Sexual Exploitation of Children in Travel and Tourism Perpetration: An Expansion of the Ecosystem Model.

The sexual exploitation of children in travel and tourism (SECTT), also referred to as child sex tourism, involves engaging in sexual activity with someone under the age of 18 in the context of travel and/or tourism. Research on the perpetration of SECTT is vastly underdeveloped. The present review considers the operationalization of SECTT, its prevalence, and existing theoretical models. Existing theory on SECTT provides a good overview of environmental factors that contribute to SECTT, but the model is insufficient in fully accounting for individual-level risk factors related to sexual offending against children. The present paper expands an existing theoretical model of SECTT, the ecosystem model, to account for these individual risk factors and considers their interaction with environmental factors. The paper concludes by highlighting different avenues for future research.

An impact study of COVID-19 on six different industries: Automobile, energy and power, agriculture, education, travel and tourism and consumer electronics.

The recent outbreak of a novel coronavirus, named COVID-19 by the World Health Organization (WHO) has pushed the global economy and humanity into a disaster. In their attempt to control this pandemic, the governments of all the countries have imposed a nationwide lockdown. Although the lockdown may have assisted in limiting the spread of the disease, it has brutally affected the country, unsettling complete value-chains of most important industries. The impact of the COVID-19 is devastating on the economy. Therefore, this study has reported about the impact of COVID-19 epidemic on various industrial sectors. In this regard, the authors have chosen six different industrial sectors such as automobile, energy and power, agriculture, education, travel and tourism and consumer electronics, and so on. This study will be helpful for the policymakers and government authorities to take necessary measures, strategies and economic policies to overcome the challenges encountered in different sectors due to the present pandemic.

The impact of the dimensions of environmental performance on firm performance in travel and tourism industry.

This study investigates the impact of the aggregate and individual dimensions of environmental performance (EP) on financial performance (FP), based on a dataset covering the travel and tourism industry (airlines, casinos, hotels, and restaurants) across different economic regions over the period 2003-2014. The results reveal that EP positively affects the FP in the hotel industry when aggregate EP is used. When individual dimensions of EP are considered, resource reduction is found to positively (negatively) affect the performance in the hotel (airline) industry, while product innovation positively affects the performance in the restaurant industry. Hence, the trade-off effect seems to be dominant in the airline industry, and the 'heterogeneous resources and reputation-building' hypothesis is evident in both the hotel and restaurant industries. In addition, in general, the findings support the positive moderating effect of slack resources on the relationship between the individual dimensions of EP and FP in the travel and tourism industry, and, hence, are supportive of the slack resources hypothesis. These effects, however, vary depending on the travel and tourism industry under investigation.

Actions are oriented to delight travelers: A sequential mediation model to explore the relationship between travel quality and re-travel intentions.

The actions are oriented to delight travelers where existing protocols fall short of solving problems in the travel and tourism industry, seeking the retention of commuters by offering travel quality. The present study investigates the travel decision-making process by exploring the nexus between travel quality and re-travel intentions (RTI). The study also analyzes the relational switching cost's (RSC) unique role as a sequential mediator in driving travel quality through the theoretical lens of expectancy disconfirmation theory. Furthermore, the study also explores the role of gender in explaining RTI. 434 real-time responses were collected following the lifetime value (LTV) approach. The structural equation modeling (SEM) was used to test the hypotheses. The study reveals that travel quality significantly influences commuter satisfaction. The results also suggest the indirect effect of RSC on commuter satisfaction (CS) and (RTI). Finally, it is suggested that RTI is higher among female commuters than male commuters. The fundamental contribution of this study is developing and testing the travel decision-making process by extending the EDT model. Additionally, the TRAVQUAL scale contributes to measuring perceived and expected travel quality. Commuter satisfaction and relational switching costs act as sequential mediators, while gender emerges as a moderator, emphasizing the greater significance of re-travel intentions among female commuters post-RSC. These insights contribute valuable perspectives for enhancing travel experiences and decision-making processes in the travel and tourism industry.

Service failure is bound to happen: Unraveling the impact of dissatisfaction, complaint behavior and re-travel intention in travel and tourism industry.

