Background
Methods
Sample
Data collection
Data analysis
Ethics
Results
Participant characteristics
Characteristic | Sample |
---|---|
Gender | |
Female | 11 |
Male | 2 |
Age | |
25-34 | 5 |
35-50 | 4 |
+ 50 | 4 |
Highest Educational Attainment | |
Bachelor Degree | 7 |
Post-Graduate Degree | 6 |
Professional Rolea/Title | |
Public Health Nurse (RN) | 5 |
Physician (MD) | 1 |
Non-Clinical Administratorsb | 7 |
Years of Experience in Current Field | |
< 5 | 6 |
6-10 | 2 |
11+ | 5 |
Pre-Travel interventions
“It’s really only an overview. Because whether you want it or not, in the pre-departure training, we have to talk about so many other diseases, parasites, this and that. So it [STBBIs] are rarely discussed. You know, we won’t go into details.” [translation]; -male, program officer, travel services, EG11
“We have only one slide on [sexual] health. What is said is things like ‘don’t forget your condoms’ or ‘if you are a woman and are on the pill, talk with your family physician and ask them for a prescription and make sure you have enough’. We tell them ‘condoms are not always available in all sizes in all different countries, so bring what you need’. They’ll find that funny, but at least, we tell them.” [translation]- female, program director, travel services, EG02.
“It’s not our responsibility to do their sexual education necessarily, but we remind them that [sex] isn’t the same abroad, not everything we have here is available abroad, that if they need prescriptions, they need to think about that, to put it on their to-do list. I think it’s part of our responsibility, but I’m not sure that I have the right competence to go in depth [...] We don’t focus on health”. [translation], female, program director, travel services, EG02.
“…we know how difficult it is for people to talk about.. um.. sex in general, sexual assault and harassment in particular, is even more taboo and difficult, so if we talk to them before them [sic] leave, and we tell them that there is a policy and there are procedures and we take this extremely seriously, then when it does occur um- and the percentage of it occurring are quite high …, they’ll be more likely, one, to report it if um they’re the victims of harassment or assault, and two, to be more aware of it happening in their environment”. female, program director, travel services, EG07
“Our patients- it’s really to talk about safe sex, uh, we will discuss if they’re travelling to a country where there’s a high incidence of HIV. … I talk about, for young girls, especially travelling to certain places where it might be dangerous for them, that there has been cases of rape, even, kidnapping in things like group rape”- female, nurse, EG03
“In fact, we talk about sexual harassment, a lot from a work perspective, we also talk about homosexual relations, which for us too is a major issue because in many countries where we operate ... homosexuality, it is either prohibited or criminal, or otherwise it is taboo. Some countries even, it's illegal.” [translation] male, program officer, travel services EG11
“Somebody told me that like years ago, there used to be a message, like ‘no sex is best’, and they said that was so silly because people are gonna do what they wanna do, so you should be telling them more, you know, how to protect themselves in the decisions they make.”- female, program director, travel services, EG07
“In our first aid kit, we have condoms and Plan B [morning after pill]. Still, it [having sexual relationships]'s forbidden. They have signed a contract that says they can’t have sex, whether it’s sex with locals or with people from the groups. You know, we are pretty clear on that. But we could give condoms and Plan Bs. You know, at some point, they are adults and we know it can happen. So we tell ourselves that if it happens, we can deal with it” [translation] – male, program officer, travel services EG11
Barriers to sexual health promotion
“In terms of travel, because you’re seeing sometimes someone for the first time, and there’s a lot of things you need to cover. Because they’re more concerned about what vaccines they need, right? There’s a lot to cover so…I mean, I would say the sexual health part kind of gets squeezed a bit…just for time. But, I mean, I always make the attempt to talk about it”- male, travel physician, EG08
“[…] it’s time limited, and there are many clinics, or speakers, who I know who will say that, you know, we need to incorporate this [sexual health] into our consultations. But it’s easier said than done. I think having written information for clients to take home, that’s really concise, and full of information would be much more beneficial.”- female, travel nurse, EG01
“Sexual health is important for sure. But we consider that they [travellers] are adults, they are university students and they know a little bit about that stuff.” [translation] -female, program director, travel services, EG02.
“I think they’re also very shy. People are just generally shy. And not comfortable speaking about sexual health.” -female, travel nurse, EG01
“Some it seems like they’re just coming in for that vaccine... it’s to get their attention to talk about everything else, but you’ll see their eyes glaze over and you know they’re already thinking, or they’re on their phone texting somebody, and they think that the visit’s over.” -female, travel nurse, EG03
“We have to just judge from their response, whether they’re open to it or not, right? You know, some say, ‘I know, I know, you don’t have to tell me’, like that- then obviously, I’m not gonna go into it too much.” -male, travel physician, EG08
“Often they are paternalized. Often, it’s a bit like you impose a decision on them…Sometimes, youths think they know a lot. We have the feeling that they have an ‘I do not care’ attitude. They [youth] are like ‘Who are you to tell me that kind of things?’” [translation]-male, program officer, EG11.
