Overnight visitor counts in Australia and their implications for population estimation

"On the night of the 1996 Census, 5.4 per cent of the people counted in Australia were staying away from home (visitors), compared to 4.6 per cent in 1986. Queensland's share of the nation's visitors has risen since 1986, largely at the expense of Western Australia's. Queensland is now the most popular destination for interstate and overseas visitors, while New South Wales hosts a large proportion of intrastate visitors. But the overall picture is partly obscured because the Census missed around 100,000 overseas visitors."

Safer sex at holiday centres: providing contraceptive services to seasonal workers

Many seasonal workers experience an increase in sexual activity whilst employed at a holiday centre. Evidence of sexual risk-taking while at a holiday centre has important social and health implications for purchasers and providers of sexual health services in areas which experience an annual influx of seasonal workers. This research investigates the contraceptive behaviour of seasonal workers and focuses on their access to contraception and sexual health services. In-depth interviews were conducted with seasonal workers at holiday centres along the south coast of England. Respondents were, interviewed at the beginning of the season and again, five months later at the end of the season. This longitudinal methodology enabled changes in contraceptive behaviour to be identified as well as the strategies for seeking contraception and sexual health services throughout the season. The results of this study show that there are a range of different motivations which influence seasonal worker' use of contraception and sexual risk-taking while at a holiday centre. Categories of contraceptive protection are developed to assist purchasers and providers to identify the variety of sexual health needs of workers at holiday centres and determine the most effective strategies for delivering contraceptive and sexual health services to these workers. The paper describes the motivations which influence contraceptive use and sexual risk-taking amongst seasonal workers, identifies the contraceptive and sexual health needs of these workers, and discusses the difficulties workers experienced in meeting these needs while at a holiday centre.

Migrant labor takes a holiday. Reworking modernity and marginality in contemporary Thailand

This paper examines the practice of working-class group excursions in Thailand, organized by and for rural labor migrants in Bangkok. These trips involve traditional forms of Buddhist ceremonial as well as more self-consciously "modern" sightseeing activities in distant regions of the country. More than just a welcome respite from the drudgery and discipline of factory jobs, these excursions allow labor migrants to make important claims about their experiences as members of the Thai nation-state. As tourist-consumers, migrant workers appropriate powerful signs and symbols of modern Thai identity and status, in doing so they contest (and at least partly rework) their material and ideological marginalization within contemporary Thai society.

Underlying reasons for sexual conduct and condom use among expatriates posted in AIDS endemic areas

Among people who work abroad, sexual activity and therefore the risk of HIV infection appear to be relatively high. Little is known about the factors that influence sexual conduct when staying abroad, separated from their usual social environment. This is why 55 expatriates who had been sexually active in AIDS endemic areas were selected for an in-depth interview from the original sample of 864 Dutch expatriates participating in a study on sexual behaviour and HIV infection. The social and cultural context in which the sexual contacts took place was addressed in these interviews. Qualitative analysis of the data led to the identification of four styles with regard to the meaning of and motivations for having sex abroad: 'the unprepared', 'the fanatical', 'the unaffected' and 'the slightly accessible'. These styles are described separately and attention is paid to the association of these styles with protection behavior.

"An empire lost but a province gained": a cohort analysis of British international retirement in the Algarve

"The growth of international retirement in the Algarve has coincided with a number of changes in the international framework for population mobility as well as in the nature of the Algarve [Portugal] as a destination area. Tourism development, which is intimately linked to subsequent retirement migration, is particularly important in this. This paper considers the nature of the link between cycles of migration and of development in recipient areas, in the context of the remarkable and relatively late development of the Algarve as an area of tourism and retirement.... Cohort analysis...provides the basis for an examination of changes over time in the socio-demographic profiles of the migrants, their motivations, their residential patterns and their integration."

The sexual health of travelers

Sex and travel do not infrequently coincide as pleasurable occupations. This articles explores the possible risks of unsafe sexual activity in a travel-related context, gives guidelines on how to decrease risks for both partners, and outlines how to manage the exposed or infected traveler on his or her return home. Both sexually transmitted infections and contraception are covered.

