Abstract
Background:Increased travel abroad has a significant impact on the incidence and prevalence of Sexually Transmitted Infections (STIs). Previous reviews have focused on the knowledge, attitudes and behaviour of tourists and acquisition of STIs. Less is known about the impact on tourism operators in countries visited by tourists. The aim of this review is to ascertain factors influencing sexual behaviour between workers in the tourism industry and tourists; exploring the prevalence of sexual behaviour between the two populations, their perceptions of sexual risk while engaging in sexual activities and the knowledge of tourism operators regarding STIs.Methods:A systematic review was conducted. Database searches were performed in Medline/Ovid, EMBASE, Cochrane library and CINAHL for studies published between 2000 and March 2016. Grey literature searches were completed in the NHS database and Google Scholar between 2000 and December 2013. Papers were independently selected by two researchers. Data were extracted and critically appraised using a pre-designed extraction form and adapted CASP checklist.Results:The search identified 1,602 studies and 16 were included after review of the full text. Studies were conducted in nine countries. Findings suggest that STI knowledge, attitude and practice were fairly good among tourists and tourism workers, but there is a need for pre-travel advice for travellers, especially those travelling to low and middle-income countries. Greater importance was given to tourists than to tourism operators and locals interacting with tourists. Studies suggest that as a group both tourist and tourist workers were likely to engage in sexual activities. Overall, both condom use and STI screening were low, among tourists as well as tourism operators. Furthermore, studies reported links between drug and alcohol use and sexual behaviour and risk taking.Conclusion:Although less research appeared to have been conducted among tourism workers than tourists, it does demonstrate the need for education, training and promotion of travel medicine. STI screening, pre-travel advice, travel history in terms of contracting STIs and safe-sex awareness-raising are needed. More and better sexual health education and relevant tourism policies are needed globally.
Highlights
Increased travel abroad has a significant impact on the incidence and prevalence of Sexually Transmitted Infections (STIs)
Sexual behaviour in travellers Sexual behaviour of young visitors to Ibiza, sexual risk taking & substance use Sexual behaviour of young British working in bars and nightclubs Sexual behaviour, prevalence & knowledge of STI in tour guides Risk factors casual / protected sex Condom use of female bar/hotel workers HIV & STIs
In terms of tourism workers, the risks of STIs were associated likely (55.0% versus 47.9%) to sexually approach them than with substance misuse, condom use, number of sexual the other way round [10], others noted that sexual encounters partners, history of STIs, risk perception and working among tourists and tourism operators/ local partners were conditions
Summary
A systematic review was conducted using a review protocol developed by the research team following PRISMA guidelines [6]. Quantitative, qualitative and mixed-methods studies focusing on sexual behaviour between tourists and tourism operatives were eligible for inclusion. This review draws on research conducted on the knowledge, attitude and practice of tourists and tourism workers regarding STIs (including HIV) and measures used to prevent infection. Studies conducted in any country were considered. A total of 16 papers were included in this review (Table 1). The database search provided a total of 4,010 papers. Duplicates were removed using the Mendeley Desktop 1.11 software resulting in 1,602 papers. Six studies were removed after review of full text due to insufficient information and one additional study was included from hand-searching (Figure 1)
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