Purpose
Introduction
Travel is often accompanied by the desire for new social interactions and experiences. Loss of inhibition associated with being away from home can lead some travelers to take sexual and behavioral risks. These behaviors can involve sex with new, unknown, or multiple partners. Use of alcohol or drugs (which further decrease inhibition) and geosocial networking applications ("apps," which increase the efficiency of meeting sexual partners) can amplify a traveler's chances of having risky exposures. Educating travelers regarding risks of condomless sex or unplanned sexual encounters is critical to prevent sexual assault, unintended pregnancy, and exposure to sexually transmitted infections (STIs, including those that are drug-resistant), HIV infection, and emerging infectious diseases, such as mpox.
Healthcare professionals have an opportunity to help patients reduce their risk for STIs, HIV infection, and unintended pregnancy through pre-travel risk-reduction counseling and medical interventions. The pre-travel consultation also gives healthcare professionals a chance to review safety recommendations to prevent sexual assault during travel (see The Pre-Travel Consultation chapter).
Clinical interventions to reduce sexual risk during travel
Medical interventions and behavioral counseling to reduce risk of STIs and unintended pregnancy are essential for travelers planning to engage in sex. Recommended elements of a pre-travel clinical encounter can include: STI and HIV prevention guidance, such as the use of condoms or other barrier methods; STI and HIV pre- and post-exposure prophylaxis discussion; options for contraception (including emergency contraception); and vaccination (Box 8.8.1). Tailored prevention interventions and counseling should be guided by a thorough sexual and substance use history to understand the traveler's potential risks during travel and at the destination (Box 8.8.2). For example, travelers planning to engage in sexual activity can be screened or referred for pre-travel STI or HIV testing and treatment. Available vaccines for prevention of viral infections transmitted through sexual contact (e.g., hepatitis A vaccine, hepatitis B vaccine, human papillomavirus vaccine, mpox vaccine) should be considered based on patient demographics (e.g., age, sex), sexual behavioral risk, and prior vaccination history (more information available at the CDC websites found in Box 8.8.3).
Box 8.8.1
Box 8.8.2
Box 8.8.3
Notes
1Vaccines require multiple doses prior to initiating travel to confer full protection (see Vaccination and Immunoprophylaxis—General Principles and Hepatitis A chapters).
Healthcare professionals should consider providing pre-exposure prophylaxis (PrEP) to prevent HIV infection in travelers planning to have condomless sex. PrEP is a highly effective method to prevent HIV acquisition among people without HIV who are at risk of being exposed. There are 3 available medications for use as HIV PrEP (Table 8.8.1). Two oral options each consist of 2 drugs combined in a single oral tablet taken daily. Oral PrEP can also be used on demand, which is also known as "event driven" PrEP or 2-1-1 (2 pills 2–24 hours before sex, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose). This approach has been studied among men who have sex with men (MSM) but, as of February 2025, is not approved by the U.S. Food and Drug Administration or recommended by the Centers for Disease Control and Prevention (CDC). More information regarding on-demand PrEP can be found on CDC's website. The third option is cabotegravir 600 mg given by intramuscular injection. After the initial injection, a second injection should be given at 1 month and then every 2 months thereafter. When initiating daily oral PrEP or injectable PrEP, patients should be advised to abstain from sex or use barrier methods for the first 7 days of therapy because protection is not immediate.
Table 8.8.1: Medication options for HIV and sexually transmitted infection pre- and post-exposure prophylaxis
| HIV pre-exposure prophylaxis (PrEP) | Option 1
Tenofovir disoproxil fumarate/emtricitabine1 300/200 mg One oral tablet daily |
|---|---|
| Option 2
Tenofovir alafenamide/emtricitabine2 25/200mg One oral tablet daily |
|
| Option 3
Cabotegravir3 600 mg intramuscularly After the initial injection, a second injection should be given at 1 month, and then every 2 months thereafter |
|
| HIV post-exposure prophylaxis (PEP) | Tenofovir disoproxil fumarate/emtricitabine1 300/200 mg
PLUS Dolutegravir 50 mg Within 72 hours of an exposure One tablet of each orally daily × 28 days4 |
| STI post-exposure prophylaxis (PEP or DoxyPEP) | Doxycycline 200 mg orally
Within 72 hours of condomless sex for eligible populations5 |
Notes
1Brand name Truvada; also referred to as TDF/FTC or F/TDF; available in a generic formulation.