Sexual networks in Uganda: mixing patterns between a trading town, its rural hinterland and a nearby fishing village

The study was based in south-west Uganda where significant differences in HIV prevalence have been found between urban and rural areas. Longitudinal data collected in a diary format was used to determine the extent to which high-risk men and women living in a truck stop/trading town had sexual contact with people from surrounding rural areas and a nearby fishing village. Study participants were 143 men, 75 of whom were resident in the town, 40 in a fishing village and 28 in rural areas, and 81 women, of whom 47 were resident in the town, 25 in the fishing village and 9 in a rural area. During 1687 man weeks the 143 men made 3149 trips and had 5189 sexual contacts. Ninety-two per cent of these sexual contacts occurred in the man's current place of residence and 21% were with a new partner. The 81 women participated for 1280 women weeks during which they recorded 6378 sexual contacts. Women who lived in the fishing village and the rural area had around 90% of their contacts with local men while those who lived in the town fell into 3 categories: women who charged a relatively high price for commercial sex had only 11% of contacts with men living in the town, while those who charged a tenth of the price had 71% of contacts with town men. The small number of women who fell into an intermediate category, in terms of price, had sexual contact with a wide variety of men. These findings show that there is little scope for HIV infection to spread between different residential or occupational groups. This may help to explain how large differences in HIV seropositivity between neighbouring localities can be maintained for long periods, despite considerable social and economic mixing between groups and high levels of sexual partner change within groups.

Sexual risk of HIV infection among expatriates posted in AIDS endemic areas

OBJECTIVE

To assess the prevalence of HIV infection and related risk factors among Dutch expatriates returning from assignment in sub-Saharan Africa, Latin America, and South and South-east Asia.

METHODS

From July 1994 to January 1996, a questionnaire on the risks of sexual exposure was completed by 864 respondents, and blood samples were taken.

RESULTS

Of the 634 men, 41% reported having sex with casual or steady local partners and 11% with casual or steady expatriate partners, during an average stay of 26 months in the previous 3 years. Of the 230 women, these figures were 31 and 24%, respectively. Of the men with local casual partners (29%), 59% paid for sex at least once. For men as well as women, having sexual contacts abroad was associated with younger age, positive intention prior to departure to have sex abroad, being single at departure, and, only for the men, working for a commercial organization, and feelings of loneliness and boredom. Among men, consistent condom use with casual local partners was 69%, and with casual expatriate partners 63%. Among women, these figures were 64 and 48%, respectively. Consistent condom use with steady local or expatriate partners was much lower. Among men, non-consistent condom use with casual partners was more prevalent if they had been abroad for a longer time, condoms were not taken along from The Netherlands, the country where they were posted was Asian, and the estimated HIV prevalence among the local population was lower. Among the women, non-consistent condom use was more prevalent if condoms were not taken along, and if they did not have the intention before departure to have sex abroad. Of the persons from whom blood could be obtained, one man was HIV-positive. Another man who refused to participate in the study indicated that he was HIV-positive.

CONCLUSIONS

Although 23% of the expatriates had unprotected sex with partners from endemic areas, very few HIV infections were found. In comparison with a previous study among this population carried out in 1987-1989, which found five out of 1968 expatriates to be HIV-infected, consistent condom use with casual local partners did increase considerably (from 21 to 67%). However, health education is needed to reduce the risk of HIV infection, which should emphasize the sociocultural differences in sexual practices.

Schistosomiasis in Lake Malawi

BACKGROUND

In 1992 two US Peace Corps volunteers (PCVs) developed central nervous system schistosomiasis due to infection with Schistosoma haematobium following recreational water exposure at Cape Maclear on Lake Malawi, an African lake considered by many to be free of schistosomiasis. To determine the transmission potential and risk for aquiring schistosomiasis in Lake Malawi, a cross-sectional survey of resident expatriates and visitors to Malawi was done during March and April, 1993.

METHODS

A volunteer cohort of expatriates and visitors representing a cross-section of Malawi's foregn population answered detailed questions about freshwater contact and provided blood specimens to determine the seroprevalence of S haematobium and S mansoni by ELISA and immunoblot analyses. A survey for vector snails was conducted along Lake Malawi's southwestern shore.

