Sex, tourism and STD

health

EVIDENCE suggests that sexually

transmitted diseases (STD) are

assuming epidemic proportions

within the Pacific region and are grossly under-reported, according to a report from the East-West Center called “AIDS and Tourism”. The author, Dr Nancy Davis Lewis, who has specialised in Pacific health issue, says one of the region’s problems is that open discussion of sex and sexuality is uncomfortable because of the norms and values in most of the island states.

The report states the South Pacific Commission has noted particularly high rates of gonorrhoea in the Cook Islands, French Polynesia, Northern Mariana Islands, Palau and Papua New Guinea, Syphillis is a major problem in French Polynesia, Marshall Islands, Nauru, New Caledonia and Papua New Guinea.

“In areas where STDs are high, the potential for transmission of HIV (the AIDS precursor) is great,” said Dr Lewis.

Travel is a prime cause of the spread of AIDS, and the report urges measures to prevent the tourist industry in the Pacific becoming affected by fear of catching te disease. With so many tourists coming from the United States, where AIDS is growing rapidly, the report urges that action be taken to head off the spread of the disease in the region. “The epidemic of STDs in the Pacific is especially alarming, given the links between STDs and HIV transmission,” said Dr Lewis.

She said that contemporary patterns of sexual behaviour are poorly understood

in the region. In many traditional Melanesian societies, ritual male homosexuality was common while it was unclear to what degree these practices prevailed, they have been implicated in the transmission of Hepatitis B.

In Polynesia, the role of the male raised as female (raerae, mahu or faafafine) is a culturally important one but these individuals often find themselves in the tourism, entertainment or service sectors. Dr Lewis said they are potentially a high risk group.

Both male and female prostitution is on the rise in the region both “professionals” and those who work occasionally when money is needed, an activity parti-

cularly profitable with tourists carrying

foreign currency. It is a route for the introduction of the HIV virus to the general population. In 1988 researchers found two female prostitutes in Port Moresby who were HIV positive.

With the Pacific undergoing rapid social and cultural change due to urbanisation and modernisation, the values and mores which govern sexual behaviour have become a complex mix of traditional, Christian and modern ethics. “This problem can be particularly grave in terms of governments’ attempts to cope with the disease where Western ways dietate what is acceptable in polite society and where reality is tied to more traditional practices,” Dr Lewis said.

In many parts of the developing world, anal intercourse was used by heterosexual couples as a means of con-

traception it is unknown how com mon this practice could be in the Pacific region. The report said intravenous drug use was not yet a common practice in the region, although it was becoming so in Palau and Guam, and extending to other parts of Micronesia. The high pre valence of diabetes in Polynesian and Micronesian populations meant that many young people have access to syringes in the home and become accus tomed to see them in use.

The report also identified the revival

of tattooing as another danger, especially

where instruments were not sterilised.

With HIV, as with other sexually transmitted diseases, under-reporting is a problem, but in July 1988 there were known to be 43 cases of HIV infection in French Polynesia, 7 in Guam, one in Marshall Islands and 17 in New Caledo nia. “The cold truth is that HIV infec tion has gained a foothold in the region, and the threat it poses must be addres sed immediately,” said Dr Lewis.

The report argues that HIV screening of tourists is difficult to undertake and has flaws, such as the inability to detect infection in the early stages. It recom mends that culturally sensitive education must be directed at the general popula tion, high-risk groups, the travel indus try and arriving tourists.

“The opportunity exists to deal with the disease at an early stage, building on the mistakes of other countries,” Dr Lewis concludes. “The cost of education programmes today will be much less than the cost of increasing HIV infection and AIDS in five years. A rapid re sponse is imperative.” □