel is a major preventable factor in the global transmission of sexually transmissible infections (STI). Pre-travel consults present an excellent opportunity for practitioners to educate travellers about sexual and reproductive health (SRH) and safety. This scoping review aims to explore and understand the extent to which SRH is included in pre-travel consultations. METHODS PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline and Web of Science were systematically searched for primary research articles exploring whether health care practitioners (HCP) included SRH in pre-travel consultations. Extracted findings were synthesized and presented in narrative form. RESULTS Findings across 13 articles suggest HCPs infrequently broached SRH in pre-travel consultations with HCP discomfort, and lack of time and resources presented as key barriers. Urban practice settings, HCP experience, training in travel medicine and traveller characteristics such as sexual orientation were positively associated with discussions about SRH. SRH advice reported was general in nature, primarily focusing on safer sex, condoms or unspecified STI advice. Risk assessments based solely on age or stereotypes around sexual preferences led to key aspects of SRH care being missed for some (e.g. SRH was less likely to be discussed with older travellers). CONCLUSIONS HCPs frequently miss opportunities to integrate SRH into pre-travel consultations. Strategies to promote HCP confidence and awareness present a promising means to boost the frequency and quality of SRH advice disseminated. Integrating culturally safe and responsive SRH history-taking and advice into pre-travel consultations may contribute to global reductions in STI transmission and promote traveller SRH well-being.
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Affiliation(s)
- Carlos Santaolaya
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Juhi Malhotra
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - James A Fowler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Sarah Warzywoda
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Joe Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Brisbane, QLD 4053, Australia
| | | | - Colleen Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Jo Durham
- School of Public Health and Social Work, Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Amy B Mullens
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD 4305, Australia
| | - Satrio N Istiko
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
- UQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD 4066, Australia
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Shiferaw W, Martin BM, Dean JA, Mills D, Lau C, Paterson D, Koh K, Eriksson L, Furuya-Kanamori L. A systematic review and meta-analysis of sexually transmitted infections and blood-borne viruses in travellers. J Travel Med 2024; 31:taae038. [PMID: 38438164 PMCID: PMC11149723 DOI: 10.1093/jtm/taae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/18/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) impose a global health and economic burden. International travellers facilitate the spread of infectious diseases, including STIs. Hence, this review assessed the prevalence/proportionate morbidity of travellers with STIs and sexually transmitted BBVs and factors associated with the infection in this population. METHODS PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Cochrane Library were searched from inception of the databases until November 2022. Published analytical observational studies reporting the prevalence/proportionate morbidity of travellers with STIs and factors associated with STIs by type of traveller [i.e. tourists, business travellers, students, visiting friends or relatives (VFRs), international truck drivers, backpackers, expatriates and men who have sex with men (MSM)] were included. The selection of articles, data extraction and risk of bias assessment were conducted by two independent reviewers. Meta-analyses were conducted for each STI by clinical presentation and type of traveller. RESULTS Thirty-two studies (n = 387 731 travellers) were included; 19 evaluated the proportionate morbidity of STIs among symptomatic travellers, while 13 examined the prevalence of STIs in asymptomatic travellers. The highest proportionate morbidity was found among VFRs (syphilis, 1.67%; 95% CI: 1.03-2.81%), backpackers (Chlamydia trachomatis, 6.58%; 95% CI: 5.96-7.25%) and MSM (HIV [2.50%;95% CI: 0.44-12.88%], gonorrhoea [4.17%; 95% CI: 1.1.5-13.98%], lymphogranuloma venereum [4.17%;95% CI: 1.1.5-13.98%] and HAV [20.0%; 95% CI: 14.99-26.17%]). The highest prevalence of STIs among asymptomatic were found in MSM (HIV [25.94%; 95% CI: 22.21-30.05%] and HBV [24.90%; 95% CI: 21.23-28.96%]) and backpackers (C. trachomatis, 3.92%; 95% CI: 2.72-5.32%). Short duration of the trip (<1 month), not having pre-travel consultation, travelling to Southeast Asia and being unvaccinated for HBV were identified as risk factors for STIs. CONCLUSION Strategies to prevent STIs and sexually transmitted BBVs should be discussed at pre-travel consultations, and recommendations should be prioritized in high-risk groups of travellers, such as backpackers, VFRs and MSMs. Additionally, healthcare providers should tailor recommendations for safe sex practices to individual travellers' unique needs.
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Affiliation(s)
- Wondimeneh Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Asrat Woldeyes Health Science Campus, Debre Berhan University, Ethiopia
| | - Beatris Mario Martin
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Judith A Dean
- UQ Poche Centre for Indigenous Health, Faculty of Health, and Behavioural Sciences, The University of Queensland, Toowong, Australia
| | - Deborah Mills
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Colleen Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - David Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Kenneth Koh
- Gladstone Road Medical Centre, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Herston, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
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Sinka K. The global burden of sexually transmitted infections. Clin Dermatol 2024; 42:110-118. [PMID: 38142791 DOI: 10.1016/j.clindermatol.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Understanding the global burden of sexually transmitted infections (STIs) is fundamental to being able to address and control these infections and the health harms they cause. The World Health Organization has renewed its global health sector strategy for the prevention and control of STIs. Reducing STIs remains an integral part of HIV prevention and of sexual and reproductive health programs. Data to measure and describe the global burden continue to improve, with systematic reviews and modeling providing global and regional data for the major STIs. Although substantial gaps remain, as many countries have limited data, the measures available demonstrate the scale of the problem for the main curable STIs, gonorrhea, chlamydia, syphilis, and trichomoniasis; the most common viral STIs, human papillomavirus and genital herpes; the interrelation between STIs and HIV; and the substantially unequal burden of these infections globally and among key populations. Regional and global trends in these infections are affected by population changes; the impact and availability of interventions, such as vaccination; changing behaviors that alter the dynamics of STI transmission; and the role of international travel in promulgating STIs in an increasingly interconnected world.
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Affiliation(s)
- Katy Sinka
- STI Section, Blood Safety, Hepatitis, STI, and HIV Division, UK Health Security Agency, London, United Kingdom.
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Warzywoda S, Fowler JA, Debattista J, Mills DJ, Furuya-Kanamori L, Durham J, Lau CL, Mullens AB, Istiko SN, Santaolaya C, Malhotra J, Dean JA. The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians. Sex Health 2024; 21:SH23098. [PMID: 38219736 DOI: 10.1071/sh23098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice. METHODS A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference. RESULTS Of the 67 respondents, most (n , 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n , 37) had worked in travel medicine for over 10years. Only 22.4% (n , 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n , 42; 62.7%), or based on the patient's history (n , 37; 55.2%). Over half the sample (n , 40; 59.7%) expressed interest in further training in SRH. CONCLUSION Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.
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Affiliation(s)
- Sarah Warzywoda
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - James A Fowler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Joe Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Windsor, Qld, Australia
| | - Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Qld, Australia; and UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Qld, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Qld, Australia
| | - Jo Durham
- School of Public Health and Social Work, Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Faculty of Health Queensland University of Technology, Kelvin Grove, Qld, Australia
| | - Colleen L Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Qld, Australia
| | - Amy B Mullens
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Qld, Australia
| | - Satrio Nindyo Istiko
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Carlos Santaolaya
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Juhi Malhotra
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
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De la Herrán-Arita AK, González-Galindo C, Inzunza-Leyva GK, Valdez-Flores MA, Norzagaray-Valenzuela CD, Camacho-Zamora A, Batiz-Beltrán JC, Urrea-Ramírez FJ, Romero-Utrilla A, Angulo-Rojo C, Guadrón-Llanos AM, Picos-Cárdenas VJ, Camberos-Barraza J, Rábago-Monzón ÁR, Osuna-Ramos JF. Clinical Predictors of Monkeypox Diagnosis: A Case-Control Study in a Nonendemic Region during the 2022 Outbreak. Microorganisms 2023; 11:2287. [PMID: 37764131 PMCID: PMC10535336 DOI: 10.3390/microorganisms11092287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Monkeypox (Mpox) is an emerging zoonotic disease with the potential for severe complications. Early identification and diagnosis are essential to prompt treatment, control its spread, and reduce the risk of human-to-human transmission. This study aimed to develop a clinical diagnostic tool and describe the clinical and sociodemographic features of 19 PCR-confirmed Mpox cases during an outbreak in a nonendemic region of northwestern Mexico. The median age of patients was 35 years, and most were male. Mpox-positive patients commonly reported symptoms such as fever, lumbago, and asthenia, in addition to experiencing painful ulcers and a high frequency of HIV infection among people living with HIV (PLWH). Two diagnostic models using logistic regression were devised, with the best model exhibiting a prediction accuracy of 0.92 (95% CI: 0.8-1), a sensitivity of 0.86, and a specificity of 0.93. The high predictive values and accuracy of the top-performing model highlight its potential to significantly improve early Mpox diagnosis and treatment in clinical settings, aiding in the control of future outbreaks.