Service failure is bound to happen, but dissatisfaction has always been undermined by scholars previously. The present study investigates dissatisfaction factors in travel decision-making leading towards re-travel intention with the help of the expectancy disconfirmation theory (EDT) model. Moreover, complaint behavior mediates the relationship between dissatisfaction and re-travel intention concerning the factors involved in it. For the findings, 434 real-time responses were collected through an offline survey following the lifetime value (LTV) approach. Kaiser-Meyer-Olkin (KMO) and Bartlett's tests were conducted to test the sphericity of the variables one by one. Furthermore, structural equation modeling (SEM) was implied to test the measurement and structural models. All the hypotheses supported and accepted the proposed research questions. The findings reveal that the dissatisfaction factors, with their interaction terms (transaction-based and experience-based), help study the variable dissatisfaction and its multifaceted concept in travel and tourism literature. Moreover, complaint behavior is identified as a key mediating factor in the relationship between dissatisfaction and re-travel intention, suggesting that commuters' response to dissatisfaction, including complaints, shapes their future re-travel intentions. The theoretical implications of the study are substantial, as it advances our understanding of commuter behavior in the context of public transport travel and tourism. Practically, the findings offer actionable insights for public transport authorities and service providers. Understanding the specific dissatisfaction factors influencing re-travel intention allows for targeted interventions to improve service quality and customer experience. Recognizing the importance of effective complaint management systems can help organizations better address customer grievances and mitigate the negative effects of dissatisfaction on re-travel intention.

Pre- and post-pandemic risk perceptions and worries.

Introduction: The present study is a cross-sectional investigation of worry and risk perceptions regarding various hazards and destinations, measured before, during, and after the COVID-19 pandemic. Methods: Questionnaire data were collected from tourists in Norway during the summer seasons of 2012 (N = 2,669), 2019 (N = 1,666), and 2022 (N = 956), and from a representative sample of Norwegians in 2020 (N = 1,003). Results: The results show a general decline in the level of worry and risk perceptions post-pandemic compared to those pre-pandemic, with the exception of infectious diseases, whose perceived risk slightly increased in 2022. Conclusion: The results highlight the importance of employing cross-sectional or longitudinal data to investigate changes in risk perceptions over time. The findings also indicate that pessimistic predictions of a continued decline in tourism appear to be unwarranted.

The future is yesterday: Use of AI-driven facial recognition to enhance value in the travel and tourism industry.

This study aims to investigate the role of artificial intelligence (AI) driven facial recognition to enhance a value proposition by influencing different areas of services in the travel and tourism industry. We adopted semi-structured interviews to derive insights from 26 respondents. Thematic analysis reveals the development of four main themes (personalization, data-driven service offering, security and safety, and seamless payments). Further, we mapped the impact of AI- driven facial recognition to enhance value and experience for corporate guests. Findings indicate that AI-based facial recognition can facilitate the travel and tourism industry in understanding travelers' needs, optimization of service offers, and value-based services, whereas data-driven services can be realized in the form of customized trip planning, email, and calendar integration, and quick bill summarization. This contributes to strengthening the tourism literature through the lens of organizational information processing theory.

Do economic development and tourism heterogeneously influence ecological sustainability? Implications for sustainable development.

While economic development-driven anthropogenic emissions pose challenges to ecological sustainability, the international travel and tourism sector has appeared as a hot contestant to bring sustainability to the ecological systems across varying development levels. This work investigates the diversified effects of the international travel and tourism sector and economic development on ecological deterioration, in the presence of urban agglomeration and energy use efficiency, across the development levels of China's 30 provincial units from 2002 to 2019. It contributes in two ways. (i) The stochastic estimation of environmental impacts by regression on population, affluence, and technology (STIRPAT) is modified to integrate the variables like international travel and tourism sector, urban agglomeration, and energy use efficiency. (ii) We measured an international travel and tourism sector index (ITTI) and made use of a continuously updated bias correction strategy (CUBCS) and a continuously updated fully modified strategy (CUFMS) for the long-term estimations. Besides, we used the bootstrapping-based causality technique for determining causality directions. The core results are as follows: Firstly, ITTI and economic development produced an inverse U-type association with ecological deterioration for the aggregate panels. Secondly, provinces exhibited a diverse range of links in that ITTI mitigated (boosted) the ecological deterioration in eleven (fourteen) provinces presenting diversified shapes of linkages. Economic development established the environmental Kuznets curve (EKC) theory with ecological deterioration in merely four provinces; however, the non-EKC theory is verified in twenty-four divisions. Thirdly, in China's east zone (high development scale), the ITTI revealed the ecological deterioration reduction (promotion) impact in eight (two) provinces. China's central zone (moderate development scale) exhibited ecological deterioration promotion in half of the provinces, and the other half showed a reduction impact. In China's west zone (low development scale), it promoted ecological deterioration in eight provinces. Economic development promoted (reduced) ecological deterioration in a single (nine) province(s). In China's central zone, it boosted (mitigated) the ecological deterioration in five (three) provinces. In China's west zone, it promoted (reduced) ecological deterioration in eight (two) provinces. Fourthly, urban agglomeration and energy use efficiency deteriorated and improved the environmental quality in aggregated panels, respectively; however, a diverse range of effects are observed for provinces. Finally, a unilateral bootstrap causality, from ITTI (economic development) to ecological deterioration, is revealed in twenty-four (fifteen) provinces. A bilateral causality is established in a single (thirteen) province(s). Based on empirical findings, policies are suggested.