FINDINGS

The study population of 955 included 305 US citizens and 650 non-US foreign nationals. 303 of the study population had serological evidence of current or past schistosome infection. Seroprevalence was 32% (141/440) among expatriates whose freshwater exposure was limited to Lake Malawi; S haematobium antibodies were found in 135 of 141 (96%) seropositive specimens. Risk of seropositivity increased with the number of freshwater exposures at Lake Malawi resorts. Although many resort areas in the southwestern lake region posed a significant risk, Cape Maclear was the location most strongly associated with seropositivity (OR 2.9, 95% Cl 1.6-5.1). Schistosome-infected Bulinus globosus, the snail vector of S haematobium in Malawi, were found at Cape Maclear and other locations along the lakeshore.

INTERPRETATION

S haematobium infection is highly prevalent among expatriates and tourists in Malawi. Recreational water contact at popular resorts on Lake Malawi is the most likely source of infection. Transmission of schistosomiasis is occurring in Lake Malawi, a previously under-recognised site of transmission.

Seroprevalence survey of Egyptian tourism workers for hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and Treponema pallidum infections: association of hepatitis C virus infections with specific regions of Egypt

Blood samples from 740 Egyptian Nationals working in the tourism industry at two sites in the South Sinai governorate were screened for markers of infection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum. Study subjects included 467 individuals from a rural seashore tourist village and 273 persons at two hotels in a well-established resort town. Subjects' ages ranged from 15 to 70 years; 99.3% were male. The prevalence of serologic markers for currently asymptomatic or past HBV infection alone was 20.7% (n = 153), of markers for past or chronic HCV infection alone was 7.4% (n = 55), and of markers for both HBV and HCV was 6.9% (n = 51). Of the 204 individuals positive for anti-HBV core antibody, 12 (5.9%) were also positive for hepatitis B surface antigen. Two individuals (0.3%) had a serologic market suggestive of an active syphilitic infection. No subject was found to be HIV-seropositive. History of prior injections and number of injections were associated with infection with HCV. Primary residence in the Nile delta and valley areas where schistosomiasis is highly endemic, was also a statistically significant risk factor for HCV, but not HBV infection.

Movement patterns of persons with HIV receiving treatment in public clinics in the Southern Health Region, Puerto Rico

Health planners suspect there is a pattern of movement, dubbed the "air bridge," between Puerto Rico and the continental United States by persons living with human immunodeficiency virus (HIV) who are seeking health services. The authors tested this hypothesis in publicly supported HlVclinics in the Puerto Rican Southern Health Region (SHR). A survey was conducted of 187 patients who were at least 18 years of age, confirmed HIV positive, and not incarcerated. Only 7% of the respondents had been outside the SHR for 2 weeks or more in the past year. Intravenous drug users and men who have sex with men were 7 to 8 times more likely to have traveled than were heterosexual respondents. Fifty-seven percent of all movement was within Puerto Rico, and no one had traveled to the United States primarily to receive medical services. Thus the results of this study do not support the concept of an "air bridge. "

AIDS in rural Africa: a paradigm for HIV-1 prevention

Networks of concurrent sexual partnerships may be the primary cause of epidemic spread of HIV-1 in parts of sub-Saharan Africa. This pattern of sexual behaviour increases the likelihood that individuals experiencing primary HIV-1 infection transmit the virus to other persons. Networks of concurrent partnerships are likely to be important in both the early ('epidemic') and late ('endemic') phases of HIV-1 transmission. Interventions should aim to break the sexual networks, whatever the stage of the epidemic. However, prevention of transmission in the endemic phase also requires a greater awareness of early clinical manifestations of HIV-1 infection in the general population. Such awareness, coupled with the availability of condoms and access to HIV-1 testing facilities, may reduce transmission in discordant couples.

A study of the demographic characteristics of domestic tourists

"A sample survey was conducted [in China]: more than 6,000 questionnaires were submitted and retrieved from domestic tourists in Shanghai, Xi'ian, Huangshan, and Huashan in order to provide data for demographic analysis of the special fluid population of tourists. The paper looks at the relationship between tourists' gender, age, income, occupation, education, and family structure, as well as their tourist activity, selection of destinations, shopping, and other tourist behaviors."