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Affiliation(s)
- Alberto Kousuke De la Herrán-Arita
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
| | | | - Gerardo Kenny Inzunza-Leyva
- Dirección de Prevención y Promoción de la Salud, Secretaría de Salud de Sinaloa, Culiacán Rosales 80020, Sinaloa, Mexico;
| | - Marco Antonio Valdez-Flores
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
| | | | - Alejandro Camacho-Zamora
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
| | - José Candelario Batiz-Beltrán
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
- Hospital Regional Dr. Manuel Cárdenas de la Vega, ISSSTE, Culiacán Rosales 80230, Sinaloa, Mexico
| | - Francisco Javier Urrea-Ramírez
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
- Hospital Regional Dr. Manuel Cárdenas de la Vega, ISSSTE, Culiacán Rosales 80230, Sinaloa, Mexico
| | - Alejandra Romero-Utrilla
- Departamento de Anatomía Patológica, Instituto Mexicano del Seguro Social, Culiacán Rosales 80230, Sinaloa, Mexico
| | - Carla Angulo-Rojo
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
- Maestría en Ciencias en Biomedicina Molecular, Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico
| | - Alma Marlene Guadrón-Llanos
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
- Doctorado en Ciencias en Biomedicina Molecular, Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico
| | - Verónica Judith Picos-Cárdenas
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
| | - Josué Camberos-Barraza
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
| | - Ángel Radamés Rábago-Monzón
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
| | - Juan Fidel Osuna-Ramos
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán Rosales 80019, Sinaloa, Mexico; (A.K.D.l.H.-A.); (M.A.V.-F.); (A.C.-Z.); (J.C.B.-B.); (F.J.U.-R.); (C.A.-R.); (A.M.G.-L.); (V.J.P.-C.); (Á.R.R.-M.)
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Matsee W, Charoensakulchai S, Wirawan IMA, Imad HA. The silent, rapidly unfolding threat of mpox spread via international travel to Southeast Asia: Are we ready? Travel Med Infect Dis 2023; 54:102597. [PMID: 37263370 PMCID: PMC10229211 DOI: 10.1016/j.tmaid.2023.102597] [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: 07/22/2022] [Revised: 01/06/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
The 2022 mpox (monkeypox) outbreak has been surprisingly large and has raised several novel questions about this disease. New information, such as atypical clinical manifestations and transmission via sexual activities, have been identified. These pose a potential risk of widespread outbreaks due to unusual clinical manifestations and failure to consider mpox as a diagnosis by physicians and the sexual behaviours of some tourists in Southeast Asia. Since Southeast Asia is a popular tourist destination, there is substantial potential for the silent spread of mpox in this region. Consequently, there is an urgent need for effective surveillance measures at points of entry of international travelers to identify suspected cases and their close contacts in order to limit the spread of mpox in Southeast Asia.
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Affiliation(s)
- Wasin Matsee
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Sakarn Charoensakulchai
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - I Made Ady Wirawan
- Travel Medicine Unit, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Hisham A Imad
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand; Center for Infectious Disease Education and Research, Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Suita, 565-0871, Osaka, Japan
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Quaife M, Diallo M, Jaye A, Martinez-Alvarez M. Partnership preferences, economic drivers, and health consequences of Gambian men's interactions with foreign tourists: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001115. [PMID: 36962966 PMCID: PMC10021562 DOI: 10.1371/journal.pgph.0001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2022] [Indexed: 03/04/2023]
Abstract
The Gambia has a thriving tourist industry, but in recent decades has developed a reputation as a destination for older, female tourists to seek sexual relationships with young Gambian men. During partnerships or in return for sex, Gambian men may receive financial support or in some cases the opportunity to travel to Europe with a partner. There has been little previous research among these men on sexual risk behaviours, physical and mental health, and health service utilisation. This study describes the economic drivers and health implications of interactions between Gambian men and foreign tourists near tourist resorts in The Gambia. We conducted simultaneous mixed method data collection among Gambian men who regularly interact with tourists: a cross-sectional quantitative survey and discrete choice experiment (DCE) with 242 respondents, three focus group discussions, and 17 in-depth interviews. The survey asked questions on demographic characteristics, sexual history and health-seeking, the DCE elicited trade-offs between partnership characteristics, and qualitative data explored individual and group experiences in depth. We found that sexual activity between Gambian men and tourists was prevalent with 50% of the sample reporting ever having sex with a tourist. Condom use at last sex was significantly higher with tourist (63%) than with Gambian partners (40%, p<0.01). Condom use, money, and opportunity to travel to Europe were most important to respondents in the DCE. Qualitative data validated and explained quantitative findings, notably pressures to engage in unprotected sex and potential travel to Europe. Although men's physical health needs were broadly met, mental health, substance use and sexual health needs were not. Young men working on the beaches of The Gambia face substantial health risks, including from STIs and mental health issues. The health system needs to understand barriers to existing health services, and how they can meet the needs of these vulnerable men.
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Affiliation(s)
- Matthew Quaife
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mareme Diallo
- MRC Unit The Gambia at LSHTM, London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
| | - Assan Jaye
- MRC Unit The Gambia at LSHTM, London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
| | - Melisa Martinez-Alvarez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Unit The Gambia at LSHTM, London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
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9
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Nadarzynski T, Nutland W, Samba P, Bayley J, Witzel TC. The Impact of First UK-Wide Lockdown (March-June 2020) on Sexual Behaviors in Men and Gender Diverse People Who Have Sex with Men During the COVID-19 Pandemic: A Cross-Sectional Survey. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:617-627. [PMID: 36344786 PMCID: PMC9640839 DOI: 10.1007/s10508-022-02458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/30/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
The global COVID-19 pandemic resulted in strict social distancing measures restricting close physical contact. Men (cis and trans) and other gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs) and may have experienced changes in sexual behavior during government restrictions on social and sexual contact. We aimed to examine self-reported sexual behavior of MGDSM during the first UK-wide lockdown to identify the characteristics of the individuals who might most require sexual health promotion and clinical support. In April-May 2020, we conducted an online survey of MGDSM, promoted on social media and Grindr. Our exploratory approach used descriptive analysis to identify self-reported changes in sexual behavior and performed regression analyses to identify correlates of casual sex during the lockdown. A total of 1429 respondents completed the survey: mean age 36 years, 84% White, 97% male or trans male, 98% assigned male sex at birth, 2% female or non-binary, 65% degree educated or higher. During the lockdown, 76% reported not having any casual sex partners. While the majority reported reduced casual sex, 3% reported an increase in casual sex with one person and 2% with three or more people (group sex). About 12% of the sample engaged in casual sex with only one person and 5% with four or more sexual partners during the lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR = 2.37 [95% CI 1.40-4.01]; identifying as a member of an ethnic minority OR = 2.27[1.40-3.53]; daily usage of sexual networking apps OR = 2.24[1.54-3.25]; being less anxious about contracting SARS-CoV-2 through sex OR = 1.66[1.12-2.44]; using PrEP before lockdown OR = 1.75[1.20-2.56]; continuing to use PrEP OR = 2.79[1.76-4.57]; and testing for STIs during lockdown OR = 2.65[1.76-3.99]. A quarter of respondents remained sexually active with casual partners, indicating a need to provide STI screening services and health promotion targeted to groups most likely to have need over this period. Future research is required to better understand how to support sexual and gender minorities to manage sexual risk in the context of pandemic public health initiatives.