Examining the Mediating Effect of Customer Experience on the Emotions-Behavioral Intentions Relationship: Evidence from the Passenger Transport Sector.

The aim of this research is to examine the influence of customer experience on the customers' emotions-customers' behavioral intentions relationship. Moreover, this study seeks to obtain data that will help to address this research gap in the passenger transportation industry. A large-scale survey on the coastal line shipping industry was conducted. The random sampling methodology was employed, and the target respondents were ferry passengers. The anonymized questionnaires were completed by 840 passengers. The data were analyzed through exploratory and confirmatory factor analyses and regression analysis. The findings verified application of the adopted (customer experience, emotions) and adapted (behavioral intentions) measurement instruments in the examined customer journey in the passenger shipping sector and indicated the mediating role of customer experience in the relationship between customers' emotions and customers' behavioral intentions. A distinguishing feature of this work is that it measures and assesses emotions during the customer journey and not afterward based on recall journeys. Additionally, although academics have carried out extensive research on the emotions-behavioral intentions relationship, very little is known about the role of customer experience in this relationship. Thus, what is not yet clear is the impact of customer experience on the emotions-behavioral intentions relationship. Additionally, the measurement instruments used to test this research hypothesis were empirically tested for the first time in the passenger shipping service environment.

An empirical study on assistive technology supported travel and tourism for the people with dementia.

Purpose: Research shows that people with disabilities have same desire for travel and tourism as others, but many constraints prevent them from independent travelling. Although the disabled tourism market is expanding, still there is lack of empirical research on impact analysis of assistive technology (AT) assisted travel and tourism with focus on the people with dementia (PWD). This study investigates the impacts of AT assisted travel and tourism for the PWD.Methods: The questionnaire-based survey gathered data from 327 PWD. SPSS is used to perform exploratory factor analysis and canonical coefficient analysis for investigating the usability of AT assistance in travel and tourism.Results: Results reveal four motivational (facilitated travel and tourism, cost effectiveness, easier communication and needs compatibility) and three achievements dimensions (improved achievements, improved independence and improved safety). Independent travel is desired by the PWD without any external help and ATs can help them in doing so. The use of AT can further accommodate in choosing the tourism activities, attractions and leisure management. The PWD feel improvements in their achievements through the use of ATs in travel and tourism.Conclusions: AT support, resultantly improves the confidence and self-esteem of the PWD and motivate them towards rehabilitation and independent living.Implications for rehabilitationThis study provides finer empirical understanding of the needs, motivations and achievements of the people with dementia (PWD) who use assistive technologies (ATs) for travel and tourism.Usually PWD have different motivations and accessibility needs, their travel and tourism related behaviours might also differ from the people not identified as having dementia.The ATs (facilitated travel and tourism, cost effectiveness, easier communication and needs compatibility) are the motivational factors for the PWD and should be focused during the development of ATs. These factors will allow PWD to better plan their travel and tourism activities without the help of their caregivers. The AT assisted communication opportunities will help PWD to eliminate their feeling of social isolation from rest of the community.AT supported travel and tourism results into sense of improved achievements, improved independence and improved safety on the part of the PWD. Resultantly, they feel more motivated to do activities, which otherwise they might be reluctant to perform. The sense of safety, independence and achievement does impact PWD psychologically and would help them towards rehabilitation.This study provides pointers for the dementia policy makers related to AT supported travel and tourism based on the real needs of the PWD.

