Sexual risk-taking during travel abroad – a cross-sectional survey among youth in Sweden

Summary

Background

The aim was to assess sexual risk-taking behaviour in a sample of Swedish youth who were sexually active while travelling abroad and to examine possible associations with sexual risk-taking behaviour during such travel.

Methods

From a population-based sample of 2189 Swedes 18–29 years, 768 who were sexually active while abroad, were assessed by a questionnaire concerning socio-demographic background, life-style, travel duration, sexuality, mental health, heavy episodic drinking (HED) and drug-use.

Results

Approximately 1/4 reported intercourse with a casual partner abroad. Casual sex was associated with HED, 18–24 years, and drug use in both sexes, and for women, also with ≥one month of travel. Among youth with casual partners, 48% reported non-condom use. Non-condom use with a casual partner was associated with 18–24 years, ≥one month of travel for women, and poor self-rated mental health for men. About 10% had ≥2 partners abroad. Having ≥2 partners abroad was associated with ≥one month of travel, and for men also with HED.

Conclusion

Male sex, 18–24 years of age, ≥1 month of travel, HED, and drug use were significantly associated with sexual risk-taking during travel abroad. Poor self-rated mental health and foreign-born parentage might also constitute risk factors for men.

Introduction

Due to the rising incidence of sexually transmitted infections (STI) worldwide [1], sexual risk-taking during travel abroad is an area of increasing public health concern [2]. In high-income countries, youth, defined as 15–24 years [3], represent the age group with the highest prevalence of STI [4]. In Sweden youth are also those who are the most avid foreign travellers [5]. Thus, youth are an important group to consider when examining sexual risk-taking during travel abroad [6]. However, only a limited number of studies have focused on sexual risk-taking among youth while travelling abroad.

To our knowledge only two studies concerning sexual behaviour while travelling abroad have been carried out in a general youth population, and both were conducted in the UK. The two studies showed that 10% and 23% of youth had a new sexual partner while travelling abroad [6], [7] and one of them reported that 25% had inconsistent- or non-use of condom use with a new partner [7]. According to a report issued by the Public Health Agency in Sweden, 9% of persons aged 20–24 years had casual sex during travel abroad and about half of them did not use a condom [8].

Studies made in convenience samples (e.g. backpackers at hostels or in STI-clinics, travellers in departure halls at airports or visitors and casual workers at tourist resorts) showed that 25–80% had a new sexual partner and about 30–55% had ≥2 partners while abroad. Between 35% and 65% reported inconsistent- or non-use of condom [9], [10], [11], [12], [13]. Two studies reported that about 50% of the men and 10–24% of the women intended pre-travel to engage in casual sex on the trip [10], [14].

Sex with a new or casual partner, inconsistent- or non-use of condom and multiple sex partners are commonly used in previous studies, either singly or taken together, as indicators of risky sexual behaviours [6], [7], [9], [10], [11], [12], [13], [15], [16], [17], [18]. They can in turn be seen as proxies for the risk of STI. Few studies of youth travellers have included a diagnosed STI as an outcome [13], [15], [19].

Factors that have been shown to be associated with sexual risk-taking behaviour among youth while abroad are male gender, single status or travelling alone, long-stay travel, pre-travel expectations of sex, excessive alcohol consumption, use of drugs and same-sex behaviour among men [6], [7], [9], [10], [13], [14], [16], [17], [18].

Of all chlamydia-infected in the age group 18–29 years in Sweden 2014, about 8% of women and 7% of men were infected abroad, according to statistics from the Public Health Agency of Sweden. Ten percent of all chlamydia cases had no identified country of origin of infection; thus, these figures may be underestimated. With regard to gonorrhoea in the same age group, about 26% were infected abroad (personal communication: I Velicko, Public Health Agency of Sweden, 27/02/15). Thailand, Spain, Greece and the UK are among the most common countries where Swedes acquire these two infections [20]. These countries are also among the major tourist destinations for Swedes. More than half (57%) of those who were diagnosed with syphilis [21]and the majority (83%) of those who acquired HIV during 2014 had been infected abroad [22]. Those affected were mostly persons who were infected in their country of origin and came to Sweden as a refugee or immigrant family member. About 20% of those who became HIV infected abroad were living in Sweden and were primarily infected in Thailand and Western European cities [20].

In recent decades sexual risk-taking has increased among youths in Sweden. Both the number of partners and casual sex with inconsistent condom use has increased, particularly among young women [23], [24]. To have a regular relationship does not necessarily mean that the risk of STI ceases. In a group of Swedish youth aged 15–29 in a regular relationship in 2009, 11% of women and 10% of men stated that they have had sexual partners outside the relationship [25].

Travel patterns have also changed. To travel for pleasure is the most common reason for youth in Sweden to go abroad, but for today's youth, the world is also a place of work, study and social meetings [26]. Travelling has also become a “rite of passage”. Young Swedes often make a long, low budget trip, e.g. after graduation, before a more established adulthood starts.

Thus far, no systematic studies have been conducted among youth in the general population in Sweden that focus on sexual risk-taking while travelling abroad. According to our knowledge, only one study in a convenience setting [19] and two qualitative studies had included youth [27], [28]. More research is needed concerning youth's sexual risk-taking while travelling abroad and the factors that might influence this behaviour.

The aim of this study was to assess sexual risk-taking behaviour in a sample of Swedish youth, who were sexually active while travelling abroad. A further aim was to examine possible associations between sexual risk-taking behaviour while travelling abroad and potentially relevant characteristics such as socio-demographic background, selected lifestyle factors, and mental health.