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Affiliation(s)
- Tom Nadarzynski
- School of Social Sciences, University of Westminster, Room 6.101, 115 New Cavendish Street, London, W1W 6UW, UK.
| | - Will Nutland
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The Love Tank CIC, London, UK
| | - Phil Samba
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The Love Tank CIC, London, UK
| | - Jake Bayley
- Sexual Health and HIV Department, Barts NHS Trust, London, UK
| | - T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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10
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Syndromic Treatment of STIs in Low-income Countries is Inadequate: Current Threats and Future Directions. Clin Obstet Gynecol 2022; 65:717-732. [PMID: 36260010 DOI: 10.1097/grf.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Sexually transmitted infections (STIs) pose a serious public health threat with more than 1 million curable infections diagnosed every day. While these infections are prevalent globally, the approach to evaluation and treatment varies greatly based on the capacity to make an accurate diagnosis. In low-resource settings, a syndromic approach is often used over an etiologic-based evaluation and management. Syndromic treatment of STIs recognizes groups of symptoms and recommends a multidrug empiric treatment that will cover the most likely causative organisms. By definition, syndromic treatment cannot be used as a screening tool, leaving a large portion of asymptomatic infections untreated. This will lead to the persistence of infection and associated sequelae including pelvic inflammatory disease and infertility. Syndromic treatment also leads to the overtreatment of many infections, which contributes to antimicrobial resistance. The rising threat of Neisseria gonorrhoeae resistance to last-line antibiotics is of global concern. Rapid, accurate, affordable, and easy-to-use point-of-care testing needs to be made readily available to all corners of the world to provide better care to patients and address the growing threat of multidrug resistant organisms. An urgent and collaborative global effort is needed to address the looming threat of a dangerous STI that is resistant to last-line antibiotics.
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11
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Martins SL, Hellerstedt WL, Brady SS, Mason SM. Sexual and reproductive health during international travel: Expectations and experiences among female university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2108-2115. [PMID: 33258743 DOI: 10.1080/07448481.2020.1844717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
ObjectiveTo evaluate female students' expectations and experiences related to their sexual and reproductive health (SRH) during international travel. Participants: Female students from a US university with a history of sex with men completed a cross-sectional survey about their upcoming (Pre-travelers; n = 170) or recent (Travelers; n = 340) international travel. Methods: Descriptive statistics were used to characterize pre-travel SRH expectations (for Pre-travelers) and to determine the prevalence of 15 SRH experiences during both recent and lifetime travel (for Travelers). Results: Pre-travelers overwhelmingly expected to be abstinent and many were unsure of whether SRH supplies would be accessible in their destination. During Travelers' recent trip, SRH experiences included getting off schedule with contraception (30%), unwanted sexual touching (18%), new male sex partners (17%), and unexpected sex (15%); lifetime prevalence estimates were higher. Conclusions: International travel poses risks to female students' SRH that can be addressed by pre-travel counseling from study-abroad programs and clinicians.
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Affiliation(s)
- Summer L Martins
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Wendy L Hellerstedt
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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12
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Mostafa MM, Mahdy A, Ghoniem G. Updates on Sexually Transmitted Urethro-cystitis. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose of Review
We performed recent literature review with the aim to address the updates in diagnosis and management of sexually transmitted urethro-cystitis.
Recent Findings
There are multiple, recently published studies that collectively lead to an organized stepwise plan for diagnosis and management of sexually transmitted urethro-cystitis.
Summary
Sexually transmitted urethro-cystitis is a common health condition that can be managed efficiently if the appropriate steps are taken in diagnosis and management.
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13
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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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14
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Wilder S, Scott C. Sex at Sea: Undergraduates' Perceptions of Sexual Relationships During Their Semester at Sea Voyage. SEXUALITY & CULTURE 2022; 26:2000-2018. [PMID: 35730003 PMCID: PMC9198201 DOI: 10.1007/s12119-022-09980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
Often viewed as right of passage in emerging adulthood on college campuses, most undergraduate students participate in casual sex during their undergraduate career. Sexual exploration typically continues during study abroad programs; however, these programs have previously been associated with an increase in risky sexual behavior due to a lack of familiar social norms and community. The current study examined the casual sexual relationships of 302 undergraduates participating in Semester at Sea, an eleven country, 106-day voyage which incorporates aspects of a traditional college campus combined with the novel experience of studying abroad. The purpose of this research was to explore students' casual sexual relationship perceptions and behaviors in the context of a structured and community-oriented study abroad environment. Over half (52%) of the student population completed a series of open-ended questions regarding their uncommitted sexual activity during the Semester at Sea voyage. Results indicated that 16.9% of students engaged in at least one casual sexual relationship over the course of the trip. Casual sex relationships on-board the Semester at Sea voyage were less prevalent than those on traditional college campuses, but casual sex relationships at sea appeared to focus more on the importance of communication and boundaries during the sexual relationship and concluded on a more positive note. It is likely that these decisions were influenced by the established communal culture on-board the ship, which encouraged students to maintain harmonious social relationships and a high level of awareness of others.
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Affiliation(s)
- Siri Wilder
- Department of Psychology, University of Texas at Dallas, Richardson, United States
| | - Christina Scott
- Department of Psychological Sciences, Whittier College, Whittier, United States
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15
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Truong HHM, Fatch R, McFarland W, Grasso M, Raymond HF, Holt M, Steward WT. Destination-Specific and Home Environment Condom Norms Influence Sexual Behavior During Travel. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:245-255. [PMID: 35647868 PMCID: PMC10654111 DOI: 10.1521/aeap.2022.34.3.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Travelers may adapt HIV risk-reduction practices based on perceived destination-specific norms. We examined the association between perceived condom norms and condomless anal sex (CAS) during international and domestic travel and in the home environment among men who have sex with men. Men who traveled internationally in the past 12 months were recruited by respondent-driven sampling (N = 501). Not knowing destination-specific condom norms was significantly associated with less CAS during international travel and in the home environment but not during domestic travel. Perceiving home environment condom norms to expect use of condoms was significantly associated with less CAS during domestic but not international travel. Men were less likely to engage in CAS during international travel when destination-specific condom norms were unknown. Unfamiliarity with the environment and culture may influence some men to refrain from higher-risk behaviors. During domestic travel, some men appeared to apply home environment condom norms, which may be erroneous in some situations and pose an HIV risk.
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Affiliation(s)
| | | | - Willi McFarland
- University of California San Francisco
- California Department of Public Health
| | | | | | - Martin Holt
- University of New South Wales, Sydney, Australia
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16
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Gareau E, Phillips KP. Sexual behaviors at home and abroad: an online survey of Canadian young adult travelers. BMC Public Health 2022; 22:967. [PMID: 35562691 PMCID: PMC9106270 DOI: 10.1186/s12889-022-13383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For young adults, travel- an accessible and aspirational experience- may be accompanied by high-risk lifestyle behaviors abroad, which in turn, increases the risk of sexually transmitted and blood-borne infections (STBBI). This study aimed to examine sexual and risk behaviors of young Canadian adults both at-home and during international travel. METHODS Sexually-active Canadians, aged 18-25 years (N = 646) who travelled abroad in 2016, completed an online, cross-sectional survey analyzed by descriptive statistics. Outcome measures included young Canadian adults' lifestyle risk and sexual behaviors at-home and abroad. RESULTS Sexual behaviors, both penetrative and non-penetrative activities, decreased significantly (p < 0.001; McNemar test) abroad compared to at-home. International travel elicited a statistically significant increase in alcohol consumption compared to at-home (Wilcoxon, z = - 11.341, p < 0.001). Partner type (new trip-acquired partner) abroad was associated with a greater number of travel-acquired sexual partners (Mann-Whitney, U = 4901, p < 0.001), inconsistent condom use during penetrative sex (U = 7215, p = 0.009), and sex under the influence of alcohol (Test of Two Proportions, p < 0.001). CONCLUSIONS Although many young Canadian respondents practiced abstinence in their 2016 travel, for sexually-active travelers, new partner-type was related to high risk sexual behaviors. Young Canadians exhibited sexual risk behaviors both at-home and while travelling; suggesting the need for both domestic and pre-travel sexual health interventions.
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Affiliation(s)
- Emmanuelle Gareau
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 6N5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 6N5, Canada.
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17
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Ivarsson L, de Arriba Sánchez de la Campa M, Elfving K, Yin H, Gullsby K, Stark L, Andersen B, Hoffmann S, Gylfe Å, Unemo M, Herrmann B. Changes in testing and incidence of Chlamydia trachomatis and Neisseria gonorrhoeae – the possible impact of the COVID-19 pandemic in the three Scandinavian countries. Infect Dis (Lond) 2022; 54:623-631. [DOI: 10.1080/23744235.2022.2071461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Lovisa Ivarsson
- Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Magdalena de Arriba Sánchez de la Campa
- Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Elfving
- Department of Clinical Microbiology, Laboratory Medicine, Falu Hospital, Falun, Sweden
| | - Hong Yin
- Department of Clinical Microbiology, Laboratory Medicine, Falu Hospital, Falun, Sweden
| | - Karolina Gullsby
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Lisa Stark
- Department of Clinical Microbiology, Ryhov County Hospital, Jönköping, Sweden
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steen Hoffmann
- Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Åsa Gylfe
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, United Kingdom
| | - Björn Herrmann
- Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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18
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Gareau E, Phillips KP. Key informant perspectives on sexual health services for travelling young adults: a qualitative study. BMC Health Serv Res 2022; 22:145. [PMID: 35120510 PMCID: PMC8814567 DOI: 10.1186/s12913-022-07542-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022] Open
Abstract
Background International travel has become increasingly popular among young adults. Young adults often engage in casual sexual relationships abroad, exhibit sexual risk behaviours and may thus be at risk of contracting sexually transmitted and blood-borne infections. Pre-travel interventions and consultations may mitigate this risk. At present, we know little about sexual health-related pre-travel interventions. The aim of this study was therefore to document key informants’ experiences, perceptions and recommendations in the context of sexual health of young adult travellers. Methods Key informants were professionals working in Ottawa, Canada travel clinics, travel organizations or sexual health clinics with a young adult clientele. This study used a qualitative approach and consisted of 13 in-person or Skype semi-structured interviews with key informants. Thematic content analysis was informed by a sexual health framework, with themes emerging both inductively and deductively. Results Sexual health was not common in pre-travel interventions described by key informants. Risk-assessment, and practical or purpose-driven pre-travel interventions were identified, resulting in risk mitigation strategies tailored to the destination region and/or mission/culture of the travel organization. Dissemination (e.g. limited time, lack of training) and uptake (e.g. young adults’ embarrassment, provider discomfort, financial constraints) barriers limited in-depth discussions of pre-travel interventions related to sexual health. Key informants acknowledged the importance of early sexual health education, and recommended ongoing, comprehensive sexual education for both youth and young adults. Conclusion The findings of this study suggest that more time and resources should be allocated to the topic of sexual health during pre-travel interventions with young adults. Professionals who guide and prepare young adults for travel must develop concomitant skills in sexual health promotion. Early, comprehensive sexual education is recommended to improve overall sexual health in young adults and mitigate risk behaviours during travel.
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Affiliation(s)
- Emmanuelle Gareau
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 6N5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 6N5, Canada.
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Sex Abroad Among Men Who Have Sex With Men and Its Association With Chemsex, Sexual Risk Behavior, and Sexually Transmitted Diseases: A Cross-Sectional Study in the Netherlands. Sex Transm Dis 2021; 47:e29-e32. [PMID: 32496389 DOI: 10.1097/olq.0000000000001207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Almost half of men who have sex with men visiting Dutch sexually transmitted disease clinics reported sex abroad in the past 6 months, mainly in Western countries. One in 4 men who have sex with men who had sex abroad used drugs during sex ("chemsex") abroad. Having sex abroad was associated with having multiple sex partners and casual sex partner(s).
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20
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Aggarwal S, Singh AK, Balaji S, Ambalkar D. Sexually transmitted infections (STIs) and its changing scenario: A scoping review. Comb Chem High Throughput Screen 2021; 25:1630-1638. [PMID: 33645477 DOI: 10.2174/1386207324666210301093001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) have existed worldwide since ancient time, causing significant morbidity and mortality. To maintain healthy sexual and reproductive life, it is highly essential to prevent STIs, RTIs and related illnesses. STIs are transmitted by swapping body fluids among people during sexual intercourse. The etiological agents for STIs are bacteria, virus and parasites for most cases, but proportions by different aetiology are changing. Various studies have shown that STIs are increasing, and its primary aetiology is changing worldwide. That should be considered seriously and needs necessary actions. Several factors related to hosts and disease-causing agents have identified to influence STIs' current strategies in the prevention and control program. The present assessment attempts to review the history, changing aetiology and antimicrobial resistance in STIs. This review has also highlighted the prevalence of STIs at the global level and their past and present trends in India, emphasising its future challenges and perspectives for making effective public health policies to prevent and control STIs.
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Affiliation(s)
- Sumit Aggarwal
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi-110029. India
| | - Amit Kumar Singh
- ICMR-National JALMA Institute for Leprosy and other Mycobacterial diseases, Tajgani, Agra-282004. India
| | - Sivaraman Balaji
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi-110029. India
| | - Deepti Ambalkar
- Department of lab medicine, Max Super speciality hospital, Saket Delhi -110017. India
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21
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Correlates of Casual Sex Amidst Vulnerability to HIV Among ACB Heterosexual Men in Ottawa and Windsor, Ontario Canada. J Racial Ethn Health Disparities 2021; 9:444-455. [PMID: 33559111 PMCID: PMC7870027 DOI: 10.1007/s40615-021-00975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/23/2022]
Abstract
Heterosexual exposure is the second highest means of HIV transmission; and African, Caribbean, and Black (ACB) men face greater risks. Black men can reduce the disproportionately high HIV prevalence in their communities by changing their socially misconstrued masculine role. We analysed factors predisposing heterosexual ACB men to risky sexual behaviour, particularly multiple casual sex partnerships in Ottawa and Windsor, Ontario, Canada. We employed quantitative datasets from a broader mixed methods study within hierarchical logistic regression model to determine the association between psychosocial factors and casual sex partnerships. The model controlled for city level clustering effect and sociodemographic factors. Precisely 55.0% (n = 52) of men in Windsor and 70.2% (n = 99) in Ottawa had one or more casual sex partners within the past year. Some of them (Windsor, 32.1% [n = 18], and Ottawa, 34.3% [n = 36]) used condom always. HIV knowledge (OR = 0.80, p < 0.01, CI = 0.67/0.95) and pro-Black community attitudes (OR = 0.72, p < 0.05, CI = 0.56/0.94) decreased the odds of casual sex partnerships, while traditional masculinity scores (OR = 1.21, p < 0.05, CI = 1.01/1.46) increased it. The behavioural factors jointly predicted casual sex more than sociodemographic variables and city of residence. We conclude that heterosexual ACB men are predisposed to casual sex partnerships at differing magnitude across cities, and this may constitute a risk factor for HIV exposure. Hence, propagation of HIV knowledge, community attitudes and reconstruction of masculine ideology among ACB men, with due attention to geopolitical differences in city of residence, are recommended.
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Kutsuna S, Asai Y, Yamamoto K, Shirano M, Konishi K, Asaoka T, Yamato M, Katsuragi Y, Yamamoto Y, Sahara T, Tamiya A, Nakamura-Uchiyama F, Sakamoto N, Kosaka A, Washino T, Hase R, Mito H, Kurita T, Shinohara K, Shimizu T, Kodama F, Nagasaka A, Ogawa T, Kasahara K, Yoshimura Y, Tachikawa N, Yokota K, Yuka Murai NS, Sakamaki I, Hasegawa C, Yoshimi Y, Toyoda K, Mitsuhashi T, Ohmagari N. Epidemiological trends of imported infectious diseases in Japan: Analysis of imported 2-year infectious disease registry data. J Infect Chemother 2020; 27:632-638. [PMID: 33309629 DOI: 10.1016/j.jiac.2020.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The epidemiology of infectious diseases in Japan remains undefined despite the increasing tourism. GeoSentinel, an epidemiological surveillance system for reporting imported infectious diseases, has only two participating facilities in Japan. Although the number of infectious diseases is reported by the National Institute of Infectious Diseases, there is no detailed clinical information about these cases. Therefore, we established J-RIDA (Japan Registry for Infectious Diseases from Abroad) to clarify the status of imported infectious diseases in Japan and provide detailed information. METHODS J-RIDA was started as a registry of imported infectious diseases. Case registration began in October 2017. Between October 2017 and September 2019, 15 medical institutions participated in this clinical study. The registry collected information about the patient's age, sex, nationality, chief complaint, consultation date, date of onset, whether visit was made to a travel clinic before travel, blood test results (if samples were collected), travel history, and final diagnosis. RESULTS Of the 3046 cases included in this study, 46.7% to Southeast Asia, 13.0% to Africa, 13.7% to East Asia, 11.5% to South Asia, 7.5% to Europe, 3.8% to Central and South America, 4.6% to North America, 3.9% to Oceania, and 2.8% to Central and west Asia. More than 85% of chief complaints were fever and general symptoms, gastrointestinal symptoms, respiratory symptoms, or dermatologic problems. The most common diseases were travelers' diarrhea, animal bite, upper respiratory infection, influenza, and dengue fever. CONCLUSIONS We summarized two-year cases registered in Japan's imported infectious disease registry. These results will significantly contribute to the epidemiology in Japan.
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Affiliation(s)
- Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Yusuke Asai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Michinori Shirano
- Osaka City General Hospital, 2-13-22, Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan
| | - Keiji Konishi
- Osaka City General Hospital, 2-13-22, Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan
| | - Tomohiro Asaoka
- Osaka City General Hospital, 2-13-22, Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan
| | - Masaya Yamato
- Rinku General Medical Center, Rinku Ourai Kita 2-23, Izumisanoshi, Osaka, 598-8577, Japan
| | - Yukiko Katsuragi
- Rinku General Medical Center, Rinku Ourai Kita 2-23, Izumisanoshi, Osaka, 598-8577, Japan
| | - Yudai Yamamoto
- Rinku General Medical Center, Rinku Ourai Kita 2-23, Izumisanoshi, Osaka, 598-8577, Japan
| | - Toshinori Sahara
- Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, 3F 2-5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Aya Tamiya
- Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, 3F 2-5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Fukumi Nakamura-Uchiyama
- Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, 3F 2-5 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Naoya Sakamoto
- Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Atsushi Kosaka
- Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takuya Washino
- Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Ryota Hase
- Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Haruki Mito
- Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Takashi Kurita
- Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Koh Shinohara
- Kyoto City Hospital, 1-2 Mibuhigashitakadacho, Nakagyo Ward, Kyoto, 604-8845, Japan
| | - Tsunehiro Shimizu
- Kyoto City Hospital, 1-2 Mibuhigashitakadacho, Nakagyo Ward, Kyoto, 604-8845, Japan
| | - Fumihiro Kodama
- Sapporo City General Hospital, Kita 1 Nishi 2, Chuo-ku, Sapporo, 060-8611, Japan
| | - Atsushi Nagasaka
- Sapporo City General Hospital, Kita 1 Nishi 2, Chuo-ku, Sapporo, 060-8611, Japan
| | - Taku Ogawa
- Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kei Kasahara
- Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yukihiro Yoshimura
- Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama City, Kanagawa, 221-0855, Japan
| | - Natsuo Tachikawa
- Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama City, Kanagawa, 221-0855, Japan
| | - Kyoko Yokota
- Kagawa Prefectural Central Hospital, 1-2-1, Asahicho, Takamatsu, Kagawa, 760-0065, Japan
| | - N S Yuka Murai
- Kagawa Prefectural Central Hospital, 1-2-1, Asahicho, Takamatsu, Kagawa, 760-0065, Japan
| | - Ippei Sakamaki
- Toyama University Hospital, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan
| | - Chihiro Hasegawa
- Nagoya City East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya-city, Aichi, 464-8547, Japan
| | - Yusuke Yoshimi
- Japanese Red Cross Nagoya Daini Hospital, 9, Myokencho, Nagoya, Aichi, 466-8650, Japan
| | - Kazuhiro Toyoda
- Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Mitsuhashi
- Aomori Prefectural Central Hospital, Higashi Tukurimiti 2-1-1, Aomori, 030-8553, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Sun, sea and sex: a review of the sex tourism literature. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2020; 6:24. [PMID: 33292661 PMCID: PMC7691961 DOI: 10.1186/s40794-020-00124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/16/2020] [Indexed: 01/24/2023]
Abstract
Background Sex tourism is defined as travel planned specifically for the purpose of sex, generally to a country where prostitution is legal. While much of the literature on sex tourism relates to the commercial sex worker industry, sex tourism also finds expression in non-transactional sexual encounters. This narrative review explores current concepts related to travel and sex, with a focus on trans-national sex tourism. Methods The PubMed database was accessed to source relevant literature, using combinations of pertinent search terms. Only articles published in the English language were selected. Reference lists of published articles were also examined for relevant articles. Results With regard to preferred destinations, South/Central America and the Caribbean were more likely to receive tourists looking for casual sex. Longer duration of travel, travelling alone or with friends, alcohol or drug use, being younger and being single were factors associated with higher levels of casual sex overseas. The majority of literature retrieved on sex workers focused on risk behaviours, sexually transmitted infections (STI), mobility of sex workers and how these factors affected their lives. Sex tourists require better access to effective methods of preventing HIV, such as pre-exposure prophylaxis, and better education on HIV prevention. Drugs and alcohol play a major role as risk factors for and cofactors in casual sexual behaviour while abroad. Conclusions Travellers need to be informed of the increased risks of STI before travel. They should be aware of the local prevalence of STIs and the risks associated with their sexual practices when they travel, including engaging with commercial sex workers, having unprotected sexual intercourse and becoming victims of sexual violence.
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Beach boys in Galle, Sri Lanka: multiple HIV risk behaviours and potential for HIV bridging. BMC Public Health 2020; 20:1604. [PMID: 33097015 PMCID: PMC7585175 DOI: 10.1186/s12889-020-09699-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background There are limited data globally on HIV in men who engage in casual and transactional sex with female tourists. Methods In 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey. Results We recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women. Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists. The prevalent infections were: HIV, 0.3% (95% CI 0.0–0.4%); syphilis, 0.5% (0.0–1.2%); herpes virus type-2, 5.0% (2.5–7.5%). Conclusions There are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual female population in Sri Lanka. More research is needed in South-East Asia on men who trade sexual services to female and male tourists.
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Choi EPH, Fong DYT, Wong JYH. The use of the Multidimensional Condom Attitude Scale in Chinese young adults. Health Qual Life Outcomes 2020; 18:331. [PMID: 33032622 PMCID: PMC7545565 DOI: 10.1186/s12955-020-01577-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Attitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18–29 years old.
Methods In this cross-sectional study, a total of 500 people aged 18–29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed. Results Instead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all. Conclusions Overall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.
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Affiliation(s)
- Edmond Pui Hang Choi
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong.
| | - Daniel Yee Tak Fong
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Janet Yuen Ha Wong
- School of Nursing, The University of Hong Kong, Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pok Fu Lam, Hong Kong
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Phillips TR, Fairley CK, Chen MY, Bradshaw CS, Chow EPF. Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007-17. Sex Health 2020; 16:508-513. [PMID: 31203836 DOI: 10.1071/sh19027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/01/2019] [Indexed: 11/23/2022]
Abstract
Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. METHODS Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. RESULTS The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46-12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30-5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39-4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77-2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14-1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143). CONCLUSIONS There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.
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Affiliation(s)
- Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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Tardivo S, Zenere A, Moretti F, Marchiori F, Berti D, Migliorini M, Tomasi A, Ferrari S, Tognon F, Napoletano G, Rossanese A. The Traveller's Risk Perception (TRiP) questionnaire: pre-travel assessment and post-travel changes. Int Health 2020; 12:116-124. [PMID: 31294781 PMCID: PMC7057134 DOI: 10.1093/inthealth/ihz033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/18/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Travellers' risk perception is a key component of travel risk assessment because it influences the adequate implementation of safety precautions. The aims of this study are to validate a tool to analyse travellers' risk perception to identify which factors can influence it and how it changes upon return. METHODS The Traveller's Risk Perception (TRiP) questionnaire was developed and administered to outpatients before and after travel in three travel clinics. A principal component analysis (PCA) was performed to validate the questionnaire and multivariate regression analysis was used to evaluate the effect of travellers' characteristics on the risk scores. RESULTS A total of 1020 travellers completed the questionnaire. PCA identified two latent factors: 'generic-disseminated risks' and 'specific-circumstantial risks'. Cronbach's α was acceptable (0.76 and 0.70, respectively). The 'generic-disseminated risks' dimension scored higher than the 'specific-circumstantial risks' (p<0.001). The items with the highest scores were insect bites, gastrointestinal disorders and malaria. The mean scores were significantly lower after the travel for all items but one. CONCLUSIONS The TRiP questionnaire is a valid and reliable tool for rating travellers' perceptions. Staff in travel clinics should be trained to systematically assess travellers' risk perception in order to tailor the consultation according to specific information needs.