Impact of the Covid-19 pandemic on perceptions and behaviors of university students in Vietnam.

This article presents a novel data set on perceptions and behaviors of university students collected after the beginning of the Covid-19 outbreak in Vietnam. Our questionnaire design is based on employing both qualitative interview with students and survey of SARS literature, probing into the sensitivity of students toward the crisis in making crucial decisions of daily routines, as well as future travel plans in presence of a grave health concern. The data set consists of 440 valid responses from Vietnamese university students through Internet platforms (Facebook, Google Form). Besides descriptive statistics, this article also includes the results of explanatory factor analysis, which may serve as a good reference for future studies.

Prevalence of HIV-1 in east African lorry drivers.

Sixty-eight lorry drivers and their assistants were examined for evidence of infection with HIV-1 because of their association and regular contact with prostitutes. Out of a total of 68 drivers, 24 (35.2%) were serologically found to be HIV-1 positive. Epidemiological evidence demonstrated a wide travel history involving seven different countries served by the port of Mombasa. History of other sexually transmitted disorders were significantly higher in HIV-seropositive individuals. The data presented here further support the hypothesis that a major route of heterosexual transmission of HIV in Africa is dissemination through a group such as lorry drivers and their assistants, whose behaviour puts them at risk of acquiring sexually transmitted diseases.

PIP: Participants in the study were drivers and turnboys who passed through a transport depot in Kampala, Uganda, in November 1986. Each participant answered a questionnaire aimed at determining basic demographic data, countries visited within the previous 3 years, level of prostitute contact within those countries, and whether they had had a history of urethral discharge or genital ulceration. A total of 45 drivers and 23 turnboys with a mean age of 38 and 26 years, respectively, were interviewed and blood samples were taken. Serological controls were selected from people of the same age as the study group from individuals donating blood. Serum immunoglobulin (Ig) antibodies to HIV were determined by a competitive enzyme-linked immunosorbent assay and a competitive ELISA using recombinant HIV core and envelope proteins. All serological results were verified by immunoblot assays or were prepared by electrophoretic separation of U937 cell lysates infected with a Ugandan HIV-1 isolate. Antibodies to Treponema pallidum were detected by a hemagglutination test. They were of Ugandan (66.2%) or Kenyan (33.8% ) origin. All were sexually active, and all denied homosexuality and intravenous drug use. The overall HIV-1 seropositivity rate was 35.2%, compared with the control group of 9.2% (24 out of 68 versus 12 out of 130; p 0.01). Using the antigen detection systems, 7 of the seronegative sera proved to be antigen positive. In addition, 4 out of the 24 seropositive sera (16.6%) also proved to be antigen positive. 36.7% of the population admitted more than 50 lifetime sexual partners. Of the remainder, 83.7% had had more than 10 lifetime sexual partners. The level of urethral discharge and genital ulceration revealed a significant difference (p 0.01) between seropositive and seronegative individuals. The overall level (55.8%) of T. pallidum antibodies among drivers and turnboys was significantly higher than in the control group (p 0.01). The drivers had the highest level of T. pallidum antibodies (62.2%) compared with turnboys (43.8%), reflecting the older average age and, thus, the greater sexual experience.

HIV risk behavior among Peace Corps Volunteers.

OBJECTIVE: To describe HIV risk behaviors among Peace Corps Volunteers (PCV) and to examine correlates of sexual risk behaviors. METHOD: Cross-sectional data were collected from 1242 randomly selected PCV serving in 28 countries in 1991. PCV reported the frequency of specific risk behaviors in self-administered questionnaires, which were completed anonymously and returned to the Centers for Disease Control and Prevention. RESULTS: Non-sexual HIV risk behaviors were rarely reported by PCV. Sixty-one per cent of the 1080 PCV who answered questions about sexual behavior during their Peace Corps service reported having at least one sex partner. Sixty per cent of PCV had another PCV partner, 39% had a host-country national partner, and 29% had a non-PCV expatriate partner. Overall, less than one-third (32%) of unmarried PCV used condoms during every episode of sexual intercourse; more frequent use was reported in relationships with non-steady and (for male PCV) host-country national partners. Among male PCV, condom use was positively related to lower alcohol use and the belief that HIV was a problem in the host country. Female PCV reporting more condom use with male partners were younger and had fewer partners than those reporting less use. CONCLUSION: These data indicate that PCV are at risk for acquiring HIV through unprotected vaginal intercourse. All persons who become sexually active with new partners while travelling or living abroad should be encouraged to use condoms consistently.

