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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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2
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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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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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4
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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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5
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Sex Tourism, Condomless Anal Intercourse, and HIV Risk Among Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2020; 30:405-414. [PMID: 31241505 DOI: 10.1097/jnc.0000000000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sex tourism affects the sexual health of tourists and locals with whom they interact. However, a few studies have examined whether sex tourism is a risk factor for the acquisition of HIV and other sexually transmitted infections among men who have sex with men, and no such studies have been conducted in Western Europe. Almost 28% of our respondents reported engaging in sex tourism in their lifetime. Sex tourism was associated with an elevated risk of engagement in condomless receptive anal intercourse, use of alcohol/drugs during sex, participation in group sex, and an elevated risk of diagnosis with any type of sexually transmitted infection over the previous year, specifically gonorrhea and chlamydia. Research with men who have sex with men who engage in sex tourism should explore high-risk sexual behavior during sex tourism and also the feasibility and acceptability of the use of episodic pre-exposure prophylaxis for short periods of participation in elevated risk behaviors by tourists and local sex partners.
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Datta S, Pink J, Medley GF, Petrou S, Staniszewska S, Underwood M, Sonnenberg P, Keeling MJ. Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK. BMC Infect Dis 2019; 19:552. [PMID: 31234784 PMCID: PMC6591963 DOI: 10.1186/s12879-019-4108-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection. METHODS We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection. RESULTS At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective. CONCLUSIONS Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective.
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Affiliation(s)
- Samik Datta
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK. .,National Institute of Water and Atmospheric Research, Wellington, 6021, New Zealand.
| | - Joshua Pink
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Graham F Medley
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Sophie Staniszewska
- Royal College of Nursing Research Institute, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK
| | - Matt J Keeling
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK
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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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8
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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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9
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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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10
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Bishop S, Limmer M. Negotiating the Edge: The Rationalization of Sexual Risk Taking Among Western Male Sex Tourists to Thailand. JOURNAL OF SEX RESEARCH 2018; 55:871-879. [PMID: 28885043 DOI: 10.1080/00224499.2017.1365329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Every year thousands of Western men travel to Thailand as sex tourists to participate in paid-for sex. Although many of these men will use condoms to protect themselves against sexually transmitted infections (STIs), others will not, despite the risks. By applying Steven Lyng's (1990) concept of edgework to data collected from 14 face-to-face interviews with male sex tourists in Pattaya, Thailand, and 1,237 online discussion board posts, this article explores the ways in which these men understood and sought to rationalize the sexual risks they took. We argue that notions of likelihood of infection and significance of consequence underpin these behaviors, and we identify the existence of understandings of sexual risk that reject mainstream safer-sex messages and frame condomless sex as a broadly safe activity for heterosexual men. The article concludes by summarizing the difficulties inherent in driving behavior change among this group of men, for whom sexual risks appear to be easily rationalized away as either inconsequential or irrelevant.
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Affiliation(s)
- Simon Bishop
- a School of Healthcare Sciences , Bangor University
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11
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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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12
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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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13
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Brown G, Prestage G, Down I, Ellard J, Triffitt K. Not so different? Comparison of risk profile of gay men who acquired HIV while travelling with those who acquired HIV in Australia. Health Promot J Austr 2017; 29:58-64. [PMID: 29700942 DOI: 10.1002/hpja.16] [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: 07/12/2016] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Many countries now identify HIV and international mobility as a priority issue within a global and shared epidemic, including Australia. To support health promotion in this complex area, we investigated recent HIV infections that occurred among Australian gay men while travelling and compared to HIV infections that occurred in Australia. METHODS 446 gay men recently diagnosed with HIV completed an on-line survey regarding the high risk event (HRE) where they believed that they acquired HIV. Those who acquired HIV while in their usual place of residence (308 men), those who were travelling within Australia (59 men), and those who were travelling overseas (79 men) were compared. RESULTS Those who acquired HIV while overseas had very similar risk profiles, sexual behaviour, and made similar assumptions about their partners and their own HIV status, as those who acquired HIV in Australia. Only HIV status disclosure at the HRE differed across locations (P = .030). Three quarters (74.7%) of the men who acquired HIV while overseas were not diagnosed until they returned to Australia. CONCLUSIONS Our findings challenge the idea that there are necessarily differences in behaviour and assumptions for HIV transmission in Australia and overseas. However, the men travelling may be in communities where HIV status is less commonly disclosed, and where HIV prevalence is higher. SO WHAT?: A deeper understanding of contextual factors may be required for HIV prevention and health promotion strategies targeting gay men travelling to locations with different cultural, HIV prevalence, and HIV testing considerations. This would also identify opportunities for new tools such as Pre-Exposure Prophylaxis and self-testing.
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Affiliation(s)
- Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Garrett Prestage
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Ian Down
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Jeanne Ellard
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Kathy Triffitt
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
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14
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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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15
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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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International Sexual Partnerships May Be Shaped by Sexual Histories and Socioeconomic Status. Sex Transm Dis 2017; 44:306-309. [PMID: 28407648 DOI: 10.1097/olq.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exchange sex and higher education were associated with an increased likelihood of international sexual partnerships (ISPs). Exchange sex and older age were associated with an increased likelihood of condomless sex in ISPs. Educational and socioeconomic factors may create unbalanced power dynamics that influence exchange sex and condomless sex in ISPs.
