Whether or not sex is the purpose of a trip, sex with a new partner is common during travel of any length. An estimated 5%–50% 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 the high prevalence of HIV and STDs in some other countries. For example, antibiotic-resistant gonorrhea has been considered a public health threat since it was first identified internationally.
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 low quality, stored improperly, or past their expiration date are more likely to break. Clinicians seeing travelers at high risk for acquiring HIV infection should consider discussing preexposure prophylaxis with them (see www.cdc.gov/hiv/prep and HIV section in this chapter).
All people who have sex with a new partner should consult a clinician 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 3-5 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 common among commercial sex workers. Also, sex tourism helps to support sex trafficking, among 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 report tips anonymously by using the Operation Predator smartphone app (https://itunes.apple.com/us/app/operation-predator/id695130859?mt=8), calling the Immigration and Customs Enforcement hotline toll-free at 866-347-2423, or submitting the information online at www.ice.gov/tips. 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). At least 8,000 Americans have been arrested for child sex exploitation and 99 Americans have been convicted for child sex tourism since 2003, when the federal 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), Eastern Europe (Estonia, Latvia, 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 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 tests for HIV and treatable STDs. Be aware of STD symptoms in case any develop.
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.
Condoms, used consistently and correctly, can decrease the risk of HIV and STDs.
If indicated, be prepared to start taking medications for HIV postexposure prophylaxis 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, get recommended tests for HIV and treatable STDs.
Abdullah AS, Ebrahim SH, Fielding R, Morisky DE. Sexually transmitted infections in travelers: implications for prevention and control. Clin Infect Dis. 2004 Aug 15;39(4):533–8.
Marrazzo JM. Sexual tourism: implications for travelers and the destination culture. Infect Dis Clin North Am. 2005 Mar;19(1):103–20.
Newman WJ, Holt BW, Rabun JS, Phillips G, Scott CL. Child sex tourism: extending the borders of sexual offender legislation. Int J Law Psychiatry. 2011 Mar–Apr;34(2):116–21.
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.
Perspectives sections are written as editorial discussions aiming to add depth and clinical perspective to the official recommendations contained in the book. The views and opinions expressed in this section are those of the author and do not necessarily represent the official position of CDC.