PIP: At least 10 former Peace Corps volunteers are believed to have acquired human immunodeficiency virus (HIV) during their time of service. To assess HIV risk behavior among current Peace Corps volunteers, cross-sectional data were collected from 1242 randomly selected volunteers in 28 countries in 1991. 474 (38%) were stationed in sub-Saharan Africa. Non-sexual HIV-related risk activities included injection from local health facilities (209) and ears or body parts pierced (59). Of the 1018 volunteers who were unmarried or not living with a spouse, 61% of men and 60% of women indicated they had at least one sexual partner during their time of service; 30% and 20%, respectively, had three or more partners. Only 17 men and 12 women reported having a same-sex partner. 52% of sexually active Peace Corps volunteers stationed in Eastern Europe, 43% of those in Central or South America, 36% in sub-Saharan Africa, and 32% in Asia and the Pacific had a sexual partner from the host country. 32% of these volunteers used condoms on every occasion with partners from the host country, 49% used condoms some of the time, and 19% never used them. For male volunteers, consistent condom use was negatively associated with alcohol use and positively related to the perception that HIV was a problem in the host country; for female volunteers, younger age and fewer partners were the significant correlates of condom use. The inconsistent use of condoms in countries where HIV is widespread suggests a need for Peace Corps leaders to educate volunteers about local seroprevalence rates, cultural differences in sexual negotiation, and the importance of condom use.

AIDS knowledge, risk behaviors, and factors related to condom use among male commercial sex workers and male tourist clients in Bali, Indonesia.

OBJECTIVES: To describe the AIDS/sexually transmitted diseases (STD) knowledge and risk behaviors, and to determine factors related to condom use among male commercial sex workers (CSW) and male tourist clients in Bali, Indonesia. DESIGN: Individual survey interviews were conducted with a sample of 80 male CSW and 100 tourist clients in the Kuta area of Bali. METHODS: Survey interviews included detailed questions on AIDS/STD knowledge, sexual behavior, and psychosocial measures related to risk taking. RESULTS: Most of the male CSW had heard about AIDS and other STD, although some misconceptions about transmission and risks of different sexual practices remained. Both oral and anal intercourse with tourists were common and condom use was far from consistent. Factors related to condom use for anal intercourse with tourist clients were condom beliefs, self efficacy, susceptibility to STD infection, and STD knowledge. Tourist clients were mainly from Australia and Europe and many had paid for sex in other parts of Indonesia as well as in high prevalence countries. Knowledge of AIDS/STD was very good among the tourists and previous experience with STD was common. Factors related to condom use with male CSW were condom beliefs and self efficacy. CONCLUSION: There is a very active and mobile group of male CSW and tourist clients present in Bali. Interventions with these men are needed due to the low level of knowledge about AIDS among CSW, their experience with STD and STD symptoms, and their level of risky sexual behavior.

PIP: Interviews conducted in 1992-93 with 80 male commercial sex workers in Bali, Indonesia, and 100 of their tourist clients revealed low levels of accurate knowledge about acquired immunodeficiency syndrome (AIDS) and widespread high-risk sexual behaviors. Although most male sex workers were aware of AIDS, 30% did not know that healthy-appearing persons could be infected. The mean number of clients in the week preceding the interview was 2.8 (range, 0-12); 61% had engaged in anal intercourse in that period. Condom use with clients averaged 48% for receptive anal intercourse, 55% for insertive anal intercourse, and 14-17% for oral intercourse; these rates were 19%, 33%, and 0%, respectively, for unpaid partners. Only 30% of clients serviced by male prostitutes insisted on condom use. Factors related to condom use with commercial clients were condom beliefs, self-efficacy, perceived susceptibility to infection, and knowledge of sexually transmitted diseases. The tourist clients, 60% of whom were from Europe and 25% from Australia, were significantly older (mean age, 38.4 years) than the sex workers. 64% reported a history of STD infection, primarily gonorrhea. In the week before the interview, clients had an average of 1.7 paid and 0.3 unpaid partners and 53% engaged in anal intercourse. Condom use was 75% for receptive and 69% for insertive anal intercourse. Although 87% of tourists brought condoms to Bali, only 62% knew of a local source. Factors related to condom use with a commercial sex worker were condom beliefs and self-efficacy.