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17
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Lejelind E, Westerling R, Sjögren Fugl-Meyer K, Larsson K. Condom use among Swedes while traveling internationally: A qualitative descriptive study. Nurs Health Sci 2017; 19:257-263. [PMID: 28371120 DOI: 10.1111/nhs.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/15/2016] [Accepted: 01/21/2017] [Indexed: 11/29/2022]
Abstract
This study explores factors influencing condom use among Swedish women and men who visited a sexual health clinic after unprotected sex during international travel. Semi-structured interviews were conducted with 25 women and 25 men. The data were analyzed using conventional content analysis. The informants' narratives were categorized as strategies and barriers. Strategies found were: risk assessment, testing, and treatment for sexually transmitted infections. The barriers were characterized as technical and personal or emotional. The findings indicate that sexual behavior may be different while traveling internationally, and that a release of social constraints and increased alcohol consumption were risk factors for practicing unprotected sex. Some of the strategies may be appropriate for the prevention of sexually transmitted infections, but several strategies and most barriers were used to explain why unprotected sex was practiced. Thus, people need the opportunity to reconsider strategies and strengthen confidence in their ability to use condoms. An individual-based approach employed within routine health care may support the practice of safer sex and prevent further transmission of sexually transmitted infections.
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Affiliation(s)
- Eva Lejelind
- Department of Dermatology and Venereology, Uppsala University Hospital, Uppsala, Sweden
| | - Ragnar Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kerstin Sjögren Fugl-Meyer
- Department of Neurology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Kjerstin Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Neurology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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18
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O'Mullan C, Debattista J, Browne M. Risky business or not? FIFOs, sexual risk taking and the Australian mining industry. Health Promot J Austr 2017; 27:4-9. [PMID: 26603027 DOI: 10.1071/he15011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/21/2015] [Indexed: 11/23/2022] Open
Abstract
Issue addressed The fly-in, fly-out (FIFO) and drive-in, drive-out (DIDO) models of mining in Australia have led to concerns about adverse health and psychosocial impacts. Despite speculation that increased levels of sexually transmitted infections (STIs) in Australia, including HIV, are associated with FIFO/DIDO work, we know little about sexual risk-taking behaviours in mining populations. This study explores differences in sexual risk taking and perceptions of risk between FIFO/DIDO miners and residential miners. Methods A cross-sectional survey was administered to a sample (n=444) of male miners working in Queensland, Australia. The self-completed survey contained 49 questions relating to knowledge, attitudes and behaviour and included demographic information and specific items related to sex and relationships. Results FIFO/DIDO status was not associated with any differential sexual risk-taking behaviours, except for an increased probability of reporting 'ever being diagnosed with an STI'; 10.8% of FIFO/DIDO respondents versus 3.6% of others (x(2) (1)=4.43, P=0.35). Conclusions Our results appear to counter anecdotal evidence that FIFO/DIDO miners engage in higher sexual risk behaviours when compared with residential miners. So what? Anecdotal evidence linking the rise of sexually transmitted infections with the FIFO/DIDO mining workforce could drive costly and unnecessary approaches to prevention. Further research, surveillance and monitoring are required to inform health promotion interventions.
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Affiliation(s)
- Cathy O'Mullan
- School of Human, Health and Social Sciences, Central Queensland University, Locked Bag 3333, Bundaberg, Qld 4670, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Locked Bag 2, Stafford, Qld 4053, Australia
| | - Matthew Browne
- School of Human, Health and Social Sciences, Central Queensland University, Locked Bag 3333, Bundaberg, Qld 4670, Australia
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19
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Crawford G, Lobo R, Brown G, Macri C, Smith H, Maycock B. HIV, Other Blood-Borne Viruses and Sexually Transmitted Infections amongst Expatriates and Travellers to Low- and Middle-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1249. [PMID: 27999275 PMCID: PMC5201390 DOI: 10.3390/ijerph13121249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
| | - Graham Brown
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne 3083, Australia.
| | - Chloe Macri
- School of Public Health, Curtin University, Perth 6845, Australia.
| | - Hannah Smith
- School of Public Health, Curtin University, Perth 6845, Australia.
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth 6845, Australia.
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Tanton C, Johnson AM, Macdowall W, Datta J, Clifton S, Field N, Mitchell KR, Wellings K, Sonnenberg P, Mercer CH. Forming new sex partnerships while overseas: findings from the third British National Survey of Sexual Attitudes & Lifestyles (Natsal-3). Sex Transm Infect 2016; 92:415-23. [PMID: 27272533 PMCID: PMC5013104 DOI: 10.1136/sextrans-2015-052459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/06/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Travelling away from home presents opportunities for new sexual partnerships, which may be associated with sexually transmitted infection (STI) risk. We examined the prevalence of, and factors associated with, reporting new sexual partner(s) while overseas, and whether this differed by partners' region of residence. METHODS We analysed data from 12 530 men and women aged 16-74 years reporting ≥1 sexual partner(s) in the past 5 years in Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010-2012. RESULTS 9.2% (95% CI 8.3% to 10.1%) of men and 5.3% (4.8% to 5.8%) of women reported new sexual partner(s) while overseas in the past 5 years. This was strongly associated with higher partner numbers and other sexual and health risk behaviours. Among those with new partners while overseas, 72% of men and 58% of women reported partner(s) who were not UK residents. Compared with those having only UK partners while abroad, these people were more likely to identify as 'White Other' or 'Non-White' (vs White British ethnicity), report higher partner numbers, new partners from outside the UK while in the UK and paying for sex (men only) all in the past 5 years. There was no difference in reporting STI diagnosis/es during this time period. CONCLUSIONS Reporting new partners while overseas was associated with a range of sexual risk behaviours. Advice on sexual health should be included as part of holistic health advice for all travellers, regardless of age, destination or reason for travel.