2Brand name Descovy; also referred to as TAF/FTC or F/TAF.
3Brand name Apretude; also referred to as CAB.
4Some providers use tenofovir alafenamide/emtricitabine (TAF/FTC) 25/200 mg plus bictegravir 50 mg, available as a combined tablet (brand name, Biktarvy).
5Eligible populations are described in the 2024 CDC Doxy PEP guidelines.
People already taking HIV PrEP should continue its use during international travel. Travelers taking PrEP should be aware that some countries deny entry to people with evidence of HIV infection (see Travelers with HIV chapter). Because PrEP medications are also used for treatment of HIV, these medications in their labeled packaging might be misconstrued by customs officials as indicating the traveler has HIV infection.
Post-exposure prophylaxis (PEP) with antiretroviral medications can also prevent HIV infection. HIV PEP should be offered as a prevention method following a single high-risk exposure to HIV during sex, sharing needles or syringes, a needlestick, or following sexual assault. To be effective, HIV PEP must be started within 72 hours of an exposure for eligible persons (see Table 8.8.1 for regimens). Regimens are prescribed for 28 days. HIV testing is recommended prior to initiation and after completion of treatment.
The use of doxycycline post-exposure prophylaxis (Doxy-PEP) to prevent gonorrhea, chlamydia, and syphilis has demonstrated efficacy and tolerability against these common STIs, reducing syphilis and chlamydia by >70% and gonorrhea by approximately 50% in specific populations. CDC Guidelines state that doxycycline 200 mg administered within 72 hours of condomless sex is recommended for specific populations of patients with HIV or those taking HIV PrEP or populations who have had a history of a bacterial STI in the past 12 months. Healthcare professionals should continue to screen, test, and treat for bacterial STIs in accordance with CDC's STI Treatment Guidelines and CDC's PrEP for the Prevention of HIV guidelines among people who may be using doxycycline as STI PEP or who use HIV PrEP.
Foundational to pre-travel counseling for STI and HIV prevention is education on the behavioral risks of condomless sex during travel. STI incidence is increased up to 3-fold in people who experience casual sex while traveling internationally, a consequence of new sexual partnerships and unprotected intercourse. Condoms prevent STIs, HIV, and unintended pregnancy. Travelers should consider packing condoms from their home country to avoid the need to search for them in countries visited during travel. Condoms in luggage may need to be concealed to avoid questions related to sexual activity or assumed behaviors.
Upon return, patients who have engaged in sexual activity during travel should be asked about condomless sexual encounters, sexual partners, region of travel, clinical symptoms, and anatomic sites of sexual exposure. STI and HIV testing should be offered based on reported history of exposure as appropriate. HIV RNA nucleic acid amplification testing is the preferred method for diagnosing acute HIV in a person presenting with symptoms of acute retroviral syndrome.
Table 8.8.2: Pathogens associated with sexual transmission
| Bacteria | ||
|---|---|---|
| Pathogen and Type | Manifestations and Sequelae | Special Considerations |
| Campylobacter spp. | Proctitis, proctocolitis, enteritis, acute arthritis | Following oral-anal exposure |
| Chlamydia trachomatis | Urethritis, epididymitis, proctitis, cervicitis, endometritis, salpingitis, perihepatitis, bartholinitis, pharyngitis, conjunctivitis, prepubertal vaginitis, prostatitis, accessory gland infection, reactive arthritis | Intrapartum exposure can cause conjunctivitis and pneumonia |
| Chlamydia trachomatis (serovars L1–L3) | Lymphogranuloma venereum proctitis, suppurative lymphadenitis | |
| Escherichia coli | Proctitis, proctocolitis, enteritis | Following oral-anal exposure |
| Gardnerella vaginalis | Bacterial vaginosis in association with other anaerobes | |
| Haemophilus ducreyi | Chancroid | Now uncommon as cause of genital ulcer disease in US and Europe |
| Klebsiella granulomatis | Granuloma inguinale (Donovanosis) | |
| Mycoplasma genitalium | Nongonococcal urethritis, pelvic inflammatory disease, cervicitis, prostatitis, epididymitis, possibly proctitis | Widespread resistance to macrolide antibiotics |
| Neisseria gonorrhoeae | Urethritis, epididymitis, proctitis, cervicitis, endometritis, salpingitis, pelvic inflammatory disease, perihepatitis, bartholinitis, pharyngitis, conjunctivitis, prepubertal vaginitis, prostatitis, accessory gland infection, acute arthritis, septic joint, disseminated gonococcal infection (e.g., endocarditis, meningitis) |
