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In Search of the Exotic: Sex Tourism and Disease Risks
Abstract
Although the link between human mobility and infectious disease spread is well established (Wilson, 1995), scholarly interest in the possible correlation between tourism and HIV/AIDS dissemination is fairly recent (Apostolopoulos &Sönmez, 2001a, 2001b, 2002; Apostolopoulos, Sönmez, &Yu 2002; Clift &Grabowski, 1997; Mulhall, 1996; Sönmez, Apostolopoulos, Yu, Yang, Matilla, &Yu, 2006; Wright, 2003). Sexual interactions that carry STI/HIV risks occur between travellers and locals or other travellers; however, "sex tourism" in particular is an important vector for STI/HIV transmission and has potentially explosive ramifications for public health (Wright, 2003). Sex tourism is specifically motivated by persons interested in finding sexual adventure at destinations where the social norms and restrictions of their home environments are suspended. By virtue of their behavioral interactions with sex workers (a "core group" of efficient transmitters of STIs/HIV) and sex partners back in their home environments, sex tourists have a high risk of both acquiring and transmitting STIs/HIV. Consequently, sex tourists themselves become an STI/HIV core group, along with sex workers, seafarers, and truckers-a concept based on the observation that an infection is endemic among a small sub-population of highly sexually active individuals, from whom it spreads in mini-epidemics to the population at large (Mulhall, 1996). The combination of sex tourists' financial resources, the inherently risky nature of their behaviors, and acute poverty at sex tourism destinations is alarming-particularly when viewed in light of the increasing globalization of both sectors of tourism and sex. This chapter will examine sex tourism in terms of social and economic factors that fuel the activity, discuss types of locations around the world where sex tourism flourishes, and provide case studies of sex tourism destinations where STIs/HIV have become problematic.
... Greater emphasis on mitigating vector-borne diseases wherein disease burdens are highest-a global perspective on national and regional disease control Enhancing global and regional surveillance and control of disease vectors, such as has recently been initiated for Europe in the VBORNET a project 86 Expansion of coverage where vaccines already exist, such as for tick-borne encephalitis Enhancing physicians' awareness about a wider range of vector-borne diseases than they are currently accustomed to seeing This could be exacerbated in the future by widening social inequalities as well as the lack of safe sex education in regions with strained public finances; although 82% of countries in Europe and Central Asia responding to a survey in 2010 indicated that they promote health education for young people, only 43% included HIV education in the primary school curriculum. 89 Meanwhile, sexual networks will become increasingly global as a result of tourism, migration, and human trafficking. Sex tourism in particular is an important but underestimated driver; often, sex tourism occurs in regions of the world where rates of HIV and other STIs are already high, putting further strain on the health care systems and economies of these countries while facilitating the global distribution of HIV. ...
... Sex tourism in particular is an important but underestimated driver; often, sex tourism occurs in regions of the world where rates of HIV and other STIs are already high, putting further strain on the health care systems and economies of these countries while facilitating the global distribution of HIV. 89 Some categories of migrants, refugees, sex workers, and those of lower socioeconomic status will continue to be more at risk for STIs than the population at large, with evidence suggesting a higher propensity for risk-taking behavior. 90 Harmonizing reporting across the EU for STIs Although Salmonella and Campylobacter currently have a much higher incidence in Europe, listeriosis incidence could be much higher in 2020 than it is today. ...
Background: It is widely acknowledged that a range of factors associated with globalization and global change will affect communicable disease transmission patterns. Less studied is how these factors might combine to create new threats to public health.
Objective: To systematically identify principle drivers of communicable disease spread and then develop scenarios of how these drivers might interact to generate new threats to public health.
Methods: An expert workshop was used to flesh out disease drivers most important for the EU and to identify outlines of scenarios of disease spread in the year 2020. Subsequent literature reviews were used to substantiate and refine the scenarios.
Results: 12 principle drivers of communicable disease spread were identified, grouped under three headings: globalization and environmental change; social driving forces; and public health related forces (health systems and policies). Based on the potential interactions of these drivers, ten potential health threats facing the EU by the year 2020 were developed. Most prominent were antimicrobial resistance; the emergence of vector-borne diseases currently not in the EU; vaccination fatigue'; an increase in food-borne infections; and the sustained potential for pandemic influenza.
Discussion: Understanding the underlying driving forces of communicable disease spread enables the development of scenarios on how future threats may evolve. Such activities are important for they shed light on current strengths and vulnerabilities within health systems while also drawing attention to the importance of upstream public health action focused on addressing the key drivers of disease, whether social inequalities, trade, environmental change or so on.
Injection drug-using men from the US and Mexico who purchase sex in Tijuana, Mexico are at risk for transmitting HIV to their contacts in both countries via syringe sharing. We used social network methods to understand whether place of residence (US vs. Mexico) moderated the effect of emotional closeness on syringe sharing. We interviewed 199 drug-using men who reported paying/trading for sex in Tijuana, Mexico using an epidemiological and social network survey and collected samples for HIV/STI testing. Seventy-two men reported using injection drugs with 272 network contacts. Emotional closeness was strongly associated with syringe sharing in relationship where the partner lives in the US, while the relationship between emotional closeness and syringe sharing was considerably less strong in dyads where the partner lives in Mexico. Efforts to reduce HIV risk behaviors in emotionally close relationships are needed, and could benefit from tailoring to the environmental context of the relationship.
We examined how different drivers of infectious disease could interact to threaten control efforts in Europe. We considered projected trends through 2020 for 3 broad groups of drivers: globalization and environmental change, social and demographic change, and health system capacity. Eight plausible infectious disease threats with the potential to be significantly more problematic than they are today were identified through an expert consultation: extensively drug-resistant bacteria, vector-borne diseases, sexually transmitted infections, food-borne infections, a resurgence of vaccine-preventable diseases, health care-associated infections, multidrug-resistant tuberculosis, and pandemic influenza. Preemptive measures to be taken by the public health community to counteract these threats were identified.
This article explores questions about gender, race, sexuality and political community. It examines one major pattern of sex tourism in relation to contradictions within liberal theory's construction of community, Self and Other. Drawing on ethnographic research in the Dominican Republic, it argues that an interrogation of the world view of `hard core' male heterosexual sex tourists reveals something of the whiteness, maleness and heterosexuality of classical liberalism's sovereign self and the tensions generated by its partial and exclusive universalism.
Microbes have played a decisive role in human history. Between 1348 and 1352 in many European countries plague was estimated to have killed a third to a half of the population.1 2 It was not swords and guns but imported microbes, carried by explorers over oceans, that defeated native populations in the Americas,3 and in Australia and southern Africa the arrival of Europeans killed off local populations by introducing infectious diseases. Local flora and fauna were also irreversibly altered. Many of these fertile, temperate, and now less populated lands were subsequently settled by Europeans.3
By the middle of the 20th century, infectious diseases were no longer the major causes of mortality in developed countries. The eradication of smallpox reinforced the perception that infectious diseases could be eliminated. Improved sanitation, clean water, and better living conditions, along with vaccines and antimicrobial agents, brought many infectious diseases under control in industrialised countries, but infections continued to kill millions each year in the developing world. Infectious diseases remain the most common single cause of death in the world today. Of the 51 million deaths worldwide in 1993, an estimated 16.4 million resulted from infectious and parasitic diseases.4 In sub-Saharan Africa, communicable diseases account for more than 70% of the burden of ill health (as measured by disability adjusted life years), in contrast to about 10% in industrialised countries.5
Increasingly humans have changed the earth in ways that make it easier for microbes to move and to reach vulnerable populations. Widespread use of antimicrobial agents and chemicals produces selective pressure for the survival and persistence of more resistant populations of microbes, and also of more resilient insect vectors.6 Patterns of infectious diseases are changing globally and on a massive scale.7 8 Although poor and disadvantaged people are …
This paper considers how Dominican sex workers and German sex tourists imagine each other across national borders. They meet in a transnational space, Sosúa, a tourist town on the north coast of the Dominican Republic. Sex tourism has redirected migration patterns within the Dominican Republic to Sosúa, as well as off the island by building new transnational connections to Germany. I examine why Dominican women migrate to Sosúa's sex trade, how they see German men, and what happens when they actually establish ongoing relationships with them—both in Sosúa and in Germany. I also look at how German men find out about Sosúa, its sex trade, and Dominican women. I focus on forms of communication through which they find out about one another, communication that ranges from word of mouth to newspapers, magazines, and the Internet (in the case of the men only). In Sosúa we see the relationship among capitalism's disruptive, restructuring activities; powerful images, fantasies, and desires (produced both locally and globally) that are inextricably tied up with race and gender; the emergence of young, poor, black, single mothers who are willing to engage in the sex trade; and a strong demand for these women's services on the part of white, working‐class, lower‐middle, and middle‐class, foreign male tourists.
