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Abstract

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References

Here we describe an emerging category of travelers called the Visiting Internet Fiancé/ée (VIF), characterized by their travel to pursue a romantic relationship with an individual they have only encountered online. The VIF is not well identified in travel medicine literature despite having a higher risk for several travel-related issues including sexually transmitted infections, monetary fraud, and international scams. We also propose specific counseling interventions designed to minimize the adverse outcomes faced by the VIF traveler.

To understand the Visiting Internet Fiancé/ée (VIF) traveler, data on approximately 4,000 patients, collected over a 24-month period, were reviewed retrospectively from an international travel clinic affiliated with the University of Utah.[1] The study was approved by the University of Utah's Institutional Review Board. All travelers filled out a pre-travel questionnaire; however, information regarding the intent to meet an online fiancé/ée was gleaned only during conversation, and then noted in the chart, as this information was not asked on the intake form.

Results

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References

We examined 48 individuals (approximately 1% of the sample group) who were traveling to meet online fiancé/ées. The majority of these individuals were divorced men older than 39. The remaining VIFs were women younger than 35 who had never been married. The majority of men were traveling to Asia, while women were traveling to Africa. No same-gender relationships were identified. Breakdown of gender, age, marital status, country of destination, duration of travel, lodging, and location of marriage are listed in Table 1.

Table 1. Chart review of approximately 4,000 international travelers, over a 24-month period in Salt Lake City, Utah, United States
           Women          Men
  1. a

    Majority.

Total number of VIFs traveling1731
Age range23–35 years old39–57 years old
Marital statusSingleDivorceda
VIFs' destination and number travelingNigeria 9, Ghana 4, South Africa 2, Philippines 1, Brazil 1Philippines 13, Vietnam 9, China 3, Cambodia 2, Russia 1, Hong Kong 1, Thailand 1, Ukraine 1
Length of stay abroadOpen itinerarya2 weeks
Location of lodging abroadWith fiancé and his familyaWith fiancée onlya
Location of marriageAbroadaUnited Statesa

Discussion

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References

Although VIF travelers have distinctive patient profiles, they share many similarities with the well-characterized immigrant who travels home to visit friends and relatives (VFR).[2] Yet the VIF traveler is an increasingly significant group in an era of online social networking and romance. The VIF may be hard to identify, as standard pre-travel intake forms do not inquire about a person's pursuit of an online relationship.[3] Additionally, VIFs are distinctive in that they may be at risk for sexually transmitted infections (STIs), safety concerns, and marital scams.[4, 5]

VIFs who become sexually active with their new partners or who are sexually assaulted during travel and do not use birth control and protection would be at risk for pregnancy and STIs. VIFs traveling to geographic regions with a high prevalence of human immunodeficiency virus (HIV)[6] or hepatitis B virus (HBV)[7] should be informed of the increased risk for acquiring these sexually transmitted diseases.

Regardless of travel destination, education regarding birth-control options and condom use is critical during the pre-travel consult with the VIF. Additionally, the VIF should be educated about emergency contraception, HBV and human papillomavirus (HPV) vaccines, and the value of testing for HIV and other STIs prior to sexual activity. In case of sexual assault, the traveler should be informed of post-exposure prophylactic treatment for chlamydia, gonorrhea, trichomonas, and HIV, as recommended by the US Centers for Disease Control and Prevention.[8]

Being a victim of crime is another potential risk. VIFs should be counseled to take preventive measures such as carry a cell phone, know the country's local emergency number, and take a global positioning system (GPS) tracking device with rescue service. They should be advised to take door locks, door jams, and pepper spray. They should consider traveling with a known companion. If assaulted, they should seek medical care and report the incident to local law enforcement.

VIFs often travel alone, immersed in unfamiliar cultures and countries, which can increase their risk for kidnapping, assault, fraud, and marital scams as compared to other travelers. The US Department of State receives daily calls regarding international scams involving Internet dating and romance. Indications of fraud can include the online acquaintance who represents him/herself with a professional photo of a very good-looking person, who is in crisis, requests monetary assistance, or uses atypically poor grammar. For additional warnings, the VIF should be referred to the “Internet Dating and Romance Scams” section of the US Department of State, Bureau of Consular Affairs website.[9]

Because of these dangers, we recommend advising VIFs to share their travel itineraries with a trusted emergency contact and check-in on a regular basis. We also instruct VIFs to notify banks and credit card companies of their travel plans, to register with their country's foreign affairs department, and once abroad, to contact their embassy. It is also important to emphasize to the VIF the utility of preparing emergency financial resources, including cash, credit cards, travelers' checks, or pre-paid cards.

Travelers with the VIF profile should be discouraged from sharing personal financial information with their betrothed, as marriage fraud can occur. Engagement and marriage scams commonly involve foreign brides or grooms who become engaged or married to obtain access to their partner's finances and/or to secure residency abroad. The latter phenomenon is supported by the correlation of time frames when such fraudulent spouses typically leave their husbands or wives: soon after arrival in the United States, upon receipt of their green card at 3 months, after receipt of a non-conditional permanent residence at 2 years, or after obtaining citizenship at 10 years.[10] All Internet fraud should be reported to the Internet Crime Complaint Center, a partnership between the Federal Bureau of Investigation and the National White Collar Crime Center.[11] Finally, to help the VIFs best address cultural, socioeconomic, and language differences with their new partner, the benefits of personal and pre-marital counseling should be emphasized.

It may be hard to identify the VIF due to the real or perceived social stigma that exists for such travelers. As a result, VIFs may be apprehensive to share their travel plans. Additionally, many standard intake forms do not ask about this activity. Providers should modify their intake questionnaire and ask directly if the travelers plan to marry abroad someone they met on the Internet. Summary of risks and events for which VIF travelers are at increased risk, with recommendations for travelers and providers is summarized in Table 2.

Table 2. Summary of risks and events for which VIF travelers are at increased risk, with recommendations for travelers and providers
Specific risks     Recommendations for VIF
Unintended pregnancyBirth control, emergency contraception
STICondoms
Victim of sexual assaultSTI post-exposure prophylaxis treatment
 HBV, HPV vaccinations
Pre-travel STI testing and treatment
Victim of fraudCell phone
GPS tracking device
Door locks, door jams, pepper spray
Travel with companion
Share travel itinerary
Notify banks, credit card companies
Register trip with foreign affairs office
Contact embassy in destination country
Emergency financial resources
Protect personal financial information
Pre-marital and personal counseling
Specific event     Recommendations for provider
Identifying the VIFAsk on intake form or verbally

Study limitations include small sample size, limited data collection, one-site review, and an urban population. Additionally, the study identified and reported on only heterosexual relationships.

Conclusion

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References

The VIF is a unique and emerging category of traveler. Once VIFs are identified, they should be provided with specific counseling on the risk of STIs, unintended pregnancies, crime, assault, and fraud. They should be offered or referred for vaccines, prescriptions, counseling, and directed toward specific actions and resources at home and abroad, based on their travel activities and destination.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References

The authors would like to acknowledge the late Barbara Barwick, RN, who was the inspiration and main data collector for this study. We also acknowledge Charles Langelier, MD, PhD, for his assistance with editing and proofreading the manuscript.

Declaration of Interests

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References

The authors state that they have no conflicts of interest.

References

  1. Top of page
  2. Abstract
  3. Results
  4. Discussion
  5. Conclusion
  6. Acknowledgments
  7. Declaration of Interests
  8. References