Sexual risk of HIV infection among expatriates posted in AIDS endemic areas.

OBJECTIVE: To assess the prevalence of HIV infection and related risk factors among Dutch expatriates returning from assignment in sub-Saharan Africa, Latin America, and South and South-east Asia. METHODS: From July 1994 to January 1996, a questionnaire on the risks of sexual exposure was completed by 864 respondents, and blood samples were taken. RESULTS: Of the 634 men, 41% reported having sex with casual or steady local partners and 11% with casual or steady expatriate partners, during an average stay of 26 months in the previous 3 years. Of the 230 women, these figures were 31 and 24%, respectively. Of the men with local casual partners (29%), 59% paid for sex at least once. For men as well as women, having sexual contacts abroad was associated with younger age, positive intention prior to departure to have sex abroad, being single at departure, and, only for the men, working for a commercial organization, and feelings of loneliness and boredom. Among men, consistent condom use with casual local partners was 69%, and with casual expatriate partners 63%. Among women, these figures were 64 and 48%, respectively. Consistent condom use with steady local or expatriate partners was much lower. Among men, non-consistent condom use with casual partners was more prevalent if they had been abroad for a longer time, condoms were not taken along from The Netherlands, the country where they were posted was Asian, and the estimated HIV prevalence among the local population was lower. Among the women, non-consistent condom use was more prevalent if condoms were not taken along, and if they did not have the intention before departure to have sex abroad. Of the persons from whom blood could be obtained, one man was HIV-positive. Another man who refused to participate in the study indicated that he was HIV-positive. CONCLUSIONS: Although 23% of the expatriates had unprotected sex with partners from endemic areas, very few HIV infections were found. In comparison with a previous study among this population carried out in 1987-1989, which found five out of 1968 expatriates to be HIV-infected, consistent condom use with casual local partners did increase considerably (from 21 to 67%). However, health education is needed to reduce the risk of HIV infection, which should emphasize the sociocultural differences in sexual practices.

PIP: A survey conducted among 864 Dutch expatriates returning home from assignment in AIDS-endemic areas in sub-Saharan Africa, Latin America, and South and South East Asia revealed a low rate of HIV infection, despite widespread high-risk sexual practices. During an average stay out of the country of 26 months in 1991-96, 41% of the 634 male respondents reported sex with casual or steady local partners and 11% with casual or steady expatriate partners. Among the 230 female expatriates, these rates were 31% and 24%, respectively. 58% of men with casual local partners paid for sex at least once. Among men, consistent condom use was practiced in 69% of encounters with casual local partners and 63% of the time with casual expatriate partners. Among women, these rates were 64% and 48%, respectively. The prevalence of consistent condom use with casual local partners in this study was three times greater than that identified in a study conducted among Dutch expatriates in 1987-89. Condom use with regular local or expatriate partners was substantially lower (16.1-27.8%), however. Inconsistent condom use with casual partners was significantly associated, among men, with being abroad for a longer period of time, failure to bring condoms with them from the Netherlands, posting in an Asian country, and a relatively low estimated HIV prevalence in the local population. Among women, these risk factors were failure to take condoms to their destination and lack of intention at departure to have sex abroad. Only one case of HIV infection was detected in the 847 respondents who underwent serologic testing. Since expatriates function as a bridge between areas with high and low HIV prevalence, educational campaigns that prepare departing workers for differences between the sexual culture at home and abroad and encourage them to take a supply of condoms are recommended.

Impact of maternal HIV infection on obstetrical and early neonatal outcome.

In a case-control study of 177 HIV-seropositive and 326 seronegative women and their newborns in Nairobi, Kenya, maternal HIV infection at term was independently associated with travel to other African countries [odds ratio (OR) 4.9, P less than 0.0001], history of a blood transfusion since 1980 (OR 3.5, P = 0.01), history of more than one sexual partner in the previous 5 years (OR 1.8, P = 0.02) and unmarried status (OR 1.8, P = 0.02). Neonates of HIV-positive and HIV-negative women differed little with respect to occurrence of congenital malformations, stillbirths, in-hospital mortality, sex, APGAR score, or gestational age. However, the mean birth weight of singleton neonates of HIV-positive women was significantly lower than that of controls (3090 versus 3220 g, P = 0.005), and birth weight was less than 2500 g in 9% of cases and 3% of controls (OR 3.0, P = 0.007). Among neonates of HIV-seropositive women, birth weight was less than 2500 g in 17% if mothers were symptomatic and 6% if mothers were asymptomatic (OR 3.4, P = 0.08).