Multidrug-resistant strains have been associated with infection following travel-related exposure Intrapartum exposure can cause ophthalmia neonatorum and sepsis |
| Shigella spp. | Proctitis, proctocolitis, enteritis, acute arthritis | Following oral-anal exposure |
| Treponema pallidum | Syphilis (primary, secondary, latent, and tertiary stages) | In utero and intrapartum transmission can result in severe adverse outcomes |
| Ureaplasma urealyticum | Nongonococcal urethritis, cervicitis | |
| Viruses | ||
|---|---|---|
| Pathogen and Type | Manifestations and Sequelae | Special Considerations |
| Cytomegalovirus | Heterophile-negative infectious mononucleosis, hepatitis, protean manifestations in the immunosuppressed host | In utero transmission can result in severe adverse outcomes |
| Ebola virus | Fever, muscle pain, joint pain, weakness, diarrhea, vomiting, unexplained bleeding | After acute infection, viral RNA can be detected in semen for up to 6 months or, in some cases, longer |
| Epstein Barr virus | Heterophile-negative mononucleosis | |
| Hepatitis A virus | Acute hepatitis | Following oral-anal exposure; preventive vaccination recommended based on destination country (Box 8.8.3) |
| Hepatitis B virus | Acute hepatitis, chronic active hepatitis, persistent (unresolved) hepatitis, cirrhosis, polyarteritis nodosa, chronic membranous glomerulonephritis, mixed cryoglobulinemia, polymyalgia rheumatica, hepatocellular carcinoma |
Transmitted through exchange of blood, semen, or other body fluids; MSM are at increased risk for sexually transmitted hepatitis B virus; preventive vaccination recommendations can be found in Box 8.8.3 In utero exposure can result in infant infection. |
| Hepatitis C virus | Acute hepatitis, chronic active hepatitis, persistent (unresolved) hepatitis, cirrhosis, polyarteritis nodosa, mixed cryoglobulinemia, membranoproliferative glomerulonephritis, membranous nephropathy, hepatocellular carcinoma |
Sexual transmission is not common but has been reported in association with anal sex; clusters of hepatitis C virus infections reported among MSM in Europe, Canada, the United States, and Australia In utero exposure can result in infant infection. |
| Herpes simplex virus (types 1 and 2) | Initial and recurrent oral and genital herpes, cervicitis, aseptic meningitis, encephalitis, neonatal herpes | Suppressive therapy available to reduce symptom recurrence and transmission; intrapartum transmission can result in severe adverse outcomes |
| Human herpesvirus type 8 | Kaposi's sarcoma, primary effusion lymphoma, multicentric Castleman disease | |
| Human immunodeficiency virus (types 1 and 2) | Acquired immunodeficiency syndrome and opportunistic infections, acute retroviral syndrome1 | HIV can be transmitted through exchange of blood, semen, vaginal fluids, or breast milk and through in utero and intrapartum exposure; pre-exposure and post-exposure prophylaxis options are available for prevention (Table 8.8.1); HIV-2 is endemic in Western Africa |
| Human papillomavirus | Condyloma acuminata, laryngeal papilloma, cervical intraepithelial neoplasia and carcinoma, vaginal carcinoma, anal carcinoma, vulvar carcinoma, penile carcinoma | Preventive vaccination available for people aged 9–45 years (Box 8.8.3) |
| Human T-cell lymphotrophic virus, types I and II | Human T-cell leukemia or lymphoma, tropical spastic paraparesis | |
| Molluscum contagiosum virus | Genital molluscum contagiosum | A poxvirus; manifestations are generally localized to the skin |
| Mpox virus | Anogenital and oropharyngeal lesions, proctitis, urethritis | Manifestations are generally localized to the skin but can include severe oral and genital mucosal disease, eye involvement, disseminated disease (sepsis, pulmonary involvement); preventive vaccination recommendations can be found in Box 8.8.3 |
| Zika virus | Zika | After acute infection, viral RNA can be detected in semen for up to 6 months or, in some cases, longer; in utero transmission can result in severe adverse outcomes |
| Protozoa | ||
|---|---|---|
| Pathogen and Type | Manifestations and Sequelae | Special Considerations |
| Entamoeba histolytica | Proctitis, proctocolitis, enteritis, acute arthritis | Following oral-anal exposure |
| Giardia lamblia | Enteritis | Following oral-anal exposure |
| Trichomonas vaginalis | Vaginitis | |
| Fungi | ||
|---|---|---|
| Pathogen and Type | Manifestations and Sequelae | Special Considerations |
| Candida albicans | Vulvovaginitis, balanitis | |
| Dermatophytes (e.g., Trichophyton spp.) | Skin infections in genital area | |
| Ectoparasites | ||
|---|---|---|
| Pathogen and Type | Manifestations and Sequelae | Special Considerations |
| Pthirus pubis | Pubic lice infestation | |
| Sarcoptes scabiei | Scabies | |
Notes
Abbreviations: MSM, men who have sex with men.