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Affiliation(s)
- Clare Tanton
- Research Department of Infection & Population Health, University College London, London, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, London, UK
| | - Wendy Macdowall
- Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica Datta
- Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, London, UK NatCen Social Research, London, UK
| | - Nigel Field
- Research Department of Infection & Population Health, University College London, London, UK
| | - Kirstin R Mitchell
- Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kaye Wellings
- Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, London, UK
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Lewis CT, de Wildt G. Sexual behaviour of backpackers who visit Koh Tao and Koh Phangan, Thailand: a cross-sectional study. Sex Transm Infect 2016; 92:410-4. [PMID: 27272532 DOI: 10.1136/sextrans-2015-052301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/12/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To measure the proportion of backpackers engaging in unprotected sex while travelling in Thailand and to identify predictors of unsafe sexual behaviour. METHODS A cross-sectional study using an anonymous questionnaire was performed. English-speaking backpackers, excluding US and Thai citizens, were recruited while travelling through the piers of Koh Tao and Koh Phangan between 25 January and 13 March 2013. RESULTS 61.5% (1238/2013) respondents were travelling without a long-term sexual partner, of whom 39.1% (29.4% females; 51.9% males) reported intercourse with a new partner. 36.8% of these reported inconsistent/no condom use. Inconsistent condom use was independently associated with age <25 years, UK (vs Canadian) nationality and not bringing condoms from home. Backpackers who brought condoms from home were more likely to have sex with a new partner. Male gender and longer trip length increased the likelihood of new partner acquisition and overall risk of unsafe sex but were not associated with inconsistent condom use. New partners were most commonly backpackers from other countries. Men were more likely than women to have sex with a local person. CONCLUSIONS Backpackers visiting Thailand frequently report unsafe sex. Partner demographics demonstrate a mechanism of international sexually transmitted infection (STI) transfer. In an era of growing antibiotic resistance and continuing HIV transmission, targeting unsafe sex in backpackers has the potential to reduce STI incidence internationally. These data highlight the need for innovative public health intervention. To focus such measures, future research may elucidate why certain groups are at higher risk.
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Affiliation(s)
- C T Lewis
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - G de Wildt
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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22
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Sexual risk-taking during travel abroad - a cross-sectional survey among youth in Sweden. Travel Med Infect Dis 2016; 14:233-41. [PMID: 27083687 DOI: 10.1016/j.tmaid.2016.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 03/09/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim was to assess sexual risk-taking behaviour in a sample of Swedish youth who were sexually active while travelling abroad and to examine possible associations with sexual risk-taking behaviour during such travel. METHODS From a population-based sample of 2189 Swedes 18-29 years, 768 who were sexually active while abroad, were assessed by a questionnaire concerning socio-demographic background, life-style, travel duration, sexuality, mental health, heavy episodic drinking (HED) and drug-use. RESULTS Approximately 1/4 reported intercourse with a casual partner abroad. Casual sex was associated with HED, 18-24 years, and drug use in both sexes, and for women, also with ≥one month of travel. Among youth with casual partners, 48% reported non-condom use. Non-condom use with a casual partner was associated with 18-24 years, ≥one month of travel for women, and poor self-rated mental health for men. About 10% had ≥2 partners abroad. Having ≥2 partners abroad was associated with ≥one month of travel, and for men also with HED. CONCLUSION Male sex, 18-24 years of age, ≥1 month of travel, HED, and drug use were significantly associated with sexual risk-taking during travel abroad. Poor self-rated mental health and foreign-born parentage might also constitute risk factors for men.
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23
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Alcedo S, Kossuth-Cabrejos S, Piscoya A, Mayta-Tristán P. Factors associated with non-use of condoms in an online community of frequent travellers. Travel Med Infect Dis 2015; 12:750-6. [PMID: 25457304 DOI: 10.1016/j.tmaid.2014.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 08/01/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. METHODS Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). RESULTS Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. CONCLUSION An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience.
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24
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Truong HHM, Fatch R, Grasso M, Robertson T, Tao L, Chen YH, Curotto A, McFarland W, Grant RM, Reznick O, Raymond HF, Steward WT. Gay and bisexual men engage in fewer risky sexual behaviors while traveling internationally: a cross-sectional study in San Francisco. Sex Transm Infect 2015; 91:220-5. [PMID: 25355773 PMCID: PMC10630101 DOI: 10.1136/sextrans-2014-051660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/05/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND International travel poses potential challenges to HIV prevention. A number of studies have observed an association between travel and behavioural disinhibition. In the present study, we assessed differences in sexual behaviour while travelling internationally and within the USA, compared with being in the home environment. METHODS A probability-based sample of men who have sex with men (MSM) from the San Francisco Bay Area who had travelled internationally in the previous 12 months was recruited through an adapted respondent-driven sampling methodology (N=501). Participants completed interviewer-administered, computer-assisted surveys. RESULTS Detailed partner-by-partner behavioural data by destination type were collected on 2925 sexual partnerships: 1028 while travelling internationally, 665 while travelling within the USA and 1232 while staying in the San Francisco Bay Area. The proportion of partnerships during international travel that involved unprotected anal intercourse (UAI) was lower compared with during domestic travel and staying locally. International travel was associated with decreased odds of receptive UAI (AOR=0.65, p=0.02) compared with staying locally and there was a trend towards decreased odds of insertive UAI (AOR=0.70, p=0.07). CONCLUSIONS MSM engaged in proportionately fewer sexual activities which present a high HIV transmission risk when travelling internationally, namely unprotected receptive and insertive anal intercourse and particularly with HIV serodiscordant partners. The lower sexual risk-taking during international travel was robust to controlling for many factors, including self-reported HIV serostatus, age, relationship status and type of partnership. These findings suggest that when travelling internationally, MSM may experience behavioural disinhibition to a lesser extent than had been described previously.