Epidemic cholera in Latin America: spread and routes of transmission

In the most recent epidemic of cholera in Latin America, nearly a million cases were reported and almost 9000 people died between January 1991 and December 1993. The epidemic spread rapidly from country to country, affecting in three years all the countries of Latin America except Uruguay and the Caribbean. Case-control studies carried out in Peru showed a significant association between drinking water and risk of disease. Cholera was associated with the consumption of unwashed fruit and vegetables, with eating food from street vendors and with contaminated crabmeat transported in travellers' luggage. This article documents the spread of the epidemic and its routes of transmission and discusses whether the introduction of the epidemic to Peru and its subsequent spread throughout the continent could have been prevented.

AIDS knowledge, risk behaviors, and factors related to condom use among male commercial sex workers and male tourist clients in Bali, Indonesia

OBJECTIVES

To describe the AIDS/sexually transmitted diseases (STD) knowledge and risk behaviors, and to determine factors related to condom use among male commercial sex workers (CSW) and male tourist clients in Bali, Indonesia.

DESIGN

Individual survey interviews were conducted with a sample of 80 male CSW and 100 tourist clients in the Kuta area of Bali.

METHODS

Survey interviews included detailed questions on AIDS/STD knowledge, sexual behavior, and psychosocial measures related to risk taking.

RESULTS

Most of the male CSW had heard about AIDS and other STD, although some misconceptions about transmission and risks of different sexual practices remained. Both oral and anal intercourse with tourists were common and condom use was far from consistent. Factors related to condom use for anal intercourse with tourist clients were condom beliefs, self efficacy, susceptibility to STD infection, and STD knowledge. Tourist clients were mainly from Australia and Europe and many had paid for sex in other parts of Indonesia as well as in high prevalence countries. Knowledge of AIDS/STD was very good among the tourists and previous experience with STD was common. Factors related to condom use with male CSW were condom beliefs and self efficacy.

CONCLUSION

There is a very active and mobile group of male CSW and tourist clients present in Bali. Interventions with these men are needed due to the low level of knowledge about AIDS among CSW, their experience with STD and STD symptoms, and their level of risky sexual behavior.

HIV risk behavior among Peace Corps Volunteers

OBJECTIVE

To describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors.

METHOD

Cross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention.

RESULTS

Non-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use.

CONCLUSION

These data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

HIV and STD prevalence among bus and truck drivers in Cameroon

It is generally accepted that transport workers will have a higher level of seroprevalence than the general population--and that their employment means that they are at greater risk. There have been a few studies on this, primarily in east Africa. Among the studies reported in Yokohama was a 1993 survey of 128 truck drivers in Douala and 40 bus drivers in Ekok (on the Cameroon-Nigerian border). The survey found that drivers (whose mean age was 24.5 years) spent an average 14 days away from home on each trip. As might be expected there was a high incidence of seeking partners away from home, 62% had sex during the trip and 25% had sex every night they were away. The main partners were commercial sex workers, followed by girl friends. Drivers had high levels of STDs. 50% had had gonorrhea during the past six months, while 16% had had syphilis. As might be expected, the level of HIV prevalence were also high. 15% of drivers tested positive, the third highest prevalence in the country after commercial sex workers (35%) and prisoners (17%). The conclusion was that special prevention messages should be designed for drivers. The first need is to see the groups as a target who need to change their behavior, the second is to look at the determinants of this behavior and to seek to change the environment in which the drivers operate. For example, can the trips be shorter? Could drivers be encouraged to take partners with them? There is a need to move beyond the simple measuring of prevalence and identifying of the "risk groups" to looking at the socioeconomic setting in which they operate.

Worldwide pattern of mortality from motor vehicle accidents, 1950-1990

Trends in age-specific and age-standardized death certification rates from motor vehicle accidents over the period 1950-1990 were analyzed for 48 countries from four continents (2 from North America, 10 from Latin America, 8 from Asia, 26 from Europe, Australia and New Zealand) on the basis of data produced by the World Health Organization mortality database. In most developed western and Asiatic countries, mortality rates increased until the late 1960's or early 1970's, and declined thereafter to reach values often lower than those of the early 1950's, although the number of circulating vehicles has substantially increased over the same calendar period. The extent of the decline was, however, different in various countries, as well as in the two sexes and in various age groups, thus leading to complex cohort and period patterns. In general, countries (like the U.S.A. or U.K.), where the number of motor vehicles had increased earlier, have now comparatively higher rates at younger than at middle and older age, while the opposite is observed in countries with later spread of motor vehicles. Further, there were a few countries, including Kuwait, Venezuela and several other Latin American countries, Australia and New Zealand, and several southern and eastern European countries, with exceedingly high rates from motor vehicle accidents, and where comprehensive interventions on this important cause of death are therefore a public health priority.

