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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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Gao S, Martcheva M, Miao H, Rong L. The impact of vaccination on human papillomavirus infection with disassortative geographical mixing: a two-patch modeling study. J Math Biol 2022; 84:43. [PMID: 35482215 DOI: 10.1007/s00285-022-01745-z] [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: 08/03/2021] [Revised: 12/29/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
Human papillomavirus (HPV) infection can spread between regions. What is the impact of disassortative geographical mixing on the dynamics of HPV transmission? Vaccination is effective in preventing HPV infection. How to allocate HPV vaccines between genders within each region and between regions to reduce the total infection? Here we develop a two-patch two-sex model to address these questions. The control reproduction number [Formula: see text] under vaccination is obtained and shown to provide a critical threshold for disease elimination. Both analytical and numerical results reveal that disassortative geographical mixing does not affect [Formula: see text] and only has a minor impact on the disease prevalence in the total population given the vaccine uptake proportional to the population size for each gender in the two patches. When the vaccine uptake is not proportional to the population size, sexual mixing between the two patches can reduce [Formula: see text] and mitigate the consequence of disproportionate vaccine coverage. Using parameters calibrated from the data of a case study, we find that if the two patches have the same or similar sex ratios, allocating vaccines proportionally according to the new recruits in two patches and giving priority to the gender with a smaller recruit rate within each patch will bring the maximum benefit in reducing the total prevalence. We also show that a time-variable vaccination strategy between the two patches can further reduce the disease prevalence. This study provides some quantitative information that may help to develop vaccine distribution strategies in multiple regions with disassortative mixing.
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Affiliation(s)
- Shasha Gao
- Department of Mathematics, University of Florida, Gainesville, FL, 32611, USA
| | - Maia Martcheva
- Department of Mathematics, University of Florida, Gainesville, FL, 32611, USA.
| | - Hongyu Miao
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Libin Rong
- Department of Mathematics, University of Florida, Gainesville, FL, 32611, USA.
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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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Dias S, Gama A, Loos J, Roxo L, Simões D, Nöstlinger C. The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities. PLoS One 2020; 15:e0228584. [PMID: 32023309 PMCID: PMC7001961 DOI: 10.1371/journal.pone.0228584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/18/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Migrants from high endemic countries accounted for 18% of newly diagnosed HIV infections in Europe in 2017. Knowledge on the link between HIV risk and post-migration travels and their impact on HIV acquisition is scarce, but critical to inform prevention. This study aims to explore risky sexual behaviour and HIV-acquisition among sub-Saharan African migrants, and to assess post-migration mobility as a determinant of sexual risk behaviour. METHODS Data from two cross-sectional bio-behavioural surveys to assess HIV-prevalence conducted in Lisbon and Antwerp were analysed to explore migration-related characteristics, travel patterns, and sexual risk taking in the host country and abroad. Bi- and multivariate associations were estimated through adjusted odds ratios and 95% confidence intervals; multivariable logistic regression determined factors associated with condomless sexual intercourse. RESULTS Among N = 1508 participants above 18 years (58% males), 68% travelled post-migration (49.2% reported intercourse abroad). The overall proportion of condomless sex at last sexual intercourse was high (68.1%). The odds of condomless sex in the host country was five times higher when the last sexual intercourse abroad was also condomless [OR:5.32; 95%CI:2.98-9.25]. About half of the travellers reported concurrency, i.e. a regular partner in the host country while having other sexual partners abroad. Almost three percent of the participants reported being HIV+, but 5% had a reactive HIV test-result, with similar proportions among travellers and non-travellers. Also, among the n = 75 participants with reactive HIV test-results, condomless sex occurred (n = 40) and was associated with mobility. CONCLUSIONS Sub-Saharan African migrants are mobile and engage in sexual risk behaviours in the countries of residence and while travelling, increasing risk of post-migration HIV-acquisition. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants' HIV risk related to their mobility.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
- * E-mail:
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luis Roxo
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
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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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Mitchell KR, Mercer CH, Prah P, Clifton S, Tanton C, Wellings K, Copas A. Why Do Men Report More Opposite-Sex Sexual Partners Than Women? Analysis of the Gender Discrepancy in a British National Probability Survey. JOURNAL OF SEX RESEARCH 2019; 56:1-8. [PMID: 30044926 PMCID: PMC6326215 DOI: 10.1080/00224499.2018.1481193] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In a closed population and defined time period, the mean number of opposite-sex partners reported by men and women should be equal. However, in all surveys, men report more partners. This inconsistency is pivotal to debate about the reliability of self-reported sexual behavior. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey of the British population, to investigate the extent to which survey sampling, accounting strategies (e.g., estimating versus counting), and (mis)reporting due to social norms might explain the inconsistency. Men reported a mean of 14.14 lifetime partners; women reported 7.12. The gender gap of 7.02 reduced to 5.47 after capping the lifetime partner number at the 99th percentile. In addition, adjusting for counting versus estimation reduced the gender gap to 3.24, and further adjusting for sexual attitudes narrowed it to 2.63. Together, these may account for almost two-thirds of the gender disparity. Sampling explanations (e.g., non-U.K.-resident partners included in counts; sex workers underrepresented) had modest effects. The findings underscore the need for survey methods that facilitate candid reporting and suggest that approaches to encourage counting rather than estimating may be helpful. This study is novel in interrogating a range of potential explanations within the same nationally representative data set.
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Affiliation(s)
- Kirstin R. Mitchell
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow
- Centre for Sexual Health, Public Health, and Policy, London School of Hygiene and Tropical Medicine
| | | | - Philip Prah
- Department of Infection and Population Health, University College London
| | - Soazig Clifton
- Department of Infection and Population Health, University College London
| | - Clare Tanton
- Department of Infection and Population Health, University College London
| | - Kaye Wellings
- Centre for Sexual Health, Public Health, and Policy, London School of Hygiene and Tropical Medicine
| | - Andrew Copas
- Department of Infection and Population Health, University College London
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8
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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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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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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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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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Brett-Major DM, Scott PT, Crowell TA, Polyak CS, Modjarrad K, Robb ML, Blazes DL. Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2016; 2:25. [PMID: 28883969 PMCID: PMC5530928 DOI: 10.1186/s40794-016-0042-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/15/2016] [Indexed: 12/17/2022]
Abstract
The HIV pandemic persists globally and travelers are at risk for infection by the Human Immunodeficiency Virus (HIV). While HIV-focused guidelines delineate risk stratification and mitigation strategies for people in their home communities, travel issues are not addressed. In this review, direct and indirect evidence on HIV risk among travelers is explored. The burgeoning practice of employing pre-exposure prophylaxis (PrEP) with anti-retroviral therapy in the non-travel setting is introduced, as well as the more established use of post-exposure prophylaxis (PEP). Challenges in applying these lessons to travelers are discussed, and a new guidelines process is scoped and recommended.
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Affiliation(s)
- D M Brett-Major
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA.,Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD USA
| | - P T Scott
- Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - T A Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - C S Polyak
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - K Modjarrad
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - M L Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - D L Blazes
- Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD USA.,Bill and Melinda Gates Foundation, Seattle, WA USA
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14
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Cassell JA. Highlights from this issue. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Matteelli A, Capone S. The Holy Grail of prevention of sexually transmitted infections in travellers. Sex Transm Infect 2016; 92:405-6. [DOI: 10.1136/sextrans-2016-052573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/31/2016] [Indexed: 11/03/2022] Open
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