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Affiliation(s)
- Hong-Ha M Truong
- University of California, San Francisco, California, USA Gladstone Institute of Virology and Immunology, San Francisco, California, USA
| | - Robin Fatch
- University of California, San Francisco, California, USA
| | - Michael Grasso
- Department of Public Health, San Francisco, California, USA
| | | | - Luke Tao
- Department of Public Health, San Francisco, California, USA
| | - Yea-Hung Chen
- Department of Public Health, San Francisco, California, USA
| | | | - Willi McFarland
- University of California, San Francisco, California, USA Department of Public Health, San Francisco, California, USA
| | - Robert M Grant
- University of California, San Francisco, California, USA Gladstone Institute of Virology and Immunology, San Francisco, California, USA
| | - Olga Reznick
- University of California, San Francisco, California, USA
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Jones KG, Johnson AM, Wellings K, Sonnenberg P, Field N, Tanton C, Erens B, Clifton S, Datta J, Mitchell KR, Prah P, Mercer CH. The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Sex Transm Infect 2014; 91:116-23. [PMID: 25404706 PMCID: PMC4345903 DOI: 10.1136/sextrans-2014-051683] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who pay for sex (MPS) are considered a bridging population for sexually transmitted infections (STI). However, the extent, characteristics and role of MPS in transmission is poorly understood. We investigate these questions using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). METHODS We performed complex survey analyses of data from 6293 men aged 16-74 years resident in Britain who completed Natsal-3, a probability sample survey undertaken during 2010-2012, using computer-assisted personal interviewing and computer-assisted self-interview. RESULTS 11.0% (95% CI10.1% to 11.9%) of all men reported ever paying for sex. Among MPS, 18.4% (95% CI 18.2% to 18.7%) of their lifetime sexual partners were paid. 3.6% (95% CI 3.1% to 4.2%) of men had paid for sex in the past 5 years. Partners of MPS constitute 14.7% of all reported partners and MPS report 15.6% of all reported STI diagnoses in the past 5 years. Paying for sex in the past 5 years was strongly associated with reporting larger numbers of sexual partners (adjusted OR, AOR for 5+ partners, past 5 years, 31.50, 95% CI 18.69 to 53.09). After adjusting for partner numbers, paying for sex remained strongly associated with reporting new foreign partners outside the UK (AOR 7.96; 95% CI 4.97 to 12.73) and STI diagnosis/es (AOR 2.34; 95% CI 1.44 to 3.81), all in the past 5 years. Among men ever paying for sex, 62.6% (95% CI 58.3% to 66.8%) reported paying for sex outside the UK, most often in Europe and Asia. CONCLUSIONS MPS in Britain remain at greater risk of STI acquisition and onward transmission than men who do not. They report high numbers of partners, but the minority are paid partners. They are an important core group in STI transmission.
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Affiliation(s)
- Kyle G Jones
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Nigel Field
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Clare Tanton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Bob Erens
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK NatCen Social Research, London, UK
| | - Jessica Datta
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Kirstin R Mitchell
- Department of Social and Environmental Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Phillip Prah
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London, UK
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Blood, sex and trust: The limits of the population-based risk management paradigm. Health Place 2014; 26:21-30. [DOI: 10.1016/j.healthplace.2013.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 11/21/2013] [Accepted: 11/24/2013] [Indexed: 11/24/2022]
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Brown G, Ellard J, Mooney-Somers J, Prestage G, Crawford G, Langdon T. ‘Living a life less ordinary’: exploring the experiences of Australian men who have acquired HIV overseas. Sex Health 2014; 11:547-55. [DOI: 10.1071/sh13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/03/2014] [Indexed: 11/23/2022]
Abstract
Background
Increasing international mobility has led to a growth of cross-border HIV transmission around the world. In Australia, increasing rates of HIV infections acquired overseas have been reported, particularly among men. This qualitative study explored experiences and risk perceptions of 14 Australian men who acquired HIV while living or travelling overseas from the year 2000. Methods: Symbolic interaction provided the study’s theoretical perspective and analytical framework. Australian men living with HIV who were aged 18 years and older, believed they had acquired their infection while working or travelling overseas during or after the year 2000, and were diagnosed from 2003 onwards were eligible to participate. A semistructured interview schedule was developed and tested for content validity with the study reference group. Analysis was conducted using an adapted form of grounded theory to form the basis for the development of the experiences domains. Results: Analysis produced four domains of experience: (1) a fantasy realised, (2) escaping and finding a new self or life, (3) living a life less ordinary and (4) living local but still an outsider. The description of the four experience domains highlights how risk generally, particularly sexual risk, did or did not feature in these men’s understanding of their experiences. Conclusion: Perceptions and experiences of long-term travel played a decisive role for men who acquired HIV when travelling overseas. Appealing to desired experiences such as connection to local culture or sustaining a new or adventurous life may provide important implications for guiding health promotion programs and policy.
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Circulation of HIV-1 CRF02_AG among MSM population in central Italy: a molecular epidemiology-based study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:810617. [PMID: 24369538 PMCID: PMC3863479 DOI: 10.1155/2013/810617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022]
Abstract
Introduction. The evolutionary and demographic history of the circular recombinant form CRF02_AG in a selected retrospective group of HIV-1 infected men who have sex with men (MSM) resident in Central Italy was investigated. Methods. A total of 55 HIV-1 subtype CRF02_AG pol sequences were analyzed using Bayesian methods and a relaxed molecular clock to reconstruct their dated phylogeny and estimate population dynamics. Results. Dated phylogeny indicated that the HIV-1 CRF02_AG strains currently circulating in Central Italy originated in the early 90's. Bayesian phylogenetic analysis revealed the existence of a main HIV-1 CRF02_AG clade, introduced in the area of Rome before 2000 and subsequently differentiated in two different subclades with a different date of introduction (2000 versus 2005). All the sequences within clusters were interspersed, indicating that the MSM analyzed form a close and restricted network where the individuals, also moving within different clinical centers, attend the same places to meet and exchange sex. Conclusions. It was suggested that the HIV-1 CRF02_AG epidemic entered central Italy in the early 1990s, with a similar trend observed in western Europe.
