Chapter 3Infectious Diseases Related To Travel

Emilia H. Koumans

SEX DURING INTERNATIONAL TRAVEL

Two studies in sexually transmitted disease (STD) clinics found that 20%–42% of international travelers had sex with a new partner during travel. STDs, including HIV, are a risk worldwide, not only in local people but also in fellow travelers. However, official data on the prevalence of STDs are often unknown, and many travelers may be unaware of the risks.

SEX TOURISM

“Sex tourism” has been defined as travel specifically planned to procure sex. However, travelers may solicit or engage in sex during travel whether or not this was the intended purpose of the trip. In certain destinations, travelers may find that sex workers are readily available and culturally acceptable, lowering the threshold for purchasing sexual encounters. Alcohol, drugs, and the encouragement of friends may lead to encounters that the traveler may later regret.

SEXUAL EXPLOITATION

While commercial sex work is legal in some countries, child prostitution is universally illegal. The International Labor Organization works globally with governmental and nongovernmental partners to reduce child exploitation. Sex with a minor may be prosecuted in the United States, even if the behavior occurred while abroad.

PRE-TRAVEL INFORMATION

Regardless of whether or not sex is purchased, sex with a new partner during travel places the traveler at risk for an STD, including HIV. All travelers should be counseled before travel on risks and prevention of STDs and be given information on the illegality of child prostitution. Travelers may also benefit from the following information about child prostitution:

• Report suspected commercial child sexual exploitation in tourist destinations to the authorities abroad or to the Department of Homeland Security’s Immigration and Customs Enforcement. If travelers have information regarding a person who has sexually exploited a child or suspect someone of child sex tourism, they can e-mail the Immigration and Customs Enforcement (ICE) Operation Predator (operation.predator@DHS.gov) or call the ICE hotline: 866-347-2423.
• Federal law prohibits adult US residents and citizens from engaging in sexual acts with people aged <18 outside the United States (18 USC 2423). Travelers should be aware that any US citizen or permanent legal resident arrested in a foreign country for sexually abusing minors may be subject to return to the United States and, if convicted, can face up to 30 years in prison.
• Governmental and nongovernmental organizations are working to protect children from commercial sexual exploitation.
• If immediate assistance is needed, contact the regional security officer at the local American embassy or consulate or foreign law enforcement officials.

BIBLIOGRAPHY

1. Carter S, Horn K, Hart G, Dunbar M, Scoular A, MacIntyre S. The sexual behaviour of international travellers at two Glasgow GUM clinics. Glasgow genitourinary medicine. Int J STD AIDS. 1997 May;8(5):336–8.
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3. Hawkes S, Hart GJ, Bletsoe E, Shergold C, Johnson AM. Risk behaviour and STD acquisition in genitourinary clinic attenders who have travelled. Genitourin Med. 1995 Dec;71(6):351–4.
4. International Labour Organization, International Programme on the Elimination of Child Labour. Commercial sexual exploitation of children. Geneva: International Labour Organization; 2010 [cited 2008 Nov 20]. Available from: http://www.ilo.org/ipec/areas/CSEC/lang--en/index.htm.
5. Marrazzo JM. Sexual tourism: implications for travelers and the destination culture. Infect Dis Clin North Am. 2005 Mar;19(1):103–20.
6. Pan American Health Organization. Trafficking of Women and Children for Sexual Exploitation in the Americas. Washington DC: Women, Health and Development Program. Pan American Health Organization; 2001 [cited 2008 Nov 30]. Available from: http://www.paho.org/English/AD/GE/TraffickingPaper.pdf.
7. US Department of Justice. Child sex tourism. Washington, DC: US Department of Justice. Available from: http://www.usdoj.gov/criminal/ceos/sextour.html.
8. US Department of State. Office to monitor and combat trafficking in persons. Washington, DC: US Department of State. Available from: http://www.state.gov/g/tip/.