“I don’t think there are a lot of family doctors or travel clinics who are comfortable talking about this [sexual health; translation].” - female, sexual health nurse, EG04
A humanitarian travel organization key informant seemed ill at ease when discussing sexual health topics during the interview,“That’s why the physician didn’t speak to you [EG]; he doesn’t feel as comfortable. Now he’s an older gentleman, it’s a different generation. He doesn’t like to bring up the sexual aspect of the visit. So I think it’s a matter of even healthcare professionals feeling comfortable enough to discuss it without feeling embarrassed or shy, or feeling like you’re imposing your opinion. But you have to put yourself outside of it somehow and be comfortable to just give factual information, in a way that they’re gonna take it in.” -female, travel nurse, EG03.
“I don’t think it’s [sexual health] a common topic. I don’t know if it’s because the organization might think that talking about it might encourage people…encourage [sexual] actions…For us, it’s difficult…We are all together during fifteen days in the same environment…I don’t think it’s appropriate.” [translation] -female, travel services mission lead, EG13
“Many times, young adults- because of cost issues and finances- may- sometimes will come in, and only- they know they only want Hepatitis A and B. That’s it. Sometimes they don’t want to hear about anything else. Sometimes they only want uh what’s required. And the only thing that is required can be Yellow fever vaccine. There’s nothing else that’s required to go uh into certain countries. So, there are times where they don’t want to listen to a consult, they don’t want all the information; but mostly, it’s because of budget. They have a small budget, and they want the bare necessities… our hands are tied there. Our cost is what it is. Um, we cannot give free vaccines; we cannot lower the prices of our vaccines.” . […]” -female, travel nurse, EG01
“The cost, as in the services we give have a cost behind it. It’s not covered by OHIP [Ontario Health Insurance Plan] if it’s travel. If they’re coming in for their booster, their visit it’s covered by OHIP, but otherwise they’re paying for their services here”- female, travel nurse, EG03
“You never have enough time to get young people- certain young people comfortable enough to start talking and to get really engaged with them. And when you just start to get really close to them, really talking outward and honest with you, and displaying their needs and their issues, and getting questions, their time is up, and you don’t get enough time with them. And our services cost, so it’s not like they can just keep coming back and back and back, and taking all that time. They can’t afford that!” -female, travel nurse, EG09.
Sexual behaviours and travel
“Well, I think we all know that alcohol and sex go to together ... When you’re away, um you will drink- most people will drink more…. where there’s a lot of drinking involved, they’ll absolutely be at a higher risk of sexually transmitted diseases and probably more frequent unplanned sex.”- female, travel nurse, EG01
The anonymity of travel, being away from social networks at home, was recognized as a contributing factor to increased sexual activity abroad. A volunteering program officer explains:“You know, students, when they travel abroad, they party. Often, they party a lot and they meet people and they are more vulnerable” [translation]- female, program director-travel services, EG02.
“You’ll keep your anonymity and you will do more things…and this is the danger that we often witness. You have less pressure, or at least, the pressure you feel is different. While travelling, you’ll do things that you wouldn’t necessarily do. There’s the exotic side of things. People always have risky behaviours, but while abroad, I’ll say that 10-15%, even 10-20% of travellers have problematic risky behaviours. You allow yourself to do more things because you’re just passing through the country. You’re more nonchalant.” [translation] -male, program officer, travel services, EG11
Anonymity is undoubtedly part of the exoticism of travel, but also perceptions that restrictions, obligations and rules are left behind while on vacation. Key informants acknowledged that pre-travel sexual health promotion was necessary to challenge the “what happens in Vegas stays in Vegas” culture frequently embraced by young adults.“Travellers take more risks. There is a lot of infidelity. People travel to have sexual encounters and be unfaithful, because it’s less likely that you’ll have to deal with the repercussions. If they are at home in Ottawa and want to have a one-night stand, casual sex, there are more risks involved that people may see you or that you see your one night partner again. I think that people find it easier to go on a trip and be anonymous. We see a lot of that” [translation]- female, sexual health nurse, EG04
“[…] people will behave differently on vacation. And maybe throw caution to the wind more” -female, travel nurse, EG03
“I’d say that the sexual health of young adults travelling is more at risk as people are in a new context, one of adventures, new experiences and discoveries and because of this thrill they feel, will be less cautious, especially when they just arrived.” [translation] -female, volunteering organization recruitment agent, EG12
A healthcare professional considered that many young adults may return from travel and reflect on their travel-related sexual behaviours with regret, health or safety concerns resulting in “post-travel anxiety”.“… you know the famous notion of when you are abroad, anything goes. Then I think you start to associate it with a lot more abroad than at home…” [translation] -male, program officer, travel services, EG11
“People will travel, come back and only then will the reality strikes. They’ll be very, very anxious and they’ll have regrets about behaviours they had or things that happened. There will be a lot of anxiety like “what have I done”, anxiety towards STIs, towards [STI] testing, things like that. We often see anxious people, coming back from a trip, who have regrets and fears [concerning their sexual health; translation],” -female, sexual health nurse, EG04
Key informant recommendations
“We can obviously do more because we have such a high rate of sexually transmitted diseases, so obviously we’re not doing our job. For sure, there could be more done and more taught. Starting from maybe making it easier taught in schools, but they do talk about it. ….. I do believe that there is a lot of ignorance and a lot of young people, they still think that they are invincible. It only happens once, or it’s not going to happen to me.” -female, travel nurse, EG01
“I think there’s this idea still that maybe a lot of us [young adults] are invincible, and that it happens to other people. And I think there’s a lot of myths and misinformation when it comes to health. Definitely.” - female, sexual health counsellor/coordinator, EG06