1HIV RNA nucleic acid amplification testing is the preferred method for diagnosing acute HIV in a person presenting with symptoms consistent with acute retroviral syndrome. National Academies of Sciences, Engineering, and Medicine. (2021). Sexually transmitted infections: Adopting a sexual health paradigm. The National Academies Press. https://www.doi.org/10.17226/25955. CDC 2021 STD Treatment Guidelines.
Sexually transmitted infections, including HIV
Epidemiology
The World Health Organization estimated that 374 million new infections with curable sexually transmitted pathogens (e.g., chlamydia, gonorrhea, trichomoniasis, and syphilis) occurred in 2020. Globally, >500 million adults are estimated to be infected with a genital herpes virus and >300 million with human papillomavirus, the cause of cervical, other anogenital, and oropharyngeal cancers. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), 39 million (range 33.1–45.7 million) people globally were living with HIV in 2022. There are at least 30 infections that can be sexually transmitted, several of which are incurable, and most are not vaccine-preventable (Table 8.8.2).
The distribution of both STI and HIV prevalence and antimicrobial resistance to available treatment varies globally; some countries and regions have very high rates of infections with STIs or with HIV. Healthcare professionals and travelers should be aware of the burden of infections at planned destinations. International travelers having condomless sex with new partners while abroad are exposed to different sexual networks than at home and can also serve as a conduit for importing novel STIs or antimicrobial-resistant STIs into parts of the world where they are unknown or rare. For example, rates of multidrug-resistant Neisseria gonorrhoeae isolates are higher in countries in Europe, South America, and Asia. Multidrug-resistant gonorrhea infections have been associated with commercial sex and encounters that include oral sex during travel. Antimicrobial-resistant gonococcal infections should prompt healthcare professionals to ask patients about their travel histories and the travel histories of their sex partners.
Risk for sexually acquired viral infections while traveling primarily depends on behaviors (e.g., condomless sex, injection drug use). Although rare, viral pathogens such as Zika virus and Ebola virus may be spread through travel-related sexual encounters in endemic or outbreak-associated countries (see Zika chapter). In 2022, a multinational outbreak of mpox emerged in Europe and the Americas and then spread worldwide, with over 100,000 mpox cases in more than 120 countries and territories. Infection is spread person-to-person primarily through close skin-to-skin (particularly sexual) contact. Most cases worldwide occurred among gay, bisexual, and other MSM. International travel played a major role in introducing the virus to non-endemic countries.
The Advisory Committee on Immunization Practices recommends that people at risk of mpox complete an mpox vaccination series (Box 8.8.4). Persons who anticipate those risks, including during travel, should ideally receive the second dose of the vaccine at least 2 weeks prior to anticipated exposures. Travelers who have not been previously vaccinated or have not previously been diagnosed with laboratory-confirmed mpox can receive vaccination after an exposure. This should be administered as soon as possible (ideally within 4 days of exposure but not later than 14 days) to prevent disease or make it less severe. Travelers who return with mpox symptoms should be assessed for not only mpox but also other infections that can be confused with mpox (or can occur concomitantly with mpox). Supportive care, including pain control, is essential. For those with, or at risk for, severe mpox manifestations, additional therapeutics should be considered.