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Bauer IL. Romance tourism or female sex tourism? Travel Med Infect Dis 2013; 12:20-8. [PMID: 24332659 DOI: 10.1016/j.tmaid.2013.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/17/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Love, sex and the female traveller: romance tourism or female sex tourism? The phenomenon of women travelling in search of relationships with local men in developing countries has been studied for the last 20 years. However, it appears little known in travel medicine. METHODS Relevant literature was found through PubMed, Science Direct, ProQuest and Google Scholar. The reference lists of selected articles identified further sources. RESULTS Historical records of women travellers to far-away countries abound. Then, as now, women not only searched for the erotic 'other' but made romance and sex the purpose of their trip. Today, increasing numbers of women travel to destinations in developing countries where sex with local men is the main attraction. This pastime raises concerns not only for the women themselves but for the local men involved as well as their sex partners and the local communities. CONCLUSIONS Although more research is necessary, comparing the criteria that describe men travelling for sex and relationships and women travelling for sex and relationships appears to suggest that there is very little difference between the two, regardless of what the pursuit is called. Women looking for sex with local men are sex tourists, too. Recognition of this fact needs to influence the pre and post travel care of female travellers.
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Affiliation(s)
- Irmgard L Bauer
- School of Nursing, Midwifery & Nutrition, James Cook University, Townsville, QLD 4811, Australia; Tropical Health Research Unit for Nursing and Midwifery Practice, James Cook University, Townsville, QLD 4811, Australia; International Health Program, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia.
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Fischer JA, Debattista J, Rostami S, Peet AR, Dean JA, Allen KE, Stewart M. Sexual risk taking in a community sample of international backpackers visiting Brisbane, Australia. Asia Pac J Public Health 2013; 27:NP2400-9. [PMID: 23572374 DOI: 10.1177/1010539513483822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We sought to examine correlations between international backpackers' alcohol consumption and sexual behaviors and determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoea in this population. A cross-sectional study design consisting of a convenience sample (N = 168) of non-treatment-seeking international backpackers visiting Brisbane, Australia was recruited. Participants were asked to self-complete a questionnaire on sexual behavior and to undertake a urine-based polymerase chain reaction test for C trachomatis and N gonorrhoea. Since arriving in Australia, 73.2% reported having had sex, with a median number of 2 different sex partners (range = 0-21). Most participants had consumed alcohol (53.7%) and used condoms (46.3%) the last time they had sex. In our sample, there was a 4.3% prevalence of C trachomatis and a 0% prevalence of N gonorrhoea. This study identified a variable pattern of risk among backpackers, with those spending longer periods in the country more likely to have sex with Australians.
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Affiliation(s)
- Jane A Fischer
- Centre for Drug and Alcohol Studies, Queensland Health, Brisbane, Queensland, Australia
| | - Joseph Debattista
- Sexual Health and HIV Service, Queensland Health, Brisbane, Queensland, Australia
| | - Soulmaz Rostami
- Ethnic Communities Council of Queensland, Brisbane, Queensland, Australia
| | - Anthony R Peet
- Metro South Health Service District, Queensland Health, Brisbane, Queensland, Australia
| | - Judith A Dean
- Sexual Health and HIV Service, Queensland Health, Brisbane, Queensland, Australia Griffith University, Brisbane, Queensland, Australia
| | - Kate E Allen
- Sexual Health and HIV Service, Queensland Health, Brisbane, Queensland, Australia
| | - Mary Stewart
- Centre for Drug and Alcohol Studies, Queensland Health, Brisbane, Queensland, Australia
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Short-term mobility and the risk of HIV infection among married couples in the fishing communities along Lake Victoria, Kenya. PLoS One 2013; 8:e54523. [PMID: 23336005 PMCID: PMC3545885 DOI: 10.1371/journal.pone.0054523] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022] Open
Abstract
Objective Mobility has long been associated with high HIV prevalence. We sought to assess sex differences in the relationship between mobility and risk for HIV infection among married couples in the fishing communities. Methods We conducted 1090 gender-matched interviews and rapid HIV testing with 545 couples proportionally representing all the different sizes of the fish-landing beaches in Kisumu County. We contacted a random sample of fishermen as our index participants and asked them to enrol in the study together with their spouses. The consenting couples were separated into different private rooms for concurrent interviews and thereafter reunited for couple rapid HIV counselling and testing. In addition to socio-economic and behavioural data, we collected information on overnight travels and divided couples in 4 groups as follows both partners not mobile, both partners mobile, only woman mobile, and only man mobile. Other than descriptive statistics, we used X2 and U tests to compare groups of variables and multivariate logistic regression to measure association between mobility and HIV infection. Results We found significant differences in the number of trips women travelled in the preceding month (mean 4.6, SD 7.1) compared to men (mean 3.3, SD 4.9; p<0.01) and when the women did travel, they were more likely to spend more days away from home than their male partners (mean 5.2 [SD 7.2] versus 3.4 SD 5.6; p = 0.01). With an HIV prevalence of 22.7% in women compared to 20.9% among men, mobile women who had non-mobile spouses had 2.1 times the likelihood of HIV infection compared to individuals in couples where both partners were non-mobile. Conclusion The mobility of fishermen’s spouses is associated with HIV infection that is not evident among fishermen themselves. Therefore, interventions in this community could be a combination of sex-specific programming that targets women and combined programming for couples.