Disseminated Penicillium marneffei infection as an imported disease in HIV-1 infected patients. Description of two cases and a review of the literature

Two cases of disseminated Penicillium marneffei infection, as an imported disease, in HIV-1-infected patients with a severe immunodeficiency are reported. These patients had a history of travel in Southeast Asia where P. marneffei is endemic. Fever, cough, malaise, hepatosplenomegaly, anaemia, skin lesions and mucosal ulcers are the main clinical characteristics. Differentiation from histoplasmosis and leishmaniasis might be difficult. Treatment with amphotericin B was successful. Anti-fungal maintenance therapy is most likely indicated.

Status of imported malaria in a control zone of the United Arab Emirates bordering an area of unstable malaria

A concerted malaria eradication programme in the United Arab Emirates has reduced local transmission to only a very few small foci in the country. The Al Ain district is now a consolidation zone. However, transmission across the undemarcated border with Oman continues. Malaria imported by the large immigrant work force from major disease endemic areas remains a large burden. An added threat is the appearance of chloroquine-resistant Plasmodium falciparum principally from Sudan and Pakistan but increasingly amongst Omani cases seen in the hospitals and clinics in Al Ain. The implications of re-introduction of malaria and the establishment of chloroquine resistance, particularly for non-immune residents and visitors, are emphasized.

Planned sexual behaviour of young Australian visitors to Thailand

OBJECTIVE

To research the knowledge of AIDS and other sexually transmitted diseases among young Australian tourists to Thailand, and their intended sexual behaviour.

DESIGN AND SETTING

A cross-sectional survey by anonymous, self-administered questionnaire, of persons seeking pre-travel medical advice in private clinics in five Australian cities.

PARTICIPANTS

213 consecutive patients travelling to Thailand without a spouse or partner.

RESULTS

Only 34% of the sample reported a definite intention not to have sex in Thailand. Regarding choice of potential partners: 24.5% more men than women said they would have sex with a Thai national; 13.7% of men said they would have sex with a "bar girl"; and 21.7% more women than men said they would choose a fellow Australian traveller. Eighty-two per cent of the sample reported that they would use condoms 100% of the time, and there was no significant difference between the number of men and women who expressed this intention.

CONCLUSIONS

Although not obviously "sex tourists", many young Australian travellers are likely to have sex while visiting Thailand. These data have important implications for education and prevention programs to control the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases.

Travel, migration and HIV

This is a review of recent publications on the subject of travel (taken in its widest sense) and HIV/AIDS. As with all epidemics caused by transmissible pathogens, AIDS has been seen in many countries as an imported problem. What this perspective fails to recognize is that with the explosion of international travel in the past thirty years it is virtually impossible to prevent the spread of infectious disease across international frontiers. Here we highlight the relative paucity of studies that describe or investigate the context in which sexual risk behaviour of travellers takes place, and suggest areas of further research which could increase understanding of the nature of sexual risk taking, and help in the design of health education programmes.

A history of sexually transmitted diseases in Thailand: policy and politics

This paper provides a brief history of sexually transmitted diseases (STDs) in Thailand. The presentation is divided into three main sections: the period up to the 1930s; the period from the 1930s until the end of the early 1980s; and the period from the early 1980s until the present, the so-called 'AIDS Era'. The discussion in each of these sections focuses, as far as sources permit, on the epidemiological picture, as well as describing public and official responses to these diseases. In the final part of the paper consideration is given to these findings in relation to the present situation in Thailand regarding the HIV/AIDS epidemic.

STDs and the overseas traveller

Although most HIV and STD patients acquire their infections in Australia there is an increase in the numbers diagnosed with these infections after international travel. Risks to the sexual health of the travellers and their subsequent partners are discussed and suggestions made for minimising risks.

The cost of the district hospital: a case study in Malawi

Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed.