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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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Yu YJ, Li X, Tam CC, Zhou Y, Chen Y, Shen Z. Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China. AIDS Care 2016; 28:1455-60. [PMID: 27240573 DOI: 10.1080/09540121.2016.1189500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs - a rapidly increasing, vulnerable population in southwest China. The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14-66) recruited over five years (2010-2014) from 35 National Sentinel Surveillance sites in Guangxi. Analyses included Fisher's exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.
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Affiliation(s)
- Yeon Jung Yu
- a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA
| | - Xiaoming Li
- a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA
| | - Cheuk Chi Tam
- b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Yuejiao Zhou
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| | - Yi Chen
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
| | - Zhiyong Shen
- c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China
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Liao W, Lau JTF, Tsui HY, Gu J, Wang Z. Relationship between sexual compulsivity and sexual risk behaviors among Chinese sexually active males. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:791-8. [PMID: 25030121 DOI: 10.1007/s10508-014-0317-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 03/03/2012] [Accepted: 03/09/2013] [Indexed: 05/25/2023]
Abstract
Compulsivity is defined as "an insistent, repetitive, intrusive, and unwanted urge to perform specific acts often in ritualized or routinized fashions." Sexual compulsivity has been shown to be associated with some high risk sexual behaviors related to HIV and sexually transmitted infection (STI). In some Western countries, the 10-item Sexual Compulsivity Scale (SCS) has been developed to assess people's sexual compulsivity but no Chinese version has been validated. This study validated the Chinese version of the SCS and investigated its associations with specific sexual behaviors. In 2008, a random telephone survey was conducted in the sexually active male general population in Hong Kong, interviewing 1,048 participants. The Chinese version of the SCS was found to be internally consistent (Cronbach's α = 0.88 for the overall scale), with a mean total score of 20.7 (SD = 4.7). An exploratory factor analysis procedure extracted two factors that were named Controllability and Functional Consequences. Higher SCS scores were associated with multiple female sexual partnerships in the last 6 months, having had sex with either non-regular partner(s) or female sex worker(s) in the last 6 months, having contracted STI in the last 6 months, and inconsistent condom use with either non-regular partner(s) or female sex worker(s) in the last 6 months. The scale can be used to assess sexual compulsivity among sexually active Chinese men in Hong Kong. It can potentially be used in other Chinese communities. Further confirmatory studies are warranted.
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Affiliation(s)
- Wei Liao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
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Lau JTF, Zhou H, Su XY, Feng TJ, Hong FC, Tsui HY, Ma YL, Wang Z, Walden D. Condoms used but sex not well protected. AIDS Behav 2014; 18:1934-44. [PMID: 24452496 DOI: 10.1007/s10461-013-0690-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Condom use is often equated to safer sex. The prevalence of condom use during sex work among female sex workers (FSW) in China is high. Condom use, however, co-exists with condom failure and improper use and hence risk of HIV transmission. In a cross-sectional study, we interviewed 195 FSW in Shenzhen, China. The prevalence of condom use in the last episode of sex work was 97.4 %, However, respectively 53.8 and 86.2 % had experienced at least one condition of condom failure that may lead to genital contact (wearing condoms after penetration, condom breakage/slippage, condoms removed by clients) and at least one condition of improper condom use (not removing air from the tip of the condom, not pulling it down to the root of penis and not choosing good quality condoms). Factors of individual level (e.g. never choosing high quality condoms for sex work), inter-personal level (e.g. agreement to have unprotected sex if fond of clients or paid more) and environmental/structural level (e.g. non-availability of condoms) were associated with various types of condom failure and improper use. Although HIV prevention interventions have increased prevalence of condom use among FSW, the risk of HIV transmission may still be high as "unsafe" sex due to condom failure and improper use is prevalent. Interventions promoting safer sex need to address such issues and take socio-ecological factors into account. Condom use during sex work is not equivalent to well protected sex as the protective effects could be compromised by frequent condom failure and improper use.
