Chapter 3Infectious Diseases Related To Travel
Perspectives: Sex & Tourism
TRAVEL AND SEXUAL HEALTH
Whether or not sex is the purpose of a trip, sex with a new partner is common during travel. An estimated 20% of international travelers have sex with a new partner while abroad, and the risk of developing a sexually transmitted disease (STD) may be up to 3 times higher in people who experience casual travel sex. Travelers may be unaware of local information about the high prevalence of HIV and STDs in certain countries. In addition, alcohol or drugs used during travel may lower the threshold for sexual encounters.
The mainstays of sexually transmitted infection prevention (condoms and vaccinations against hepatitis A, hepatitis B, and human papillomavirus), contraception, and other prescription medications may not be subject to US quality control standards in manufacturing, storage, or distribution when obtained in other countries. Condoms that are past their expiration date or that have been stored at extreme temperatures may be less effective at reducing the risk of HIV and STD transmission. Clinicians seeing travelers at high risk for acquiring HIV infection (particularly men who have sex with men) should consider discussing preexposure prophylaxis with them (see www.cdc.gov/HIV/PREP).
All people who have sex with a new partner should consult a physician about recommended screening tests to check for HIV and treatable STDs. Travelers should also be alert to attempts at coercion or fraud from previously unknown partners professing romantic interest, especially in relationships beginning exclusively online. People who have experienced a high-risk sexual encounter should consider taking medications for postexposure prophylaxis of HIV or unintended pregnancy within 72 hours. These and other prescription medications can be costly or difficult to obtain overseas, but US consular officers may be able to assist in locating needed medical services. See Box 3-05 for a summary of sexual health recommendations for travelers.
“Sex tourism” has been defined as travel planned specifically to procure sex. Sex tourism commonly involves male tourists traveling to economically disadvantaged countries to pay for sex with female sex workers. In certain regions, commercial sex work is legal and culturally acceptable. However, travelers should be aware that HIV and STD infections are more common among commercial sex workers. Also, sex tourism helps to support sex trafficking, one of the largest criminal industries in the world, in which victims are forced to perform sex work. Travelers should be familiar with applicable US and local laws and should report known or suspected violations promptly to the authorities. The regional security officer at the local US embassy or foreign law enforcement officials can assist.
SEXUAL ABUSE AND THE LAW
Although commercial sex work may be legal in some countries, sex trafficking, sex with a minor, and child pornography are always criminal activities according to US law and can be prosecuted in the United States even if the behavior occurred abroad. The Trafficking Victims Protection Act makes it illegal to recruit, entice, or obtain a person of any age to engage in commercial sex acts or to benefit from such activities. Federal law also bars US residents from engaging in sexual or pornographic activities with a child aged <18 years anywhere in the world, regardless of local age of consent, or to travel abroad for the purpose of having sex with a minor. In addition, child pornography, including sexual photographs or videos of minors in foreign countries, is illegal in the United States. These crimes are subject to prosecution with penalties of up to 30 years in prison.
Nearly 2 million children around the world are victims of commercial sexual exploitation, and roughly 1 million children are victims of trafficking. Children abused by sex tourists suffer not only sexual abuse but also poverty, homelessness, and physical, emotional, and psychological abuse, as well as health problems including illnesses, addictions, malnourishment, infections, physical injuries, and STDs.
If you suspect child sexual exploitation occurring overseas, you can call the Immigration and Customs Enforcement hotline toll-free at 866-347-2423 or submit the information online at www.ice.gov/exec/forms/hsi-tips/tips.asp. In the United States, the National Center for Missing & Exploited Children’s Cybertipline collects reports of child prostitution and other crimes against children (toll-free at 800-843-5678, www.cybertipline.com), and 655 incidents of child sex tourism were reported in 2007. At least 669 Americans have been arrested for child pornography and 67 Americans have been arrested for child sex tourism since 2003, when the PROTECT Act was passed to strengthen the US government’s prosecution of crimes related to sex tourism.