The twenty-first century brings with it some of the dark realities of the last century with respect to the commercial sexual exploitation of children. Worldwide, untold numbers of children are being systematically deprived of their human rights, dignity, and childhood through child prostitution, child pornography, and other sexploitation. Many of these children are routinely subjected to rape, beatings, displacement, drug addiction, psychological abuse, and other trauma, including exposure to the AIDS virus and a life with no future. This study examines the current state of international trafficking of children and other child sexual exploitation. Child sex tourism plays a major role in the child sex trade as prostituted youths are routinely lured or abducted into sexual slavery and sex-for-profit. Other prostitution-involved girls and boys are at the whim of pimps, pornographers, and other sexual exploiters. The global exploitation of children continues to plague society, in spite of international efforts to combat the proliferation of the child sex trade industry. Organizations such as ECPAT remain committed to addressing the central issues pertaining to the prostituting and sexual exploitation of children.
Though increasingly a focus of both political concern and academic research, ‘sex tourism’ is a difficult term to define. This article presents both quantitative and qualitative data on the sexual behaviour and attitudes of single and/or unaccompanied heterosexual female tourists in the Dominican Republic and Jamaica. In so doing it aims to contribute to the body of research evidence on the phenomenon, as well as to highlight some of the conceptual problems associated with existing analyses of both ‘sex tourism’ and ‘romance tourism’. It calls for the development of a theoretical model of sex tourism which can accommodate both the diversity of tourist-related sexual-economic exchanges which take place in economically underdeveloped countries and the complexity of the power relations that underpin them.
AIDS, like plagues throughout human history, has been blamed repeatedly on foreigners. This has heightened ramifications, from the personal to the geopolitical, in an era of escalating population movement and rapid international travel. By the end of 1990, the World Health Organization had estimated that the total number of AIDS cases worldwide was close to 1.3 million ¹ . Recent estimates suggest that by the year 2000, 38-100 million adults and over 10 million children will have been infected with HIV ² . Seventy-five to eighty-five percent of that number will be from the developing world.
AIDS has rapidly become pandemic, with wide-ranging consequences for humankind. Human population movement is an important component in the natural history of AIDS. With respect to this, a central consideration is the relationship between AIDS and international travel, especially tourism. In this paper, after reviewing HTV in the Asia-Pacific region, we present the epidemiology of HIV in the Pacific Islands, discuss its impact with particular reference to population movement, and explore some of the specific challenges that the Pacific Island region faces.
Sexually transmitted diseases (STDs) continue to be the most common notifiable infectious conditions worldwide. Their unacceptably high incidence is underlined by the recent emergence of a (presently) incurable and lethal STD--human immunodeficiency virus (HIV) infection--which merits its description as a pandemic, and with which other STDs interact in an epidemiological synergy. Data that quantify the association between STDs/HIV infection with travel and difficult to obtain; nevertheless figures are presented that reveal the lower limit to be large enough to be of considerable concern. Studies from around the world show, overall, although knowledge of STDs is increasing amongst travellers, the level of knowledge has little to do with actual behaviour, with a modest increase in the use of condoms, but abundant evidence that a wide variety of sexual behaviours take place among travellers and with local inhabitants. Certain travellers, by virtue of their behavioural interactions with 'core-groups' of efficient transmitters, may have a high risk of acquisition of an STD/HIV. Worldwide, sexual health promotion for travellers is in its infancy; indeed, it could more accurately be merely described as 'sexual education'. A fresh approach is recommended, which includes comprehensive programme planning and outcome, impact, and process evaluations.
The process of globalization has rendered societies interdependent on one another and has fostered the movement of people, goods and ideas at unprecedented speed and volume. Global travel has grown from 25 million in 1950 to 500 million in 1993, and estimations by 2010 reach 1 billion. The increased intensity and quantity of travel has resulted in greater vulnerability to the domino-type spread of old, new and re-emerging infectious diseases. Travelers and local populations are also vulnerable to death and disability due to accidents, violence and injuries, chronic diseases such as those due to substance abuse (tobacco, alcohol and others), and to undesirable behaviors such as those related to sex-tourism. This article argues that tourism, understood as any type of travel, is one of the most important sectors of the economy in many countries and, therefore, can contribute to community and national development. It also asserts that travel, as a factor in the spread of disease, lies in the realm of public health inquiry. It calls for greater collaboration between the tourism-travel industry and community, national and global leaders to promote and enforce "responsible tourism."
Although the importance of human mobility in the spread of infectious disease has been recognized for quite some time, surprisingly little attention has been given to older adults' travel-related HIV risk behavior. This essay discusses the importance of studying the role travel and tourism play in the spread of HIV infection in older adults, reviewing select research on travel/tourism and HIV risk and highlighting the theoretical and methodological challenges confronting researchers in this area.