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Try out PMC Labs and tell us what you think. Learn More. research with travelers points to higher risk behaviors during vacations. Relative to their day-to-day lives, leisure travelers have more free time to pursue sexual activities and are likely to engage in higher rates of substance use than when at home.
Risk behaviors during vacation have not been thoroughly examined in men who have sex with men MSMa key group at risk for HIV. Almost half of the sexually active men reported having sex with a partner of unknown HIV status while in New Orleans and a similar did not disclose their own HIV status to all of their sexual partners.
Traditional HIV prevention interventions do not readily lend themselves for use with transient populations. New intervention approaches are needed to reduce sexual risk behaviors in persons traveling for leisure.
Persons traveling on vacation may be particularly likely to engage in high-risk sexual behavior. Compared to their everyday lives, travelers have more free time to pursue sexual activities and are likely to engage in higher rates of substance use. A small of studies have examined risk behaviors in travelers who are men who have sex with men MSM.
Whittier and colleagues collected data from men vacationing in a popular beach town on the American east coast.
Men on vacation reported 11 times more non-main sexual partners with whom they had engaged in unprotected anal intercourse at the resort community, versus at their homes. In a second study with MSM travelers to Key West and Rehoboth Beach, Delaware, we found that unprotected sex was associated with substance use and use of medications to facilitate sexual activity e. Mardi Gras celebrations in New Orleans attract more than 1 million visitors each year, including ificant s of MSM.
Traditional festival activities include parades, dancing, alcohol consumption, and public displays of nudity, which are rewarded with be or other tokens.
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As is the case with some other tourist destinations popular among MSM, a permissive atmosphere prevails, with many celebrants encouraging and reinforcing disinhibited behavior in their fellow festival attendees. Although studies have documented high-risk sexual behavior in persons on vacation, few studies have examined the factors associated with risk among MSM traveling in the United States, particularly within the context of a coherent theoretical framework.
research has supported the utility of the IMB model in predicting risk and in planning intervention activities. Louisiana ranks sixth among U. Recruiters were outreach workers with substantial experience working with MSM. Participants were told that the survey was about the behavior of men on vacation, contained personal questions about their sexual history and substance use, was anonymous, and required approximately 10 minutes to complete. No formal incentive payment was offered, but participants were given Mardi Gras be upon survey completion. A total of men completed the self-administered questionnaires.
In order to insure that we were including in the analyses only individuals who were visitors to New Orleans, we asked participants to provide their home zip code. Men that provided a home zip code indicating that they traveled at least 50 miles to visit New Orleans were classified as visitors. Participants were asked their age, years of education, ethnicity, home zip code, sexual orientation, and HIV status.
We asked participants how many days they had spent in New Orleans on their current trip. Participants reported the total of times they had engaged in protected and unprotected receptive anal sex and protected and unprotected insertive anal sex during their present trip. They also reported the of partners with whom they had engaged in each of these acts.
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In addition, participants responded to yes or no questions asking whether or not they had asked all of their sexual partners about their HIV status, and if they had disclosed their own HIV status to each of their sexual partners. Measures of sexual behaviors similar to those used in the present study have acceptable reliability and have shown utility in research. Similar items have shown utility in research. Items were modified from measures validated in research. Three items measured personal motivations or expectations for sex on vacation on the same 4-point scale.
All surveys were examined for inconsistencies and invalid responses.
Missing data were omitted from analyses, resulting in slightly different ns for various statistical tests. Because distributions of sexual behavior were highly skewed, nonparametric analyses were used as recommended by Hays. Among the eligible participants, the mean age was The majority of the sample was White The sample represented diverse regions of the United States: participants reported 92 distinct home zip codes, representing 23 U.
Participants were most likely to report that they were HIV-negative At the time of survey completion, participants had spent an average of 3. The mean of unprotected insertive acts for the sexually active men was 0. The mean of unprotected receptive acts for the sexually active men was 0.
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Substance use in conjunction with sexual activity was associated with higher risk behaviors. Participants demonstrated high knowledge concerning how HIV is transmitted. Overall, the mean score on the 5-item knowledge test was 4. As shown in Table 1the majority of participants believed that their friends would use condoms while having sex on vacation. Similarly, only a minority of participants believed that their friends would have unsafe sex on vacation when using drugs or alcohol. Many participants appeared to have a heightened motivation for sex when on vacation.
As shown in Table 1most participants indicated that finding a new sex partner is part of what makes a vacation fun. A ificant minority of participants also believed that their interest in sex and their sexual activity increases when on vacation. As shown in Table 2participants had relatively high confidence that they could maintain safer sex practices even in a high-risk situation. Almost three-quarters Lower knowledge was associated with higher sexual risk behaviors.
Expectations were unrelated to unprotected receptive acts or partners. Perceived peer norms were not associated with sexual risk behavior in this study. Personal self-efficacy for avoiding high-risk behaviors was not related to sexual risk activity in the present sample. We performed a multivariate logistic regression analysis to examine the independent effects of different IMB constructs on sexual risk behavior.
Factors of the IMB Model AIDS knowledge, perceived peer norms, expectations of sex on vacation, and self-efficacy were entered as a block to predict if a participant had reported unprotected anal sex during his stay in New Orleans. The majority of participants in the present study did not report high-risk sexual behavior during their visit to New Orleans. A substantial minority, however, did report sexual behavior that could place them or their partners at risk for HIV or STD infection.
Participants appeared to be well informed as to the modes of HIV transmission. This is consistent with the large of HIV prevention programs directed at MSM, most of which have a strong informational or educational component. It may be beneficial to sensitize travelers to the risks associated with travel. For example, although participants demonstrated accurate HIV transmission knowledge, they were less likely to know that New Orleans is a relatively high HIV prevalence area.
Information strategies might also incorporate health information into travel brochures or the travel web sites geared towards MSM. Sections featuring cities that attract large s of MSM tourists might include information on attractions, hotels, restaurants and safer sex tips. In many of these locations, high alcohol and substance intake are common, and a party atmosphere prevails.
The IMB model suggests that motivation is an important factor in modifying sexual risk behavior. We found a small, but ificant, relationship between expectations regarding finding sexual partners on vacation and sexual risk behavior. Insofar as travelers are choosing destinations based on the availability of willing sexual partners, it may be unrealistic to attempt to modify these attitudes.
A useful approach may be to attempt to influence expectations regarding the outcomes of such behavior. If MSM vacationers have some expectation of negative consequences from engaging in high-risk behaviors, they may be motivated to take fewer risks.
Most men in the present study were confident in their ability to maintain safer-sex behaviors under difficult conditions. However, safer-sex self-efficacy was not a ificant predictor of safer behavior. Instilling the behavioral skills necessary for HIV prevention in a transient population is inherently challenging. Most effective HIV prevention interventions rely on multiple contacts with intervention participants, which is not a practical approach for use with travelers. However, one of the necessary conditions for condom use is condom availability. Efforts should be made to make condoms ubiquitous in MSM tourist areas.
Condom packs with a variety of different, interesting and funny inserts could be provided to guest houses, restaurants, bars and other venues frequented by MSM. As with much work, risk was highest for individuals who used alcohol or drugs in conjunction with sexual activity.
Like much of the literature, the present preliminary study was limited by the use of convenience samples. Generalization to all MSM travelers or travelers to other types of tourist areas may not be warranted. An additional limitation was the necessity of utilizing very brief assessments of complex constructs.
Guided only by the scant literature on MSM travelers, we deed reasonable, but necessarily limited, assessments of factors that may predict risk in this population.