Background: Travelers to the tropics have been reported to comply poorly with recommendations regarding malaria and AIDS. This study addresses the problem of influencing travelers' behavior through different approaches to conveying advice.
Method: 3509 people attending a large travel clinic were randomly allocated to different interventions, including brochures about the implications of “sex tourism” and the possibility of participating in a contest assessing knowledge of malaria and AIDS. A comparison group (n = 607) of travelers to Kenya was contacted at an airport. Anonymous, self-administered questionnaires were sent to all travelers after their return.
Results: Compliance with chemosuppressive regimen for malaria was 87%. Well-informed travelers did not protect themselves more efficiently against malaria. The efficacy of a given intervention was found to vary according to the age, sex, or travel experience of the participants. Of travelers, 51% reported casual sex abroad (M/F: 69/31). Thirty-eight percent of these contacts were unprotected. Casual sex abroad and condom use were correlated with a history of casual sex in the home country. Condom use was especially low in young women, who were also more likely to have casual sex with fellow travelers than with local partners. Eight percent of the “sex tourism” brochure readers had engaged in casual sex with local partners (all travelers, 4%).
Conclusions: Lack of knowledge does not appear to be the problem. Travelers need to be motivated to put their knowledge into practice. Our results suggest that risks relating to malaria and AIDS are perceived in a different manner and that counseling should be individualized. Contest questions can help start a discussion on ethical and health-responsible behavior. The target group of the “sex tourism” brochure was reached, but their behavior appears not to have changed. Objective criteria can help physicians recognize “high-risk” travelers. Travelers need to be made aware that they may encounter environments conducive to risky behavior and that, while abroad, they may react in unexpected ways.