Travel, migration and HIV.

ABSTRACT

This is a review of recent publications on the subject of travel (taken in its widest sense) and HIV/AIDS. As with all epidemics caused by transmissible pathogens, AIDS has been seen in many countries as an imported problem. What this perspective fails to recognize is that with the explosion of international travel in the past thirty years it is virtually impossible to prevent the spread of infectious disease across international frontiers. Here we highlight the relative paucity of studies that describe or investigate the context in which sexual risk behaviour of travellers takes place, and suggest areas of further research which could increase understanding of the nature of sexual risk taking, and help in the design of health education programmes.

ABSTRACT

PIP In this review of the current literature on the relationship between travelers and transmission or infection from the HIV virus, it is apparent that the emphasis is on the risk to travelers for contracting the infection from host countries in the developing world. This review of European, American, British, and developing country studies is reported to add to the review reported at the VIII International Conference on AIDS in 1992. Recommendations are made for future research. More research is needed on the role that travelers play in increasing the spread of HIV infection. Specifically, the sex behavior of ordinary travelers, rather than longterm travelers or expatriates, needs to be carefully examined. In order to more appropriately target health education, a greater understanding is needed of e.g, social inhibitory norms and the role played by alcohol and drug consumption. Benefits will be reaped by both the host population and tourists. Some of the early studies focused on the ethical implications of restricting an individual's travel; travel was identified as a risk factor without explaining why. Many governments were quick to blame others for the source of the infection, without considering the scapegoating and the impossibility of closing borders to international travel. Europe was quick to connect the first AIDS cases to travelers, expatriates, and returning workers. Belgian studies found that the prevalence rates among Belgian advisors and European expatriates was 1.1% and 1.9% , respectively. Dutch studies recorded slightly lower rates among expatriates returning from sub-Saharan Africa after a visit of at least 6 months. Neither study included travelers for pleasure or study, or controlled for the number of new sexual partners abroad vs. at home, or reported whether the partners were African or non-African. US studies were of similar character and included a case study of a man returning from Rwanda after an automobile accident and a prospective survey of 282 Peace Corp volunteers serving in Zaire between 1985 and 1988. British and developing country studies also found links between travelers and being HIV positive.