Americans and US permanent residents account for an estimated 25% of child sex tourists worldwide and up to 80% in Latin America. These are typically Caucasian men aged ≥40 and have been traced visiting Mexico, Central and South America (Brazil, Colombia, Costa Rica, Dominican Republic), Southeast Asia (Cambodia, India, Laos, Philippines, Thailand), and sometimes Eastern Europe (Lithuania, Russia) and other regions.
To combat child sexual abuse, some international hotels and other tourism services have voluntarily adopted a code of conduct that includes training and reporting suspicious activities. Tourist establishments supporting this initiative to protect children from sex tourism are listed online (www.thecode.org). For more ways you can help, see the US Department of State list of 20 ways to fight human trafficking (www.state.gov/j/tip/id/help).
Box 3-05. Summary of sexual health recommendations for travelers
- Obtain recommended vaccinations, including those that protect against sexually transmitted infections.
- Get recommended screening tests for HIV and treatable STDs.
- Pack sufficient quantities of needed prescription medications and supplies. Check condom expiration dates.
- Review local laws and contact information for medical and law enforcement services.
- Use good judgment in choosing consensual adult sex partners.
- Latex condoms, when used consistently and correctly, can decrease the risk of HIV and STD transmission.
- If indicated, be prepared to start taking medications for postexposure prophylaxis of HIV or unintended pregnancy within 72 hours after a high-risk sexual encounter.
- Never engage in sex with a minor (<18 years old), child pornography, or trafficking activities, in any country.
- Report suspicious activity to US and local authorities as soon as it occurs.
- To avoid exposing sex partners at home to STDs, get recommended screening tests for HIV and treatable STDs.
- CDC. Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011 Jan 28;60(3):65–8.
- International Labour Organization, International Programme on the Elimination of Child Labour. Every child counts: new global estimates on child labour. Geneva: International Labour Organization; 2002 [cited 2012 Sep 21]. Available from: http://www.ilo.org/ipecinfo/product/download.do?type=document&id=742.
- Marrazzo JM. Sexual tourism: implications for travelers and the destination culture. Infect Dis Clin North Am. 2005 Mar;19(1):103–20.
- 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 2012 Sep 21]. Available from: http://www.paho.org/English/AD/GE/TraffickingPaper.pdf.
- Public Health Agency of Canada, Committee to Advise on Tropical Medicine and Travel (CATMAT). Statement on travellers and sexually transmitted infections. Canada Communicable Disease Report [Internet]. 2006 [cited 2012 Sep 21];32(ACS-5). Available from: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/acs-05/.
- Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the US Department of Health and Human Services. MMWR Recomm Rep. 2005 Jan 21;54(RR-2):1–20.
- United Nations Children’s Fund (UNICEF). The state of the world’s children 2012: children in an urban world. New York: United Nations Children’s Fund (UNICEF); 2012 [cited 2012 Sep 21]. Available from: http://www.unicef.org/sowc/files/SOWC_2012-Main_Report_EN_21Dec2011.pdf.
- US Department of Health and Human Services, Administration for Children and Families. Rescue and restore campaign fact sheets. Washington, DC: Administration for Children and Families; 2012 [cited 2012 Sep 21]. Available from: http://www.acf.hhs.gov/trafficking/about/factsheets.html.
- US Department of Homeland Security, Immigration and Customs Enforcement. Fact sheet: operation predator—targeting child exploitation and sexual crimes. Washington, DC: Immigration and Customs Enforcement; 2012 [cited 2012 Sep 21]. Available from: http://www.ice.gov/news/library/factsheets/predator.htm.
- US Department of Justice. The national strategy for child exploitation prevention and interdiction: a report to Congress. Washington, DC: US Department of Justice; 2010 [cited 2012 Sep 21]. Available from: http://www.justice.gov/psc/docs/natstrategyreport.pdf.
- US Department of State. Internet dating and romance scams. Washington, DC: US Department of State; 2012 [cited 2012 Sep 21]. Available from: http://travel.state.gov/travel/cis_pa_tw/financial_scams/financial_scams_4554.html.
- Vivancos R, Abubakar I, Hunter PR. Foreign travel, casual sex, and sexually transmitted infections: systematic review and meta-analysis. Int J Infect Dis. 2010 Oct;14(10):e842–51.
- Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1–110.
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