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Affiliation(s)
- S Tardivo
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - A Zenere
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - F Moretti
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - F Marchiori
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - D Berti
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - M Migliorini
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - A Tomasi
- Public Health Department, Lucca, Italy
| | - S Ferrari
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | - F Tognon
- Departments of Diagnostics and Public Health University of Verona, Verona, Italy
| | | | - A Rossanese
- IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
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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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Tien V, Punjabi C, Holubar MK. Antimicrobial resistance in sexually transmitted infections. J Travel Med 2020; 27:5678669. [PMID: 31840758 DOI: 10.1093/jtm/taz101] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE FOR REVIEW International travel facilitates the spread of drug-resistant infections, including sexually transmitted infections (STIs). In 2016, the World Health Organization highlighted the global burden of 'curable' STIs, estimating 376 million new infections of gonorrhoea, chlamydia, syphilis and trichomoniasis annually, with considerable geographic variation in both the burden of disease and prevalence of resistance. Travelers' risk of contracting and transmitting drug-resistant STIs depends in part on their geographic exposure. In this review, we describe the epidemiology of antimicrobial resistance (AMR) and the management of these four common STIs and Mycoplasma genitalium, an increasingly recognized cause of non-gonococcal urethritis. KEY FINDINGS Multi-drug and extensively drug resistant gonorrhoea strains have been associated with international spread, particularly in travelers returning from Southeast Asia. Chlamydia is the most common bacterial STI worldwide. Although in vitro resistance has been reported, surveillance data suggest that clinically significant resistance to macrolides and tetracyclines is rare. Macrolide resistance in syphilis is now endemic in much of the world but there is no documented penicillin resistance, which remains first-line therapy. Trichomoniasis is the most common non-viral STI worldwide. Although clinical failure after treatment occurs, resistance to metronidazole is thought to be uncommon. Mycoplasma genitalium exhibits intrinsic resistance to many antibiotics, and the prevalence of resistance to both first- and second-line regimens (macrolides and fluoroquinolones) is increasing worldwide, with limited alternative therapeutic options. RECOMMENDATIONS International travelers are at risk for acquiring resistant STIs with limited therapeutic options. Improved diagnostics are urgently needed to improve AMR surveillance and the management of infected patients. As no vaccinations are currently available for these STIs, and pre-exposure prophylaxis is an area of active study with limited data, condom use is critical for prevention. Travel medicine providers should incorporate STI risk reduction counselling, with an emphasis on condom use, into the routine pre-travel consultation.
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Affiliation(s)
- Vivian Tien
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chitra Punjabi
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marisa K Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
PURPOSE OF REVIEW The present review considers recent evidence on travel-associated sexual intercourse and sexually transmitted infection (STI) risks and travel with regards to risk behavior and implications of travel on communities. It highlights the lack of research in this area and topics for consideration. RECENT FINDINGS A population-based study, and others, shows significant levels of sex abroad and risk behavior with inconsistent condom use despite increasing travel advice about risks. There is an increasing association of STIs in military personnel from local rather than deployment-associated sex contacts shown in United States and French studies, probably related to deployment of women. Innovative studies are showing the effect of female sex-tourism on the communities involved, and the sexual interaction and risk for tourism employees from tourists. New social networking apps require evaluation as to both their potential to increase and decrease risks. Travel sex continues to be a vector for the global spread of multidrug resistant gonorrhoeae. SUMMARY New research challenges previous perspectives with changes to risk behavior in the military, female sex tourism, the change in social networks and ongoing risk behavior research and evidence of increased cross-country partnerships. The lack of high-quality studies evaluating travel advice to reduce risk is a key area for future work.
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Berg RC, Molin SB, Nanavati J. Women Who Trade Sexual Services from Men: A Systematic Mapping Review. JOURNAL OF SEX RESEARCH 2020; 57:104-118. [PMID: 31264896 DOI: 10.1080/00224499.2019.1624680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a - possibly growing and diversifying - female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.
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Affiliation(s)
- Rigmor C Berg
- Division of Health Services, Norwegian Institute of Public Health and Department of Community Medicine, University of Tromso
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Nouchi A, Caby F, Palich R, Monsel G, Caumes AE. Travel-associated STI amongst HIV and non-HIV infected travellers. J Travel Med 2019; 26:5644976. [PMID: 31776583 DOI: 10.1093/jtm/taz090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The incidence of sexually transmitted infections (STI) is increasing in Western countries whilst travel plays a major role in STI dissemination worldwide. However, there is no study distinguishing HIV-positive and HIV-negative travellers. METHODS We retrospectively evaluated the epidemiological, clinical and biological characteristics of the patients diagnosed with a travel-related STI between 2008 and 2016. We describe and compare the spectrum of STI diagnosed amongst HIV-positive and negative travellers. METHODS Overall, 163 travel-related STI were identified in 140 patients (89% male, 54% men having sex with men, 40% HIV-positive). Symptoms occurred during travel in 39% of them, otherwise the median time between return and symptoms' onset was 13 days. Amongst the 84 HIV-negative travellers, the main STI were primary HIV infections (n = 36, 38%), Neisseria gonorrhoeae (NG) infections (17%) and primary herpes infection (14, vs 1.5% amongst HIV-positive travellers, P = 0.01). The regions of exposure to HIV were concordant with the known geographical distribution of HIV subtypes. Amongst the 56 HIV-positive travellers, the main STI were syphilis (43, vs 6% amongst HIV-negative travellers, P = 0.01), Chlamydia trachomatis (CT) infections (22, vs 13% amongst HIV-negative travellers, P = 0.08), NG infections (13%) and acute hepatitis C (12, vs 1% amongst HIV-negative travellers, P = 0.01), with a predominance of anal forms for both CT and NG infections. CONCLUSIONS The spectrum of STI diagnosed in returning travellers is broad with important differences according to HIV status. In our setting, primary HIV infection was the leading STI in non-HIV infected patients, which suggests that pre-exposure prophylaxis may have a role in HIV prevention in at-risk travellers.
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Affiliation(s)
- Agathe Nouchi
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies Infectieuses et Tropicales, Department of Infectious and Tropical Diseases, Paris 75013, France
| | - Fabienne Caby
- Department of Infectious Diseases, Victor Dupouy Hospital, Argenteuil, France
| | - Romain Palich
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies Infectieuses et Tropicales, Department of Infectious and Tropical Diseases, Paris 75013, France
| | - Gentiane Monsel
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies Infectieuses et Tropicales, Department of Infectious and Tropical Diseases, Paris 75013, France
| | - And Eric Caumes
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies Infectieuses et Tropicales, Department of Infectious and Tropical Diseases, Paris 75013, France.,Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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Abstract
In view of globalization and the associated transport of goods as well as rising travel activity, imported infections with subtropical and tropical pathogens are increasing in Germany. In returning travelers presenting with fever, general symptoms and skin rash, a number of diseases need to be considered. The clinical appearance of the skin rash, accurate travel history and epidemiological information on country-specific risks are helpful in making the correct diagnosis. In this article we provide an overview of the most common exanthemas in travelers who have returned, associated symptoms, diagnostic methods, therapies, as well as prevention strategies.
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Affiliation(s)
- Luisa Hellmich
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Robert Rongisch
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Heinrich Rasokat
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Esther von Stebut
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Mario Fabri
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Bendick C. [Sexually Transmitted Infections in the Tropics]. Hautarzt 2019; 69:945-959. [PMID: 30324430 DOI: 10.1007/s00105-018-4275-6] [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] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI) are common all over the world and the incidence of chlamydia, gonorrhea, syphilis and trichomoniasis alone is estimated at 500 million/year. Of these infections 75% occur in tropical countries in Latin America, sub-Saharan Africa and South as well as Southeast Asia. The bacterial infections chancroid, lymphogranuloma venereum (LGV) and granuloma inguinale (GI, Donovanosis) are termed tropical STI. They occur mainly in tropical countries, i. e. regions situated between the equator and the northern and southern 23.5° latitudes, regions which are characterized by hot humid climates as well as poverty and underdevelopment. These three diseases are primarily associated with ulcerations of the skin, thus their presence represents an increased risk for transmission of HIV and other STI. As with all STI, to minimize the risk of tropical infections it is essential to avoid hazardous sexual practices and to use condoms.
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Affiliation(s)
- C Bendick
- Department of Dermatology, Preah Kossamak-Hospital, BP 1006, Phnom Penh, Kambodscha.
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Pathogens without borders. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-09-2018-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Drawing insights from the ecological theory, the purpose of this paper is to explore social determinants related to pathways to high-risk sexual behaviors of international travelers across their life span.
Design/methodology/approach
Data were collected from 45 international travelers in Houston, a critical transit point frequented by international visitors.
Findings
Overall, several ecological settings (individuals, interpersonal, institutional and contextual) related to two typologies of international travelers (risk takers vs non-risk takers) and their inclination to engage in high-risk sexual practices in an international or/and local context were identified.
Research limitations/implications
This research calls for the need to assess high-risk sexual behaviors from the ecological perspective to better understand the dynamics of disease transmission among frequent international travelers from diverse backgrounds/life styles and age cohorts.
Practical implications
Prevention and treatment programs developed for at-risk international travelers should target both distal and proximal social factors that predispose travelers to vulnerable situations. To build a reliable health surveillance network, policy makers, health practitioners and educators must focus not only on individual-level determinants but also on other ecological determinants that branch out beyond the personal level (e.g. interpersonal, institutional and contextual levels). Multi-level formal and informal social networks can be developed to promote a global social climate and environment that encourage safe sex and safety precautions.