The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania.

OBJECTIVE: To determine the prevalence of HIV-1 infection and to identify the most important risk factors for infection. DESIGN: A cross-sectional population survey carried out in 1990 and 1991 in Mwanza Region, Tanzania. METHODS: Adults aged 15-54 years were selected from the region (population, 2 million) by stratified random cluster sampling: 2434 from 20 rural villages, 1157 from 20 roadside settlements and 1554 from 20 urban wards. Risk factor information was obtained from interviews. All sera were tested for HIV-1 antibodies using enzyme-linked immunosorbent assay (ELISA); sera non-negative on ELISA were also tested by Western blot. RESULTS: The response rate was 81%. HIV-1 infection was 1.5 times more common in women than in men; 2.5% of the adult population in rural villages, 7.3% in roadside settlements and 11.8% in town were infected. HIV-1 infection occurred mostly in women aged 15-34 years and men aged 25-44 years. It was associated with being separated or widowed, multiple sex partners, presence of syphilis antibodies, history of genital discharge or genital ulcer, travel to Mwanza town, and receiving injections during the previous 12 months, but not with male circumcision. CONCLUSION: This study confirms that HIV-1 infection in this region in East Africa is more common in women than in men. The results are consistent with the spread of HIV-1 infection along the main roads. There is no evidence that lack of circumcision is a risk factor in this population.

PIP: Between August 1990 and February 1991, health workers took blood samples from, and trained interviewers spoke to, 5145 15-to-54-year-old adults living in either an urban area (1554), in a rural village (2434), or in a roadside settlement (1157) in the Mwanza Region of Tanzania to determine the prevalence of HIV-1 infection and its most significant risk factors. The prevalence rate of HIV-1 infection was highest in urban areas, lower in roadside settlements, and lowest in rural areas (11.8%, 7.3%, and 2.5%, respectively), suggesting that HIV-1 had spread along main roads. Yet, there were as many people infected with HIV-1 in rural areas of the Mwanza Region as there were in Mwanza town. Women were 1.2 (rural) to 1.7 (urban) times more likely to be infected with HIV-1 than were men, indicating greater efficiency of HIV-1 transmission from men to women than from women to men. HIV-1 infection peaked in the 15-to-34-year-old group in women and in the 25-to-44-year-old group in men. Separated, divorced, or widowed men and women were at increased risk of being HIV-1 infected, even when controlled for numerous factors (odds ratio (OR) = 3.4 and 1.6, respectively). This may have been an indication of multiple partners, since the question concerning multiple partners was vague. Other important risk factors for women and men were syphilis antibodies (OR = 1.7 and 1.85), history of genital discharge or chancroid (OR = 2, 1.6 and 2.7, 1.6), travel to Mwanza town (OR = 2.1 and 1.7), and receiving injections during the previous 12 months (OR = 1.5 and 1.9). There was no link between male circumcision and HIV-1 infection. In fact, there seemed to be a moderate protective effect (OR = 0.8). This effect may be even more likely since urban men, who were at greatest risk of HIV-1 infection (8.7% vs. 5.4% [roadside] and 2.4% [rural]), had the highest rate of circumcision (61% vs. 29% and 17%, respectively).

HIV-1, sexual practices, and contact with foreigners in homosexual men in Colombia, South America.

From October 1985 to November 1987, a sample of 294 Colombian homosexual men volunteered to answer a questionnaire on sexual practices and consented to HIV-1 testing. Testing for HIV-1 was performed using an ELISA and those positive were confirmed with envelope- and core-specific ELISAs. Statistical methods for data analysis included Mantel-Haenszel methods on contingency tables. The overall seropositivity rate was 21.1%. Subjects who reported a receptive role (either as predominantly receptive or as mixed receptive-insertive intercourse) had a seropositivity rate of 23.7%, which was significantly higher than the 10.3% found in those reporting predominantly insertive intercourse (RR = 2.30, 95% C.I. = 1.16-4.57). For subjects reporting receptive intercourse, sexual contact with foreign visitors was a significant risk factor for HIV-1 infection (RR = 1.84, 95% C.I. = 1.13-3.00). Factors of borderline significance included having had more than ten homosexual partners in the preceding year (RR = 1.53) and a history of international travel (RR = 1.43). These associations did not hold for those reporting predominantly insertive intercourse. The data indicate the need to monitor the spread of HIV-1 at the international level and provide information on subgroups of high transmission rates.

