The Migration of Westerners to Thailand: An Unusual Flow From Developed to Developing World

HIV, Other Blood-Borne Viruses and Sexually Transmitted Infections amongst Expatriates and Travellers to Low- and Middle-Income Countries: A Systematic Review

In some high-income countries, a proportion of human immunodeficiency virus (HIV), other blood-borne virus (BBV) or sexually transmitted infection (STI) diagnoses have been reported as acquired overseas in low- and middle-income countries. A review was conducted to explore HIV, other BBV or STI related knowledge, risk behavior and acquisition amongst expatriates and travelers, particularly males, travelling from high to low- and middle-income countries. Seven academic databases were searched for 26 peer reviewed articles that met inclusion criteria. Significant variability in the studies was noted, in age, travel duration and frequency and outcomes/risk factors measured and reported on. Risk factors described included longer duration of stay; being single; travel for romance or sex; alcohol and other drug use; lack of travel advice; being male; higher number of sexual partners; and inconsistent condom use. Vaccination, pre-travel health advice, and having fewer sexual partners were described as protective. Studies are needed focusing on the social context in which risk-taking occurs. Better collaboration is essential to deliver comprehensive health promotion interventions alongside more consistent pre- and post- travel testing and advice. Policy measures are crucial, including consistent evaluation indicators to assess impacts of HIV, other BBVs or STIs in the context of mobility. Risks and responses for these epidemics are shared globally.

Health and social welfare of expatriates in Southeast Asia

Since the end of the Vietnam War and increasing tourism to Asia, there has been ongoing reverse migration of Westerners to Southeast Asia. Some, but not all, have pensions and modest assets. Some acquire a locals spouse and raise a second family. Many of those who arrived early are now aging rapidly and are depleting their financial resources. Health problems become socio/economic threats. None of the Asian target countries that attract reverse migrants have adequate health care and social safety nets that are available to them. The usual health care safety nets expected in western countries do not cover their nationals in a foreign country. This essay discusses these problems as seen from the perspective of two practicing physicians in Southeast Asia.