Spinal extradural hematoma in an infant with hemophilia A: an unusual presentation of a rare complication.

Epidural hematomas are a rare complication of hemophilia. This article documents the first case of an infant who initially had irritability alone without neurologic symptoms. The infant's disease was diagnosed and treated early and the child had a good neurologic outcome.

AIDS and sex tourism.

PIP: Tourists traveling internationally lower their inhibitions and take greater risks than they would typically in their home cultures. Loneliness, boredom, and a sense of freedom contribute to this behavioral change. Some tourists travel internationally in search of sexual gratification. This motivation may be actively conscious or subconscious to the traveler. Billed as romantic with great natural beauty, Thailand, the Philippines, Brazil, the Dominican Republic, and Kenya are popular destinations of tourists seeking sex. The Netherlands and countries in eastern Europe are also popular. With most initial cases of HIV infection in Europe having histories of international travel, mass tourism is a major factor in the international transmission of AIDS. While abroad, tourists have sex with casual partners, sex workers, and/or other tourists. Far from all tourists, however, carry and consistently use condoms with these partners. One study found female and non white travelers to be less likely than Whites and males to carry condoms. The risk of HIV infection increases in circumstances where condoms are not readily available in the host country and/or are of poor quality. Regarding actual condom use, a study found only 34% of sex tourists from Switzerland to consistently use condoms while abroad. 28% of men in an STD clinic in Melbourne, Australia, reported consistent condom use in sexual relations while traveling in Asia; STDs were identified in 73% of men examined. The few studies of tourists suggest that a significant proportion engage in risky behavior while traveling. HIV prevalence is rapidly increasing in countries known as destinations for sex tourism. High infection rates are especially evident among teenage sex workers in Thailand. Simply documenting the prevalence of risky behavior among sex tourists will not suffice. More research is needed on travelers and AIDS with particular attention upon the motivating factors supporting persistent high-risk behavior.^ieng

Canadian tourist and Dominican Republic sex workers.

PIP: The Dominican Republic is a popular tourist destination for Canadians. The country's sex industry for tourists developed markedly in the 1980s. The Puerto Plata/Sosua area is currently one of the most popular tourist sites and claimed the highest incidence of AIDS in 1989 at 23.2 cases/100,000 people. Two pilot phases of the Dominican Sex Workers and Canadian Tourists Study have been conducted to obtain methodological and empirical data to use in developing a major study of sex and tourism. First phase interviews were held only with beachboys who make money by having relations with female tourists, while phase two interviews were held with beachboys, female sex workers, and female and male tourists. Results indicate that female tourists consider their relations with male sex workers to be primarily social, while male tourists see their relations with female sex workers as more casual, sexual, and monetarily based. Further, women are more likely than men to continue their relationships with sex workers after returning to Canada; many help their men to immigrate and some get married. To learn more about the dynamics of tourism, sex, and AIDS prevention, the author proposes individual studies exploring the characteristics of each of the following four populations: male and female sex workers and male and female tourists.^ieng