International travelers frequently report new sexual partners, risky behaviors

New data published in the BMJ’s Sexually Transmitted Infections suggest many British travelers meet new sexual partners while abroad and frequently forgo protection or engage in other risky behaviors.

Similar findings also were reported in a separate study of backpackers visiting Thailand, indicating a need for interventions targeted at international travelers.

“Even if sex is not an explicit motivation for travel, sexual encounters may be facilitated through opportunities to meet new people, the loosening of social taboos controlling sexual expression, a sense of anonymity that being away from home confers and in the context of engaging in risk behaviors such as alcohol and drug use, which may also change when away from home,” Clare Tanton, PhD, of the research department of infection and population health at University College London, and colleagues wrote. “There is the potential for those having sex while overseas to act as a bridge from areas of high to low STI/HIV prevalence.”

Condom use infrequent among British travelers meeting new partners

Tanton and colleagues examined sexual behavior data from Natsal-3, a survey of 15,162 British men and women aged 16 to 74 years conducted between September 2010 and August 2012. The researchers asked respondents who reported at least one sexual partner (n = 12,530) within the previous 5 years if they had traveled outside of the country within the same period, and if they had sex with a new partner while abroad. After identifying such respondents, the researchers conducted analyses to determine any demographic or behavioral differences between those who did and did not meet new partners abroad.

Approximately 9% of men and 5% of women reported new sexual partners while overseas. Participants reporting overseas partners were more often young, unmarried, nonwhite or currently enrolled students. In addition, these respondents were more likely to report several risky behaviors, including condomless sex with a new partner, multiple new partners, drug or alcohol use, and paid solicitation for sex in or out of the United Kingdom. However, in adjusted analyses, male respondents with new sexual partners also were more likely to report receipt of HIV testing than those without new partners.

Of the 1,071 participants who reported new partners while overseas, 71.9% of men and 58.4% of women reported a new partner who was not from the U.K. While many of this group’s characteristics were similar to those reporting any new partners while overseas, these respondents were more likely to identify as nonwhite or “white other” and report more overall partners, but were less likely to report any unprotected sex.

These data suggest that STI transmission frequently does not occur among a “closed” population, the researchers wrote, and can span between areas with high and low risk for various infections. Further, they advocated the inclusion of sexual health education when consulting patients preparing to travel abroad “regardless of age, destination or motivation for travel.”

Infrequent condom use among younger backpackers

Frequent unsafe sex also was reported in a recent study of travelers backpacking through Thailand, conducted by Christopher T. Lewis and Gilles de Wildt, MD, MSc, both of the Institute of Clinical Sciences at the University of Birmingham.

According to Lewis and Wildt, 3.8% of U.K.-born adults with a new HIV diagnosis made between 2002 and 2010 are likely to have contracted the virus in Thailand.

“While this finding may be associated with sex tourism, it highlights the importance of developing greater understanding of sexual behavior abroad in order to improve health promotion strategies before and during travel,” they wrote.

Lewis and de Wildt distributed a questionnaire to English-speaking backpackers traveling through the Koh Tao and Koh Phangan islands between Jan. 25, 2013 and March 13, 2013. They excluded from the analysis Thai and American travelers, as well as those traveling with a long-term partner or spouse. The researchers examined the responses for any associations between age, nationality and sexual behaviors.

There were 1,238 backpackers included in the final analysis. Of these, roughly two-thirds were aged younger than 25 years, more than half were European and nearly 40% had been traveling for at least 1 month at recruitment.

Approximately 39% of the respondents reported intercourse with a new partner (29.4% of women; 51.9% of men), and 36.8% reported inconsistent or no condom use. Inconsistent condom use was more frequent among those aged younger than 25 years, and was independently associated with not bringing condoms from home; however, those who did bring condoms were more likely to report new sex partners. Male gender also was found to be a risk factor for unsafe sex, while German nationality was associated with lower risk. Backpackers were most likely to form new partnerships with travelers from other countries, and men were more likely to report sex with Thai locals.

While reports of new partners and unsafe sex were largely consistent with STI trends within a traveler’s country of origin, the researchers noted that the tendency of backpackers to engage in sex with fellow travelers from different countries contrasts previous data, which suggested a tendency to find partners from the traveler’s country of origin or the country of destination. This could imply that the sexual behaviors of backpackers may differ from those of single-destination travelers.

“Targeting unsafe sex in backpackers may have the potential to considerably reduce global STI incidence,” Lewis and de Wildt wrote. “The need for innovative public health intervention and international collaboration is clear.”

Effective interventions for travelers could be ‘transformational’

In a related editorial, Alberto Matteelli, MD, PhD, and Susanna Capone, MD, both of the infectious and tropical diseases clinic at the University of Brescia, Italy, discussed the mechanisms of international STI transmission described in these two studies. The two described notable historical records of STIs traveling to unprepared regions — such as the spread of syphilis to Europe by Christopher Columbus and the conquistadors, or HIV’s dissemination from Africa — and noted the increasing rate of STI diffusion granted by globalization and human mobility.

“Unfortunately, we do not have any patented intervention, of any kind, with proven efficacy in changing human behaviors toward lower risk sexual practices while traveling,” they wrote. “The only clinical trial about the effect of specific STI interventions so far showed that neither a motivational brief intervention nor the provision of free condoms (or a combination of the two) modified risky sexual behavior in young travelers compared with a control group of travelers who got standard pre-travel information.”

Any new research to determine effective interventions among travelers “would have the highest probability of being transformational,” they wrote, and is urgently needed to mitigate the spread of STIs. – by Dave Muoio

References:

Lewis CT, et al. Sex Transm Infect. 2016;doi:10.1136/sextrans-2015-052301.

Matteelli A, et al. Sex Transm Infect. 2016;doi:10.1136/sextrans-2016-052573.

Tanton C, et al. Sex Transm Infect. 2016;doi:10.1136/sextrans-2015-052459.

Disclosures: Capone, de Wildt, Lewis, Matteelli and Tanton report no relevant financial disclosures. Please see the full studies for a list of all other authors’ relevant financial disclosures.