Box 8.8.4
Notes
From https://www.cdc.gov/vaccines/acip/recommendations.html.
Pregnant travelers, pregnant women who are sexual partners of returning travelers, and healthcare professionals should be aware of the manifestations of STIs in pregnancy and risks to unborn infants and neonates (see Pregnant Travelers chapter). Examples of these include: chorioamnionitis, premature rupture of membranes, premature delivery, amniotic infection syndrome, and postpartum fever. Maternal infection and subsequent infant infection in utero or at delivery may result in stillbirth, neonatal death, prematurity, low birth weight, congenital deformities, developmental delay, mental retardation, sensorineural deafness, otitis media, rhinitis, pneumonia, or neonatal ophthalmia.
Sex while traveling
Sex while traveling encompasses casual consensual sex, sex tourism, sexual violence or assault, connection to sex trafficking, and sexual exploitation of children.
Casual consensual sex
Casual consensual sex during travel describes informal, non-transactional sexual encounters with other travelers or locals. Two meta-analyses estimated that 20%–34% of male international travelers engage in casual sex abroad and that about half of all travelers participating in casual sex abroad have condomless sex. Longer duration of travel, traveling alone or with friends, alcohol or drug use, younger age, and being single are some of the factors associated with engaging in casual sex while traveling internationally (Box 8.8.5).
Box 8.8.5
To lower the risk of unintended pregnancy while traveling, travelers with childbearing potential should be counseled about both contraception and emergency contraception. There are 4 options for emergency contraception in the United States: the copper intrauterine device (inserted within 5 days of condomless vaginal sex) and three types of emergency contraception pills (taken as soon as possible, within 5 days of condomless vaginal sex). Emergency contraception pills include ulipristal, levonorgestrel, or combined estrogen/progestin. Advance provision of emergency contraception pills prior to travel can facilitate timely emergency contraception as soon as possible after a sexual encounter.
Men who have sex with men
Studies examining MSM and their sexual behavior when traveling report that MSM are more likely to engage in condomless anal intercourse with partners of unknown HIV status, to have concurrent or multiple sex partners, or to have sex in conjunction with substance use while traveling (see Substance Use and Substance Use Disorders in Travelers chapter). These can be particularly true if the reason for travel is to attend group sex events or gatherings (e.g., cruises, circuit parties), which was a key linkage to the early cases during the multinational mpox outbreak. Other reports, however, indicate that MSM adapt their behaviors when traveling to destinations perceived to have a higher risk for HIV. For example, MSM who travel internationally have been reported less likely to have condomless anal intercourse with partners abroad compared with partners encountered at home or during domestic travel.
Sex tourism
Travel for the specific purpose of procuring sex is considered "sex tourism." Sex tourism destinations are frequently countries where commercial sex is legal. In some countries, sex tourism supports sex trafficking, among the largest and most lucrative criminal industries in the world. Sex tourists have traditionally been men from higher-income countries who travel to low- and middle-income countries to pay for sex with local women, including commercial sex workers. Sex tourism among American and European women also has been described, particularly during travel to the Caribbean.
Having condomless sex with commercial sex workers is associated with an increased risk for STIs and HIV. Multidrug-resistant gonorrhea infections have been linked to encounters with sex workers in both Japan and Hawaii. Historically, fluoroquinolone and penicillin resistance among Neisseria gonorrhoeae isolates and case clusters have been linked to Asia and the Pacific Islands.
A high prevalence of HIV infection is also frequently found among sex workers. Global estimates from systematic reviews indicate that over 10% of female sex workers are living with HIV, with the highest rates among those in East and Southern Africa (33%) and the lowest among those in the Middle East and Northern Africa (1.8%). Both commercial sex workers and their patrons are at risk of assault, robbery, and blackmail. Criminal prosecution is also a possibility in countries where prostitution is illegal.
Sexual violence and assault
People of any age, sex, or sexual orientation can be victims of sexual violence during travel and should be aware of this risk. The risk for sexual assault is greater among young women traveling alone and in regions of high sexual violence prevalence (e.g., central and southern Sub-Saharan Africa, Andean Latin America, Southeast Asia). In addition, some studies have identified that young gay and bisexual males traveling internationally might be victims of sexual violence more frequently than females or heterosexual males (see LGB+ Travelers chapter).