Anti HIV-2 serological screening in Portuguese populations native from or having had close contact with Africa.

PIP: To gather epidemiologic information on the spread of human immunodeficiency virus (HIV)-2 in Portugal, sera were collected in 1985 from 156 healthy adults currently living in Portugal but natives of Guinea Bissau, Cape Verde Islands, Saint Tome/Prince, Angola, and Mozambique and from 321 native Portuguese men and women who had close contact with local African populations. As a control, sera were collected from 102 health Portuguese with no previous contact with Africa or African natives. The enzyme-linked immunosorbent assay (ELISA) developed by Diagnostic Pasteur was used to screen for antibodies to HIV. No positive reactions were recorded in the control population. In contracts, 9 (6%) of the African natives and 7 (2%) of the contacts of Africans were HIV-positive, 6 of the positive sera were from women and 10 were from men. Significantly, 1 of the HIV-2-positive serum samples was from a native of Mozambique and 3 were from natives of Angola. This suggests that HIV-2 infection may have spread to other former Portuguese colonies, and foreign army soldiers who were at 1 time residents of Mozambique or Angola should be considered a risk group capable of spreading HIV-2 infection to other countries.^ieng

Macroepidemiology of the HIVs-AIDS (HAIDS) pandemic. Insufficiently considered zoological and geopolitical aspects.

The human immunodeficiency viruses (HIVs)-acquired immunodeficiency syndrome (AIDS) or HAIDS pandemic originated from lentiviruses of nonhuman primates (thus qualifying as a zoonosis) that moved into humans in Africa. The HAIDS patients eventually die of opportunistic infections, all potentially zoonotic. The HAIDS infection remained parochial, first endemically and then epidemically, until the African urbanization that occurred in each of the countries postindependence. The latter included wars and the massive movement of soldiers (virologically naive) from the American continent to Africa and back. The HAIDS viral ecology coincided with African swine fever (ASF) in the Americas. Haiti became the focal point for both infections. Some infected Haitians also became, together with some infected drug addicts in the United States, a source of contaminated human blood for transfusions and production of plasma derivatives.

PIP: Nonhuman primate lentiviruses are the source of the HIV/AIDS (HAIDS) pandemic among humans. Thus HAIDS constitutes a zoonosis. Opportunistic infections which generally are the immediate cause of death in HAIDS patients tend to be zoonoses. Some of these include tuberculosis, cryptococcosis, cytomegalovirus, toxoplasmosis. Pneumocystis carinii, Listeria monocytogenes, and candidiasis. The HAIDS viral ecology paralleled the intense migration of African swine fever into the Caribbean and the continental Americas. Haitian laborers and prostitutes went to Zaire and later returned. Sexual tourism in Haiti and poor Haitian selling their blood for transfusions and production of plasma derivatives to be marketed to developed countries such as the US and France contributed to the spread of HAIDS from Haiti to developed countries. Thus African swine fever and HAIDS originated in this hemisphere from Haiti after being bought to Haiti from Africa. HAIDS began as an endemic regional disease in Africa then became a regional epidemic disease. After African countries gained independence, urbanization increased in Africa which accounted for the spread of HAIDS in each African country. The US and the USSR played their geopolitical games using and/or resulting in famine, war, and disrupted families on the African continent and elsewhere. Thus husbands from 1 continent were moved to armies and labor camps sometimes on another continent. Prostitution spread tremendously to fulfill women's economic needs and men's sexual needs. HAIDS spread along with these events, e.g. Cuba sent troops to Angola where they were mostly stationed near 2 countries with high HAIDS rates, Zaire and Namibia. These troops often returned to Cuba then returned to Africa. During the 1980s, HAIDS prevalence was 45 times higher among Cuban boat refugees and Marielito Cuban immigrants to the US than that claimed for all of Cuba. In fact, their HAIDS prevalence matched that of Cuba's Caribbean neighbors.