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Zhou Y, Li X, Zhang C, Tan G, Stanton B, Zhang X, Cui Y. Rates of HIV, syphilis, and HCV infections among different demographic groups of female sex workers in Guangxi China: evidence from 2010 national sentinel surveillance data. AIDS Care 2013; 25:1433-41. [PMID: 23438031 DOI: 10.1080/09540121.2013.772282] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To examine the prevalence of HIV, syphilis, and hepatitis C virus (HCV) infections by demographic characteristics and identify the subgroups of female sex workers (FSW) who are at a higher risk of the infections. Secondary analysis of the 2010 National Sentinel Surveillance (NSS) data was conducted in the current study. A total of 12,622 FSW recruited from 35 NSS sites in Guangxi, China were included in the analysis. FSW were tested for HIV, syphilis, and HCV. The overall prevalence of HIV, syphilis, and HCV infections were 1.0, 6.1, and 1.0%, respectively. The prevalence of HIV and syphilis infections was significantly higher among women who were 40 years of age or older, worked in small commercial sex venues or on the street, were divorced or widowed, or had no formal schooling. A very high HIV infection prevalence (8.2%) was observed among a small number of cross-border foreign FSW (n=49). The prevalence of HCV infection did not differ by most of the demographic characteristics. Living in other provinces or being a Zhuang-ethnic served as protective factors for HCV. The multivariable analyses confirmed the bivariate results suggesting higher prevalence of HIV and syphilis infections among FSW who were older, divorced or widowed, or had no formal schooling. Future HIV intervention prevention efforts among FSW need to pay particular attention to these women in order to effectively curtail the infections among this most-at-risk population as well as to prevent the further spread of HIV and syphilis to other populations.
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Lau JT, Tsui HY, Cheng S, Pang M. A randomized controlled trial to evaluate the relative efficacy of adding voluntary counseling and testing (VCT) to information dissemination in reducing HIV-related risk behaviors among Hong Kong male cross-border truck drivers. AIDS Care 2009; 22:17-28. [DOI: 10.1080/09540120903012619] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Joseph T.F. Lau
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
| | - Hi Yi Tsui
- a Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
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Kim JH, Lau JT, Cheuk K. Sexlessness among Married Chinese Adults in Hong Kong: Prevalence and Associated Factors. J Sex Med 2009; 6:2997-3007. [DOI: 10.1111/j.1743-6109.2009.01367.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Cabada MM, Echevarria JI, Seas C, Gotuzzo E. High prevalence of sexually transmitted infections among young Peruvians who have sexual intercourse with foreign travelers in Cuzco. J Travel Med 2009; 16:299-303. [PMID: 19796098 DOI: 10.1111/j.1708-8305.2009.00324.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sexual networking in popular tourist destinations is a problem worldwide. In Peru, locals sexually interacting with travelers bridge high-risk groups, the general population, and travelers. METHODS A cross-sectional study was conducted in Cuzco about sexual behavior among young Peruvians who admitted having sex with travelers. A subgroup of the participants had serologic testing for Chlamydia trachomatis, Herpes simplex virus (HSV) type 2, and Treponema pallidum. RESULTS Eighty-eight subjects volunteered for blood sampling. Their mean age was 22.9 years (+/-4.1) and 53.4% were male. The majority were single (86.2%), but 12.6% had a stable relationship. The median number of sexual partners in the 3 months prior to the study was 2 [interquartile range (IQR): 1-4]. During that period, 43.1% reported foreign partners, 28.4% reported foreign and Peruvian partners, 17% reported Peruvian partners, and the remaining 11.5% reported combinations of Peruvian, foreign, and sex workers partners. The median number of foreign partners in the 12-month period prior to the study was 4 (IQR: 2-8). Only 25.3% reported consistent condom use. Alcohol (69%) and drugs (36.8%) were commonly used before sexual activity. Seventy-eight percent tested positive for HSV type 2, 25% for C trachomatis, and 1.1% for T pallidum. CONCLUSIONS The core group of young Peruvians we report on demonstrated a high-risk sexual behavior and a high prevalence of sexually transmitted infections. Our results underscore the need for education on safer sex practices among this group and among travelers.