Social implications
To raise awareness, the public must be constantly reminded that outbreaks of potentially health hazards can lead to unpredictable morbidity/mortality and security risks that place a burden on our nation’s economic growth, emergency responsiveness and homeland security infrastructure.
Originality/value
The study is one of very few to address international travelers’ health risk, while abroad, from an ecological lens across the life course.
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Martins SL, Hellerstedt WL, Mason SM, Brady SS. Pregnancy Prevention on the Fly: An Exploratory Study of Contraceptive Lapse Among Young Women Traveling Internationally. J Womens Health (Larchmt) 2019; 28:951-960. [PMID: 31184981 DOI: 10.1089/jwh.2018.7371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: International travel is increasingly popular, and women comprise half of all outbound travel from the United States (almost 46 million trips in 2017). The implications of international travel for women's reproductive health are not fully clear due to lack of data on travelers' contraceptive use. Methods: Women attending a U.S. university (n = 340) completed a cross-sectional survey in 2016-2017 about their sexual and reproductive health during recent international travel. Participants were 18-29 years old (mean: 21.1) and had a history of male sex partners. We calculated the prevalence of contraceptive lapse-nonadherence (e.g., missed pill) or having sex without contraception-by individual and travel-related characteristics and evaluated multivariable correlates of lapse using modified Poisson regression and prevalence ratios (PRs). Results: Prevalence of contraceptive lapse was 29% overall and especially high among pill users (50%). Multivariable correlates of lapse were the following: using the pill (PR 4.51, 95% confidence interval [CI] 2.57-7.94) compared to other or no contraception; trip duration of >30 days versus 1-7 days (PR 2.02, 95% CI 1.14-3.57); having trouble communicating with a male partner about contraception (PR 1.79, 95% CI 1.16-2.75); a high perceived impact of language barriers (PR 1.77, 95% CI 1.02-3.08); and perceiving local access to abortion as difficult (PR 1.67, 95% CI 1.22-2.27). There was a trend toward increased lapse prevalence among participants who had difficulty maintaining their contraceptive schedule while traveling across time zones (PR 1.38, 95% CI 1.00-1.91). Conclusions: During international travel, prevalence of contraceptive lapse varied by young women's chosen contraceptive method as well as travel-specific factors. Pretravel counseling by clinicians can help women anticipate contraceptive challenges and reduce the likelihood of unintended pregnancy.
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Affiliation(s)
- Summer L Martins
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Wendy L Hellerstedt
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Susan M Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Rapid increase of syphilis in Tokyo: an analysis of infectious disease surveillance data from 2007 to 2016. Western Pac Surveill Response J 2019; 10:6-14. [PMID: 31110837 PMCID: PMC6507126 DOI: 10.5365/wpsar.2017.8.2.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to examine the trends of primary and secondary syphilis in Tokyo between 2007 and 2016 using national infectious disease surveillance data. We analysed all 3269 cases reported during these 10 years. A statistically significant increase in cases was observed after 2010 with a more rapid rate of increase after 2014 mainly in urban areas in Tokyo. The notification rates per 100 000 population in 2010, 2014 and 2016 were 0.9 (n = 113), 2.2 (n = 295) and 8.7 (n = 1190), respectively. Domestic syphilis transmission was suspected in 92.6-99.3% of cases during the period 2007-2016. Until 2013, the increase was mainly observed among men who have sex with men (MSM); however, heterosexual transmission became more dominant and eventually surpassed transmission among MSM in 2015. In 2016, the notified cases of infections through heterosexual contact were 22.3 and 40.4 times higher in men and women, respectively, compared to those in 2010. The median ages of affected heterosexual men and women were 37 (interquartile range: 28-46) and 26 (interquartile range: 22-32) years, respectively. Reports of oropharyngeal lesions have been increasing among both men and women with syphilis. The number of congenital syphilis cases reported in Tokyo was 0 to 3 cases per year during the study period. More information and further analysis are needed to explain the reason for this increase.
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Addressing the rising rates of gonorrhea and drug-resistant gonorrhea: There is no time like the present. ACTA ACUST UNITED AC 2019; 45:54-62. [PMID: 31015819 PMCID: PMC6461120 DOI: 10.14745/ccdr.v45i23a02] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Increasing rates of gonococcal (GC) infection and antimicrobial resistant (AMR) GC, are a serious public health concern for Canada and around the world. Previously recommended treatments are ineffective against many of the gonorrhea strains circulating today. The current recommendation for combination therapy is now being threatened by globally emerging and increasingly resistant strains. It is important that coordinated efforts be made now to ensure these new global strains do not become established in Canada. Otherwise, we will be faced with the possibility of persistent GC infection which can lead to pelvic inflammatory disease, infertility and chronic pelvic pain in women; and epididymitis in men. The presence of GC can also increase the risk of HIV acquisition and transmission. There are a number of reasons why we are facing this public health threat. GC infection is often asymptomatic and it is highly transmissible. People may hesitate to seek testing (or to offer testing). Treatment is complex: recommendations vary by site of infection and risk of resistance. Sexual contact during travel is an important source of imported emerging resistant global strains. The new screening and diagnostic Nucleic Acid Amplification Test (NAAT) is excellent but has decreased the number of cultures being done and therefore our capacity to track AMR-GC. There are four key actions that clinicians and front-line public health professionals can take to stem the increase in rates of GC and drug resistant GC. First, normalize and increase GC screening based on risk factors and emphasize the need for safer sex practices. NAAT is useful for screening, but culture is still needed for extra-genital sites. Second, conduct pretravel counselling and include a travel history as part of the risk assessment. Third, use culture along with NAAT to establish the diagnosis and follow up for test-of-cure. Finally, refer to the most current Canadian Guidelines on Sexually Transmitted Infections or provincial/territorial recommendations on combination therapies for patients and their contacts as recommendations may have changed in response to evolving AMR-GC trends.
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Sexuell übertragbare Infektionen in den Tropen. ZENTRALBLATT FÜR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2019. [DOI: 10.1007/s40664-018-0323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Martins SL, Mason SM, Hellerstedt WL, Brady SS. Risk of Contraceptive Lapse and New Sexual Partnership Among Female University Students Traveling Internationally. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:173-180. [PMID: 30118153 DOI: 10.1363/psrh.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT International travel is common and may influence women's sexual and reproductive health through myriad pathways. Existing studies focus on travelers' risk of acquiring STDs, but not their pregnancy prevention behaviors. Further, it is unclear whether sexual and reproductive health outcomes observed for female travelers are associated with travel itself, because few studies compare travelers with nontravelers. METHODS An online survey was conducted in 2016-2017 among females attending a U.S. university who reported a history of sex with men; the sample comprised 340 students who had traveled internationally in the past three months (travelers) and 170 who intended to travel in the next three months (pretravelers). Multivariable modified Poisson regression models assessed associations between travel status and two outcomes during travelers' recent trip or a period of similar duration for pretravelers: contraceptive lapse (incorrect or inconsistent use of any method) and new sexual partnership. RESULTS Travelers and pretravelers reported similar levels of contraceptive lapse (29% and 32%, respectively) and new sexual partnerships (17% and 12%). Multivariable analysis confirmed that travelers were no more likely than pretravelers to have contraceptive lapses, but indicated that they were more likely to report a new male partner (relative risk, 1.7). Most participants (80%) had a regular source of sexual and reproductive health care; 42% of travelers had seen a health care provider in preparation for their trip. CONCLUSION If the findings are corroborated by additional research, they may suggest a role for health care providers in students' pretravel period.
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Affiliation(s)
- Summer L Martins
- Doctoral student, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Susan M Mason
- Assistant professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Wendy L Hellerstedt
- Associate professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Sonya S Brady
- Associate professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health
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Agüero F, Masuet-Aumatell C, Morchon S, Ramon-Torrell JM. Men who have sex with men: A group of travellers with special needs. Travel Med Infect Dis 2018; 28:74-80. [PMID: 30399444 DOI: 10.1016/j.tmaid.2018.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Fernando Agüero
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Morchon
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Ramon-Torrell
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain.