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Brown G, Ellard J, Mooney-Somers J, Hildebrand J, Langdon T. HIV risk among Australian men travelling overseas: networks and context matter. CULTURE, HEALTH & SEXUALITY 2012; 14:677-690. [PMID: 22591069 DOI: 10.1080/13691058.2012.678015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Increasing international mobility presents a risk for communicable disease transmission. Overseas-acquired HIV infections have been increasingly observed across Australian jurisdictions. This includes a mix of men emigrating from countries with high HIV prevalence and men travelling abroad. There is currently little research exploring international mobility and HIV risk, and as a consequence the increase of men acquiring HIV while travelling overseas is poorly understood. This paper draws on data from a qualitative study exploring the risk perspectives and experiences of 14 Australian men who acquired HIV while travelling overseas in the years between 2000 and 2009. Participants articulated a strong desire to distance themselves from the identity of a tourist. Social networks were highlighted as important entry points to engage with other foreign travellers and expatriates. These networks were highly influential and were understood by the participants to provide guidance on how they should negotiate the local scene, including where to meet sex partners. Limited discussion of safe sex and HIV was mentioned in these contexts. The findings suggest that prevalent social norms and social networks play an influential role in how participants negotiate sex and social relations in overseas settings. These networks could potentially provide sites for effective HIV-prevention programmes.
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Affiliation(s)
- Graham Brown
- Western Australian Centre for Health Promotion Research, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
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Rice B, Gilbart VL, Lawrence J, Smith R, Kall M, Delpech V. Safe travels? HIV transmission among Britons travelling abroad. HIV Med 2012; 13:315-7. [PMID: 22276810 DOI: 10.1111/j.1468-1293.2011.00983.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of the study was to identify and describe the characteristics of persons born in the UK who acquire HIV infection abroad. METHODS Analyses using case reports and follow-up data from the national HIV database held at the Health Protection Agency were performed. RESULTS Fifteen per cent (2066 of 13 891) of UK-born adults diagnosed in England, Wales and Northern Ireland between 2002 and 2010 acquired HIV infection abroad. Thailand (534), the USA (117) and South Africa (108) were the countries most commonly reported. As compared with UK-born adults acquiring HIV infection in the UK, those acquiring HIV infection abroad were significantly (P < 0.01) more likely to have acquired it heterosexually (70% vs. 22%, respectively), to be of older age at diagnosis (median 42 years vs. 36 years, respectively), and to have reported sex with a commercial sex worker (5.6% vs. 1%, respectively). Among men infected in Thailand, 11% reported sex with a commercial sex worker. CONCLUSIONS A substantial number of UK-born adults are acquiring HIV infection in countries with generalized HIV epidemics, and in common holiday destinations. Of particular concern is the high proportion of men infected reporting sex with a commercial sex worker. We recommend HIV prevention and testing efforts be extended to include travellers abroad, and that sexual health advice be provided routinely in travel health consultations and in occupational health travel advice packs, particularly to those travelling to high HIV prevalence areas and destinations for sex tourism. Safer sex messages should include an awareness of the potential detrimental health and social impacts of the sex industry.
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Affiliation(s)
- B Rice
- Department of HIV and STI,Health Protection Agency Centre for Infections, London, UK.
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Nahmias SB, Nahmias D. Society, sex, and STIs: human behavior and the evolution of sexually transmitted diseases and their agents. Ann N Y Acad Sci 2011; 1230:59-73. [DOI: 10.1111/j.1749-6632.2011.06079.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davies SC, Karagiannis T, Headon V, Wiig R, Duffy J. Prevalence of genital chlamydial infection among a community sample of young international backpackers in Sydney, Australia. Int J STD AIDS 2011; 22:160-4. [PMID: 21464454 DOI: 10.1258/ijsa.2010.010354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a chlamydia prevalence study from January to June 2009 among a community sample of young international backpackers by recruiting at hostels in Sydney, Australia. Participants completed a questionnaire; men provided a urine sample and women provided a self-collected vaginal swab, which were tested for Chlamydia trachomatis DNA by strand displacement amplification. We recruited 225 men (median age 24 years) and 207 women (median age 23 years). Most (87%) of the travellers came from Europe. A new sexual partner during travel was reported by 67%, and 51% had more than one new sexual partner. Of those reporting a new sexual partner, 40% always used condoms. Prevalence of chlamydia was 3.5% (3.1% in men, 3.9% in women). Previous testing for chlamydia was reported by 40%. Drinking alcohol at hazardous levels was reported by 58% of men and 29% of women. Despite the reporting of new sexual partners and inconsistent condom use, the prevalence of chlamydia in these backpackers was not higher than that found in more general populations, and may relate to good health-care seeking behaviour. Young travellers need education about sexual risks and promotion of condom use prior to travel, and access to public sexual health services.
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Affiliation(s)
- S C Davies
- Northern Sydney Sexual Health Service, Royal North Shore Hospital, St Leonards, Australia.
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Vivancos R, Abubakar I, Hunter P. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis 2010; 14:e842-51. [DOI: 10.1016/j.ijid.2010.02.2251] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 10/31/2008] [Accepted: 02/15/2010] [Indexed: 10/19/2022] Open
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Downing J, Hughes K, Bellis MA, Calafat A, Juan M, Blay N. Factors associated with risky sexual behaviour: a comparison of British, Spanish and German holidaymakers to the Balearics. Eur J Public Health 2010; 21:275-81. [DOI: 10.1093/eurpub/ckq021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vivancos R, Abubakar I, Hunter PR. Foreign travel associated with increased sexual risk-taking, alcohol and drug use among UK university students: a cohort study. Int J STD AIDS 2010; 21:46-51. [DOI: 10.1258/ijsa.2009.008501] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a prospective cohort study to assess sexual behaviour of students at a British University during the summer break, to explore the role of foreign travel as a risk factor of sexually transmitted infections acquisition and to determine characteristics associated with casual sex. We found that those who travelled abroad were more likely to use alcohol (RR 1.59, 95% CI 1.17–2.16) and cannabis (RR 1.35, 95% CI 1.13–1.62) and to have casual sex during holidays. They also reported more sexual relationships after holidays (RR 1.26, 95% CI 1.09–1.53). New partnerships during holidays were associated with being single, foreign travel, drinking alcohol and having previously had large number of sexual partners. The adjusted relative risk of developing new sexual partnerships with foreign travel was 2.70 (95% CI 1.11–6.61). People who travel abroad during holidays are more likely to engage in risk taking behaviour and have casual sex. They are also more sexually active after holidays.