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Affiliation(s)
- Miguel M Cabada
- Infectious Diseases Fellowship Training Program, Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
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Lau JTF, Tsui HY, Ho SPY. Variations in condom use by locale: a comparison of mobile Chinese female sex workers in Hong Kong and mainland China. ARCHIVES OF SEXUAL BEHAVIOR 2007; 36:849-59. [PMID: 17674181 DOI: 10.1007/s10508-007-9203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 01/08/2007] [Accepted: 01/08/2007] [Indexed: 05/16/2023]
Abstract
The present study investigated the prevalence of HIV and HIV-related behaviors and perceptions among 336 female sex workers (FSW) traveling from mainland China to work in Hong Kong. None of the participants tested HIV positive. Of the participants, 13.2% and 26.8%, respectively, would have unprotected sex with a client in Hong Kong or in mainland China if they liked the client; 16.7% and 21.7%, respectively, would have unprotected sex with a client in Hong Kong and in mainland China if he paid more. Of the participants, 98.5% used condoms in the last episode of sex work in Hong Kong and 78.1% were consistent condom users in Hong Kong in the last month. Yet, among those who previously worked as FSW in mainland China (n = 141), only 28.6% used condoms consistently in mainland China in the last year; 60% of those who used condoms inconsistently while in mainland China became consistent condom users in Hong Kong. Among those who did not use condoms in mainland China, willingness to have unprotected sex with a client who was liked by the FSW was a strong predictor for consistent condom use in Hong Kong (OR = 18.67, p < .001). Among those who were consistent condom users in Hong Kong, the same variable predicted inconsistent condom use while in mainland China (OR = 14.02, p < .05). Condom use behaviors change when FSW are working in different social contexts and behavioral changes are possible. Education programs should take socio-contextual factors into account.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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10
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Abstract
The study documents the characteristics of Hong Kong residents who used substances in mainland China. Characteristics of such users were compared with those using substances elsewhere. A cross-sectional survey was used. Data analyses were stratified by gender, and multivariate analyses were performed. Respondents, Hong Kong adults aged 18-30 (n = 6,528), were interviewed using a mixed interviewer and computerized mobile phone method, at the Hong Kong-mainland China boundary. Cross-border substance users and other types of substance users had characteristics that were quite different (e.g., education level, perceived harmfulness of substance use in general, having friends who frequently used substances in mainland China). Cross-boundary substance users also found it easier to obtain substances in mainland China than in Hong Kong (males: 60.5%, females: 39.6%) and perceived no chance of being arrested in mainland China because of substance use (men: 28.8%, women: 24.5%). They tended to use substances in discos/rave parties together with friends (men: 77%, women: 81%), and substances were often obtained for free (men: 63.2%, women: 78%). Ecstasy and ketamine were often used (men: 86.5% & 79.4%, women: 81% & 70.2%), and multiple uses of different substances were common (men: 81.3%, women: 68.6%). Lower price, peer influence, and better availability were reasons behind cross-boundary substance use behaviors. Cross-boundary substance users have specific characteristics. Prevention policies should take these characteristics into account. Regional collaborations are highly warranted.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Lau JTF, Cheng F, Tsui HY, Zhang Y, Zhang J, Wang N, Zhang L. Clustering of Syringe Sharing and Unprotected Sex Risk Behaviors in Male Injecting Drug Users in China. Sex Transm Dis 2007; 34:574-82. [PMID: 17277610 DOI: 10.1097/01.olq.0000253339.49181.f9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate, among male injecting drug users (IDU), the relationships between higher risk IDU-related and sex-related behaviors. GOAL To highlight the clustering effects of the 2 forms of risk behaviors. STUDY DESIGN Behavioral surveillance surveys conducted in Sichuan were analyzed (n = 3105). RESULTS Of all respondents, 35.7% had injected with others' used syringes in the last 6 months, which was associated with female sex workers (FSW) and nonregular sex partners (NRP) partnership (OR = 1.81 and 1.59 respectively), and having had unprotected sex with FSW, NRP, and regular sex partners (OR = 1.96, 1.57, and 1.38 respectively). Higher drug use frequency was associated with having unprotected sex with FSW (among client of FSW, OR = 1.7) and with NRP (among those with NRP, OR = 1.61). Giving used syringes to others for injection was also associated with unprotected sex with NRP (OR = 1.97). CONCLUSIONS Interventions are urgently required to reduce both IDU-related and sex-related risk behaviors among male IDU.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Lau JTF, Tsui HY, Lam LT. Alcohol consumption, sex, and use of psychotropic substances among male Hong Kong-mainland China cross-border substance users. Addict Behav 2007; 32:686-99. [PMID: 16839694 DOI: 10.1016/j.addbeh.2006.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 05/30/2006] [Accepted: 06/06/2006] [Indexed: 11/25/2022]