Sexual violence can occur more often in association with international recreational travel, but it is also reported in travelers participating in humanitarian aid work (see Humanitarian Aid Workers chapter). Alcohol and drug use have been shown to increase vulnerability for sexual assault (see Substance Use and Substance Use Disorders in Travelers chapter). Unfamiliar cultural norms, environments, language barriers, and safety concerns might also increase the risk.
Post-sexual-assault medical care
Victims of sexual violence (particularly rape) should seek immediate medical attention. Health care sought after 72 hours could negate the benefits of PEP for HIV and STIs, lower the effectiveness of emergency contraception, and reduce the value of any collected forensic evidence. Seeking medical care following a sexual assault can, however, be difficult in places where safety is a concern, where health care is not easily accessed, and where language, cultural, and other barriers might not facilitate appropriate evaluation.
In addition to HIV and other STI PEP, emergency contraception, and the forensic examination, medical attention after sexual assault should include treatment of injuries and provision of mental health and other supportive care. Adolescent-adapted services, if available, should be sought to address the related but different needs of youth who have been victims of sexual violence.
Sex trafficking and sexual exploitation of children
Although commercial sex work is legal in some parts of the world, sex trafficking, sex with a minor, and child pornography are always classified as criminal activities according to U.S. law, and travelers can be prosecuted in the United States even if they participated in such activities 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.
Sex with minors
Federal law prohibits U.S. residents traveling abroad from having sex with minors; this applies to all travelers, both adult and youth. Travel medicine professionals should inform student travelers and other young people going abroad that according to U.S. law, it is illegal for a U.S. resident to have sex with a minor in another country. The legal age of consent varies around the world, from 11–21 years old. Some countries have no legal age of consent, with local laws forbidding all sexual relations outside of marriage.
Child pornography
Regardless of the local age of consent, U.S. law states that participation in child pornography anywhere in the world is illegal. U.S. Code Title 18, Chapter 110 prohibits sex with minors, as well as the purchase, procurement, holding, or storage of material depicting such acts. These crimes are subject to prosecution with penalties of up to 30 years in prison. Victims of child pornography suffer multiple forms of abuse (emotional, physical, psychological, and sexual), poverty and homelessness, and health problems, including physical injury, STIs, other infections and illnesses, drug and alcohol addiction, and malnourishment.
Sexual exploitation of children
Sexual exploitation of children during travel and tourism affects all countries of the world, regardless of income level. Offenders can include expatriates, humanitarian aid workers, international business travelers, military personnel, people attending large-scale sporting and cultural events, teachers, travelers and tourists, and volunteers (see The International Business Traveler, Humanitarian Aid Workers, Long-Term Travelers and Expatriates, and Mass Gatherings chapters). Financial vulnerabilities of families and communities in destination countries, the availability of cheap and accessible travel, and expanding access to information and communication technologies increase opportunities for child sexual exploitation.
Combating sexual exploitation of children
To combat sexual exploitation of children, some international hotels and other tourism services have voluntarily adopted a code of conduct that includes training their employees to recognize and report suspicious activities. Tourist establishments supporting this initiative to protect children from sex tourism are listed online. Healthcare professionals and travelers who suspect child sexual exploitation occurring abroad can report tips anonymously by calling the Homeland Security Investigations Tip Line (toll-free at 866-347-2423) or by submitting information online to U.S. Immigration and Customs Enforcement or the International Centre for Missing & Exploited Children. In the United States, the National Center for Missing & Exploited Children's Cyber Tipline collects reports of child prostitution and other crimes against children (toll-free at 800-843-5678).
The federal PROTECT Act strengthens the U.S. government's ability to prosecute and punish crimes related to violence against children, including sex trafficking, punishable by incarceration of up to 30 years for acts committed at home or abroad. Cooperation of the host country is required to open an investigation of criminal activity. In some countries, the judicial system might be prone to bribery and corruption or the government may be willing to accept tourism revenue at the expense of children being trafficked for sex. The U.S. Department of State has published a list of ways to fight human trafficking, including recommendations for youth and their parents, attorneys, healthcare professionals, journalists, and other partners.
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