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Bartoletti R, Wagenlehner FME, Bjerklund Johansen TE, Köves B, Cai T, Tandogdu Z, Bonkat G. Management of Urethritis: Is It Still the Time for Empirical Antibiotic Treatments? Eur Urol Focus 2018; 5:29-35. [PMID: 30318465 DOI: 10.1016/j.euf.2018.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022]
Abstract
CONTEXT Urethritis prevalence in Europe changed in the last years due to both the increase of migratory streams from North Africa and the more frequent exposition of males to relevant risk factors. Owing to these reasons, urethritis treatment should be optimized by accurate microbiological investigations to avoid the risk of persistence, recurrence, or reinfection. OBJECTIVE The aim of this systematic review is to optimize the treatments for urethritis and investigate the applicability of nucleic acid amplification test (NAAT) as the primary microbiological investigation. EVIDENCE ACQUISITION A literature search in Medline, Cochrane, and Google Scholar databases was conducted up to June 2018. Subject headings were selected as follows: Urethritis OR gonococcal urethritis OR non-gonococcal urethritis AND Antibiotics OR Recurrence. A total of 528 abstracts were identified and selected. Finally, 12 full-text articles were selected for a qualitative synthesis. The Preferred Reported Items for Systematic Reviews and Meta-Analyses statement was used to perform an accurate research checklist and report. EVIDENCE SYNTHESIS Empirical treatments are no more recommended, although a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens' microbiological characterization. First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy. Specific therapies should be initiated for nongonococcal urethritis according to each single pathogen involved in the infection process. Owing to this reason, NAAT is mandatory in the clinical approach to the disease, although the Gram stain of urethral discharge or smear remains applicable for some less frequent nongonococcal urethritis. Moreover, the urethritis "modern view" also includes noninfectious etiologies that occurred after traumas or injection of irritating compounds. Sexual abstinence of at least 7 d should be observed from the start of treatment to avoid reinfection, while sexual partners should evenly be treated. CONCLUSIONS The treatment of urethritis implies accurate determination of pathogens involved in the infection process by NAAT with subsequent appropriate antibiotic therapy, thus avoiding the risk of antibiotic resistance and overuse of antibiotics indicated for empirical treatments. The population exposed to relevant risk factors should be adequately informed about the increased risk of developing infections and motivated toward the intensive use of condoms during sexual intercourses. PATIENT SUMMARY Urethritis is a sexually transmitted disease generally characterized by urethral discharge or other symptoms such as itching, tingling, and apparent difficulties in having a regular urinary flow. Microbiological investigations are mandatory to obtain satisfactory results from the treatment. Multiple antibiotic treatments are often necessary due to the high risk of multiple pathogens responsible for the disease. Similarly, sexual partners should be investigated and treated in the same way. Several risk factors such as immunodeficiency, multiple sexual partners, homo- and bisexuality, and alcohol abuse may be related to the disease. In these cases, the use of condom is strongly recommended.
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Affiliation(s)
- Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy.
| | - Florian M E Wagenlehner
- Clinic und Polyclinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Truls Erik Bjerklund Johansen
- Dept. of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bela Köves
- Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Zafer Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Gernot Bonkat
- Alta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry (COB), University of Basel, Basel, Switzerland
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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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Persson KI, Berglund T, Bergström J, Tikkanen R, Thorson A, Forsberg B. Place and practice: Sexual risk behaviour while travelling abroad among Swedish men who have sex with men. Travel Med Infect Dis 2018; 25:58-64. [DOI: 10.1016/j.tmaid.2018.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/09/2018] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
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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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Decraene V, Kühlmann Berenzon S, Andersson Franko M, Veličko I. Differences in travel-related incidence of chlamydia by age groups, gender and destination: Sweden 2000-2013. Travel Med Infect Dis 2018; 25:42-49. [PMID: 29476910 DOI: 10.1016/j.tmaid.2018.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/17/2018] [Accepted: 02/20/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The absolute number of travel-related Chlamydia cases in Sweden has consistently increased between 2000 and 2013. Given the growth in international travel, we aimed to study the trends of travel-related Chlamydia incidence to determine differences and identify high-risk groups and destinations. METHODS For 2000-2013 we calculated annual Chlamydia incidence per 100,000 travels by dividing the number of notified travel-related cases by the number of travels; the latter were collected from a yearly survey among Swedish residents. For specific destinations 95% confidence intervals were calculated and monotonic yearly trends tested. RESULTS The overall median annual travel-related Chlamydia incidence was higher for women than for men, but the opposite was true in age groups >25 years. For men, Thailand had the highest incidence, which was 3-7 times higher than the next highest destination in each age group. Spain, Turkey and Thailand had the highest incidence among women, but differences between countries were smaller than for men. For most destinations the yearly trends were stable. CONCLUSIONS We showed different profiles for men and women and age groups in terms of high incidence destinations. This specific information could allow to better tailor safe sex messages and advocate post-travel Chlamydia testing to target groups travelling to certain destinations.
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Affiliation(s)
- Valérie Decraene
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden; Public Health England North West, Liverpool, United Kingdom; The Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Inga Veličko
- The Public Health Agency of Sweden, Solna, Sweden
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Johnston N, Sandys N, Geoghegan R, O'Donovan D, Flaherty G. Protecting the health of medical students on international electives in low-resource settings. J Travel Med 2018; 25:4780173. [PMID: 29394388 DOI: 10.1093/jtm/tax092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/22/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. METHODS The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. RESULTS This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. CONCLUSION This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.
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Affiliation(s)
- Niall Johnston
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Rosemary Geoghegan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Diarmuid O'Donovan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Abstract
When traveling internationally, HIV serodisclosure and knowledge of partners' serostatus were hampered by the lack of a common language. Condomless anal intercourse was less likely to occur in partnerships where HIV serostatus was not disclosed or known. Taken together, these observations suggest that language barriers may affect sexual decision making.
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Beauté J, Cowan S, Hiltunen-Back E, Kløvstad H, Velicko I, Spiteri G. Travel-associated gonorrhoea in four Nordic countries, 2008 to 2013. ACTA ACUST UNITED AC 2017; 22:30537. [PMID: 28537548 PMCID: PMC5479976 DOI: 10.2807/1560-7917.es.2017.22.20.30537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/23/2016] [Indexed: 11/23/2022]
Abstract
Travel may be associated with a higher risk of gonorrhoea and infection by antibiotic-resistant strains. The objective of this study was to estimate the risk for gonorrhoea among travellers from four Nordic European countries using surveillance data and to identify at-risk travellers to help target interventions. We retrieved gonorrhoea surveillance data from Denmark, Finland, Norway and Sweden and tourism denominator data from the Statistical Office of the European Union. A travel-associated case of gonorrhoea was defined as one for which the reported country of infection differed from the reporting country. During 2008−2013, the four countries reported 3,224 travel-associated gonorrhoea cases, of which 53% were among individuals below 35 years of age. The overall risk associated with travel abroad was 2.4 cases per million nights abroad. The highest risk was observed with travel to Asia (9.4). Cases more likely to be reported as travel-associated were: males, heterosexuals of both sexes, people older than 65 years, and foreign-born individuals. More effective interventions targeting young adults and other at-risk groups are needed. The use of travel-planning websites and social media should be explored further.
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Affiliation(s)
- Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Susan Cowan
- Statens Serum Institut (SSI), Copenhagen, Denmark
| | | | - Hilde Kløvstad
- Norwegian Institute of Public Health (FHI), Oslo, Norway
| | - Inga Velicko
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Berdychevsky L. Toward the Tailoring of Sexual Health Education Messages for Young Women: A Focus on Tourist Experiences. JOURNAL OF SEX RESEARCH 2017; 54:1171-1187. [PMID: 28276937 DOI: 10.1080/00224499.2017.1280720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Perceived anonymity and decreased influence of sexual double standards in tourism provide female travelers with opportunities for sexual experimentation and risk taking. The purpose of this study was (a) to identify the clusters of risk takers among young women based on their perceptions of and motivations for sexual risk taking in tourism and (b) to profile the clusters with respect to the psychological, sexual, demographic, and tourist characteristics. The data were collected through an online survey of 853 women (age in years: M = 23.5, SD = 6.67). Five clusters of sexual risk takers emerged based on their factor-analyzed risk perceptions and motivations. These clusters were interpreted as (a) diversely motivated broad risk perceivers; (b) fun-seeking broad risk perceivers; (c) diversely motivated physical risk perceivers; (d) anonymity- and empowerment-seeking risk disregarders; and (e) unmotivated broad risk perceivers. Women in these clusters differed in their intentions to engage in sexual risk taking in tourism, sensation-seeking propensities, perceptions of tourist characteristics, levels of sexual experience, and demographic backgrounds. Results suggest tailoring sexual health promotion messages based on cluster affiliation, leveraging cluster-specific risk perceptions, motivations, and personal characteristics. This study provides recommendations for individually tailored, context-specific, age-appropriate, and gender-sensitive sexual health education programs.
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Affiliation(s)
- Liza Berdychevsky
- a Department of Recreation, Sport, and Tourism , University of Illinois at Urbana-Champaign
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