Abstract
The study investigated the prevalence and associated factors for co-occurrence of psychotropic substance use, alcohol consumption and sexual activities among substance users. Totally, 1167 Hong Kong Chinese males aged 18-30 having used substances in mainland China in the last year were identified. Of them, 72.5% and 42.7% respectively reported having consumed alcohol and engaged in sexual activities in conjunction with the last episode of substance use. Among those using substances exclusively in mainland China, multivariate analyses showed that having friends who frequently used substances in China (OR=3.18) and being accompanied by friends in the last episode of substance use (OR=2.31) were associated with alcohol consumption; older age (OR=2.01), higher education level (OR=2.31), alcohol consumption (OR=2.72), belief that substance use increased sexual potency (OR=2.81) and use of multiple types of psychotropic substances in China (OR=2.94) were significantly associated with having sex in conjunction with the last episode of using psychotropic substances. Cross-border psychoactive substance use often co-occurs with alcohol and sex. High levels of risk are involved. Different types of preventive programs need to be integrated.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, 5/F., School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Thomas M. 'What happens in Tenerife stays in Tenerife': Understanding women's sexual behaviour on holiday. CULTURE, HEALTH & SEXUALITY 2005; 7:571-84. [PMID: 16864223 DOI: 10.1080/13691050500256807] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Recent research has drawn attention to the epidemiological importance of international travel in the spread of HIV. Drawing on data generated in focus groups and in depth interviews with women holiday travellers, this paper explores the context of sexual risk behaviour of women on holiday. These data suggest that freedom from the constraints and realities of domestic life is a crucial aspect of the holiday experience. It is argued that holidays are a 'liminoid period' in which norms of behaviour are temporarily abandoned. Furthermore, on holiday, time becomes 'compressed'. Thus relationships follow a similar pattern to that they would at home however over a much shorter time period. Time compression and liminality lead to the rapid establishment of trust in new relationships. This has implications for sexual risk: women have sexual intercourse more quickly with a new partner on holiday than they do at home. Unqualified trust in relative strangers also raises issues for women's general safety.
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Affiliation(s)
- Michelle Thomas
- Seafarers International Research Centre, Cardiff University, UK.
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Lau JTF, Kim JH, Tsui HY. Prevalence of male and female sexual problems, perceptions related to sex and association with quality of life in a Chinese population: a population-based study. Int J Impot Res 2005; 17:494-505. [PMID: 15920459 DOI: 10.1038/sj.ijir.3901342] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The prevalence of sexual problems (SP) and sexual satisfaction and their associations with sex-related perceptions and quality of life (QOL) were investigated by interviewing 3257 and 1568 Chinese adults in Hong Kong by a specially designed computerized telephone-interviewing method. SP was prevalent among male (50.9%) and female (54%) respondents; approximately 50% were dissatisfied with their sexual life. Of respondents, 23.9% of men and 5.9% of women perceived sex as important and 52.5% for men and 33.8% of women reported adequate sexual knowledge. The prevalence of SP ranged from 3.4% (pain) to 29.7% (premature orgasm) for men and 6.9% (anxiety) to 24.7% (lack of interest) for women. Prevalence of erectile and lubrication problems were 9.6 and 23.6%, respectively. Sex-related knowledge, perceived importance of sex, perceived physical health status, sexual satisfaction were predictors of SP. Gender differences and strong cultural influences appear to exist. Moreover, SP and sexual satisfaction were associated with mental health and vitality QOL and overall life satisfaction.
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Affiliation(s)
- J T F Lau
- Centre for Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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