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Affiliation(s)
- R Vivancos
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - I Abubakar
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - P R Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
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Vivancos R, Abubakar I, Hunter PR. Sexual behaviour, drugs and alcohol use of international students at a British university: a cross-sectional survey. Int J STD AIDS 2009; 20:619-22. [DOI: 10.1258/ijsa.2008.008421] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study was to determine whether international students have greater risk-taking behaviours that could lead to importing novel and resistant strains of sexually transmitted infections (STIs). We conducted a cross-sectional web-based survey of university students' sexual behaviour, alcohol and drug use, and self-reported diagnosis of STIs and compared these between British and international students. In all, 827 students completed the survey, of whom 123 (15%) were international students. International students were less likely to have ever drunk alcohol (95.4% versus 87.8%, P = 0.002) and used drugs (56.4% versus 41.5%, P = 0.002). International students were on average almost two years older at first intercourse (18.7 versus 17 years; P < 0.001). There were no differences in the number of sexual partners between national and international students. On a discriminant analysis model, international students were characterized by being older and from a non-white background, less likely to use cocaine, they drank alcohol less frequently and were more likely to have had unprotected intercourse with two or more partners in the previous year. In conclusion, international students tend to drink more moderately and use fewer recreational drugs than British students. However, they exhibit higher sexual risk behaviours that could lead to importing novel and resistant strains of STIs.
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Affiliation(s)
- R Vivancos
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - I Abubakar
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
| | - P R Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
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van de Laar T, Pybus O, Bruisten S, Brown D, Nelson M, Bhagani S, Vogel M, Baumgarten A, Chaix ML, Fisher M, Gőtz H, Matthews G, Neifer S, White P, Rawlinson W, Pol S, Rockstroh J, Coutinho R, Dore G, Dusheiko G, Danta M. Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. Gastroenterology 2009; 136:1609-17. [PMID: 19422083 PMCID: PMC4260925 DOI: 10.1053/j.gastro.2009.02.006] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Since 2000, there has been a marked rise in acute hepatitis C virus (HCV) in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). We conducted an international phylogenetic study to investigate the existence of an HCV transmission network among MSM. METHODS HIV-positive MSM diagnosed with recent HCV (n = 226) in England (107), The Netherlands (58), France (12), Germany (25), and Australia (24) between 2000 and 2006 were enrolled into a molecular phylogenetic study. Using real-time polymerase chain reaction (PCR), the NS5B region of the HCV genome (436 base pair) was amplified, sequenced, and compared with unrelated NS5B sequences. RESULTS NS5B sequences were obtained from 200 (89%) cases. Circulating HCV genotypes were 1a (59%), 4d (23%), 3a (11%), 1b (5%), and 2b/c (3%). Phylogenetic analysis revealed 156 (78%) sequences that formed 11 clusters (bootstrap value > 70%) containing between 4 and 37 individual sequences. Country mixing was associated with larger cluster size (17 vs 4.5 sequences; P = .03). "Molecular clock" analysis indicated that the majority (85%) of transmissions occurred since 1996. CONCLUSIONS Phylogenetic analysis revealed a large international network of HCV transmission among HIV-positive MSM. The rapid spread of HCV among neighboring countries is supported by the large proportion (74%) of European MSM infected with an HCV strain co-circulating in multiple European countries, the low evolutionary distances among HCV isolates from different countries, and the trend toward increased country mixing with increasing cluster size. Temporally, this epidemic coincides with the introduction of highly active antiretroviral therapy and associated increases in sexual risk behaviors. International collaborative public health efforts are needed to mitigate HCV transmission among this population.
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Affiliation(s)
- T van de Laar
- Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands
| | - O Pybus
- Department of Zoology, University of Oxford, UK
| | - S Bruisten
- Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands
| | - D Brown
- UCL Centre for Hepatology, Royal Free Hospital, London, UK
| | - M Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospitals, London, UK
| | - S Bhagani
- Department of HIV Medicine, Royal Free and University College, London, UK
| | - M Vogel
- Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany
| | - A Baumgarten
- Practice Dupke/Carganico/Baumgarten, Berlin, Germany
| | - ML Chaix
- University Paris Descartes EA3620, Virology CHU Necker AP-HP, Paris France
| | - M Fisher
- Department of HIV Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - H Gőtz
- Department of Infectious Diseases, Health Service, Rotterdam, Netherlands
| | - G Matthews
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia
| | - S Neifer
- Practice Dupke/Carganico/Baumgarten, Berlin, Germany
| | - P White
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - W Rawlinson
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - S Pol
- Hepatology Unit, Cochin hospital/University Paris-Descartes, Paris France
| | - J Rockstroh
- Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany
| | - R Coutinho
- Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands,Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands
| | - G Dore
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia
| | - G Dusheiko
- UCL Centre for Hepatology, Royal Free Hospital, London, UK
| | - M Danta
- UCL Centre for Hepatology, Royal Free Hospital, London, UK,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Australia
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Giuliani M, Montieri S, Palamara G, Latini A, Alteri C, Perno C, Santoro M, Rezza G, Ciccozzi M. Non-B HIV type 1 subtypes among men who have sex with men in Rome, Italy. AIDS Res Hum Retroviruses 2009; 25:157-64. [PMID: 19108689 DOI: 10.1089/aid.2008.0175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An increase in the circulation of HIV-1 non-B subtypes has been observed in recent years in Western European countries. Due to the lack of data on the circulation of HIV-1 non-B subtypes among European HIV-1-infected men who have sex with men (MSM), a biomolecular study was conducted in Rome, Italy. HIV-1 partial pol gene sequences from 111 MSM individuals (76 drug naive and 35 drug experienced) were collected during the years 2004-2006. All these sequences were analyzed using the REGA HIV-1 Subtyping Tool, and aligned using CLUSTAL X followed by manual editing using the Bioedit software. A BLAST search for non-B subtype sequences was also performed. Twenty-six (23.4%) MSM were not Italians. Eight individuals (7.2%) were diagnosed as HIV infected before 1991, 20 (18.0%) between 1991 and 1999, and 83 (74.8%) from 2000 to 2006. Fifteen (15/111, 13.5%) individuals were infected with the non-B subtype. The percentage of infection with HIV-1 non-B subtypes was 8.2% (7/85) among Italian MSM and 30.8% (8/26) among the non-Italians (OR = 4.95 95% IC: 1.40-17.87). Individuals infected with the non-B subtype were significantly younger than those infected with the HIV-1 B subtype (28 years vs. 34 years, p = 0.003). The CRFs were more prevalent (8.1%) than pure subtypes (5.4%), which were distributed as follows: subtype C (2.6%), subtype A1 (1.7%), and subtype F1 (0.9%). Major mutations conferring resistance to antiretroviral drugs (ARV) were not found among HIV-1 non-B subtype drug-naive patients but were found in two ARV-experienced individuals. The data show that viral diversity is likely increasing in a population group that had been previously characterized by the circulation of HIV-1 subtype B.
