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Lack of HIV prevention for male sex workers in the Caribbean could fuel AIDS epidemic

ANN ARBOR, Mich.—Male sex tourists, largely from the United States and Europe, may be fueling an HIV/AIDS epidemic in the Caribbean, and efforts to stop the epidemic will be severely hampered unless HIV prevention dollars are diverted to help male prostitutes, a new study suggests.

Additionally, the study should serve as call to action for the tourism industry to implement HIV/AIDS prevention programs for tourists and tourism employees, said assistant professor Mark Padilla of the University of Michigan School of Public Health.

The Caribbean is second only to sub-Saharan Africa in HIV/AIDS cases. The disease has been described as primarily heterosexual, Padilla said. However, Padilla's book shows that sexual contact between Caribbean male sex workers and male tourists may be a much larger contributor to the HIV/AIDS epidemic there than previously thought.

Currently, prevention dollars in the Caribbean serve primarily heterosexuals, and this particular population of male sex workers who have sex with tourists is largely neglected. That population of male prostitutes grows larger as the traditional, agricultural jobs dry up. Funding comes from a variety of sources: governments, multilateral organizations such as the World Health Organization, and private foundations.

The Caribbean has become increasingly dependent on money from tourism, and young men have fewer options for making a living. Most male sex tourists in the study were from North America and Europe, Padilla said. The local men who served these tourists also had sexual encounters with female tourists, but Padilla's study did not directly examine that issue.

"Many men are unemployed from rural areas, and they immigrate to tourism areas," Padilla said. "Very few identify themselves as sex workers, and most have other income from tourism. Because of social stigma, these men often do not communicate with female partners about their involvement in sex work," which means the risk for HIV may be high among women.

The problem of why the bisexually behaving men do not come forth and are not reached by prevention programs is complicated, Padilla said. In Latin American culture, homosexuality is so stigmatized that men who engage in homosexual sex for money cannot speak out without becoming social pariahs. Many of them are married, but do not tell their wives about the prostitution or homosexual behavior. Many of these men do not use condoms consistently, especially with female partners, the study found.

Padilla said the tourism industry needs to be held at least partly responsible for providing a safer environment. Many of those tourism companies are based in the United States, he said.

"The tourism industry needs to prioritize HIV prevention in any initiative they begin," he said. They should not be able to establish these massive tourism conglomerates without HIV/AIDS prevention and intervention programs.

"They need to be aware that they are contributing to a sex economy that they are indirectly supporting, and to take responsibility to provide HIV prevention for these individuals," Padilla said.

Travelers can also lobby the industries directly, Padilla said. "You can have an impact on the HIV epidemic simply by stating directly to your travel agency that you prefer a place with HIV prevention as a part of its company strategy." While there is little public information on the HIV prevention efforts of tourism companies, such questions by tourists may lead to greater attention to this issue.

Padilla's new book "Caribbean Pleasure Industry: Tourism, Sexuality, and HIV/AIDS in the Dominican Republic," is the largest known study of male sex workers in the Caribbean and how their bisexual behavior impacts the spread of HIV. During the study, Padilla interviewed 298 bisexually behaving men over the course of three years.

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