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Affiliation(s)
- M. Giuliani
- Reparto Epidemiologia, Dipartimento Malattie Infettive, Parassitarie e Immunomediate (MIPI), Istituto Superiore di Sanità, Rome, Italy
- S. C. Dermatologia Infettiva, Istituto Dermatovenereologico S. Gallicano (IRCCS), Rome, Italy
| | - S. Montieri
- Reparto Epidemiologia, Dipartimento Malattie Infettive, Parassitarie e Immunomediate (MIPI), Istituto Superiore di Sanità, Rome, Italy
| | - G. Palamara
- S. C. Dermatologia Infettiva, Istituto Dermatovenereologico S. Gallicano (IRCCS), Rome, Italy
| | - A. Latini
- S. C. Dermatologia Infettiva, Istituto Dermatovenereologico S. Gallicano (IRCCS), Rome, Italy
| | - C. Alteri
- Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Università degli Studi di Roma, Tor Vergata, Rome, Italy
| | - C.F. Perno
- Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Università degli Studi di Roma, Tor Vergata, Rome, Italy
| | - M.M. Santoro
- Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Università degli Studi di Roma, Tor Vergata, Rome, Italy
| | - G. Rezza
- Reparto Epidemiologia, Dipartimento Malattie Infettive, Parassitarie e Immunomediate (MIPI), Istituto Superiore di Sanità, Rome, Italy
| | - M. Ciccozzi
- Reparto Epidemiologia, Dipartimento Malattie Infettive, Parassitarie e Immunomediate (MIPI), Istituto Superiore di Sanità, Rome, Italy
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Mercer CH, Copas AJ, Sonnenberg P, Johnson AM, McManus S, Erens B, Cassell JA. Who has sex with whom? Characteristics of heterosexual partnerships reported in a national probability survey and implications for STI risk. Int J Epidemiol 2008; 38:206-14. [PMID: 19001667 DOI: 10.1093/ije/dyn216] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sexually transmitted infection (STI) risk is determined both by partner numbers and partnership characteristics. Studies describing only recent partnership(s) overestimate long-term partnerships and underestimate the contribution of casual partnerships to STI transmission in populations. We describe all heterosexual partnerships in the past year in terms of partnership type, age and geographical mixing and how these characteristics relate to condom use. METHODS Probability sample survey of 11 161 men and women aged 16-44 resident in Britain, 1999-2001. Computer-assisted self-interviews asked respondents about partner numbers and detailed questions about their three most recent partnerships. We weight these data to represent partnerships for which detailed questions were not asked to present estimates for the population of partnerships. RESULTS Of 15 488 heterosexuals partnerships, 39.1% (95% CI 36.6-41.7%) of men's partnerships were 'not (yet) regular' vs 20.0% (95% CI 18.2-21.9%) of women's partnerships. While condoms were used at last sex in 37.1% (95% CI 35.0-39.3%) of men's and 28.8% (95% CI 27.1-30.6%) of women's partnerships, and for 55.3% (95% CI 52.6-58.0%) of first sex with new partners, these proportions declined with age. When partnerships involved an age difference of 5+ years [26.2% (95% CI 23.0-29.6%) of men's and 36.5% (95% CI 33.0-40.1%) of women's partnerships], condoms were less commonly used at first sex than when partners were closer in age [44.1% (95% CI 39.1-48.4%) vs 60.8% (95% CI 57.3-64.2%)]. Sex occurred within 24 h in 23.4% (95% CI 19.7-27.5%) of men's and 10.7% (95% CI 8.3-13.6%) of women's partnerships. CONCLUSIONS A substantial minority of partnerships in the population is casual. The proportion of partnerships not protected by condoms is high, especially for partnerships involving larger age differences and people in their 30s and 40s. Condom use with new partners needs to be promoted among all age-groups.
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Affiliation(s)
- Catherine H Mercer
- Centre for Sexual Health & HIV Research, Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
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von Sadovszky V. Preventing women's sexual risk behaviors during travel. J Obstet Gynecol Neonatal Nurs 2008; 37:516-24. [PMID: 18811771 DOI: 10.1111/j.1552-6909.2008.00274.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Sexually transmitted infections (STIs) are a global concern. Although several countries have tracked the incidence of STIs acquired during travel to foreign countries, the United States lags behind in this practice. Nevertheless, there is evidence from the US and several countries that women engage in sexual risk behaviors during travel whether domestic or foreign, thereby placing themselves at risk for contracting STIs. Guidelines for assessment, prevention, and travel-related supplies and resources are discussed.
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