But whether its reality is darker than its depiction, sex tourism—defined as travel with the intention of hiring sex workers—is a booming industry especially popular in the warm, tropical nations that also suffer higher prevalence rates of HIV and rampant poverty. The industry is full of tales of pleasure and danger; it juxtaposes the levity of vacationers with the gravity of the existence of those who serve them.
The sunny side of sex tourism is clouded over by the risks both parties take if the sex is not safe. Sex tourism encompasses a complex variety of activities and behaviors that facilitate—for a price—social and sexual interaction between people. Often confused with the trafficking of women and the sexual abuse and exploitation of children or the poor, sex tourism is not necessarily connected to human trafficking or sex slavery.
Most sex workers who service travelers seeking sex are not without self determination; and most men and women looking for intimacy from the flesh trade while on holiday do not set out to prey on the vulnerable and disadvantaged. There is no question that it has the potential to play a significant role in the spread of disease and despair.
The realities of sex tourism raise the questions: Who is ultimately accountable for safeguarding the health of those engaged in private relationships between consenting adults? How do and should these countries publicize safe-sex messages if, indeed, it is a government priority , or should the sex tourists and sex workers themselves shoulder responsibility for being aware and being safe? The incentives are palpable. And the starkly different economic realities of tourist and sex worker often put the power in the hands of those with the money.
Bill is a year-old professional from Orange County, Los Angeles, who works in the medical field and travels to Brazil every three months for a week.
But what about outside the saunas? Have I done it? Based on his experiences, Bill estimates that about 10 percent of guys have been willing to forgo safe sex. International travel in general has grown exponentially since the s, with packaged tours to resort regions in developing nations leading much of this growth.
Significantly, the countries most dependent on tourism, such as those in the Caribbean, tend also to have the highest HIV prevalence rates. Research on sex and travel suggests that tourists, especially when single, have more sex while on holiday than they do on average at home.
And because tourists are wealthier and more educated than the locals, inequality is a fundamental aspect of sex tourism.
Given such disparities, is it possible to be an ethical sex tourist who makes health—for everyone involved—a part of the pleasure equation? In Jamaica, the beach boys work the pristine coastline and chat up single female tourists from Europe, Britain and North America who flock to the island by the thousands in an annual winter migration from north to south.
We go to restaurants. That he has to think about himself. In his report, Padilla detailed the lives of Dominican male sex workers-—called bugarrones and sanky pankies. Their mostly male clients are primarily foreign tourists, and their economic hardships, family responsibilities, constant run-ins with law enforcement and predominantly heterosexual identity place them in a unique blind spot against prevention efforts.
You want to protect the tourists from getting AIDS. Where should health workers—and health reporters—concentrate limited resources in this growing arena of the tourism industry? This young man improves his standard of living through sex work with mostly North American and European tourists; he risks his safety, social status and health for money, favors and gifts.
Yet he automatically concludes: In Santo Domingo he would likely live with his parents or other relatives or he would have a wife and children of his own—all of whom depend on him for financial support, probably unaware of all his sources of income. Because unemployment is high, he creates his own work as a tour guide, as hired help in beach rentals, as a mechanic and, like the sauna boys of Brazil or the beach boys of Jamaica, as an escort; by selling his body, he can bring in many times the average income when tourists descend.
Like other financially depressed countries in the Caribbean, the Dominican Republic shifted away from an economy based on the sugar trade to one primarily dependent on tourism. Bugarrones and beach boys are as different from sauna boys as sauna boys are from the sex workers in the windows of Amsterdam. The HIV prevention resources and priorities of individual countries matter, as do the relative acceptance of homosexuality, gender norms and the openness of sex in general in the culture.
HIV prevention aimed at sex workers is complicated by many factors, not the least of which is the harassment they face in many of the countries in which tourists travel. Bugarrones and sanky pankies shield this part of their lives from family and friends but also fail to find comfort in the openly gay communities of Santo Domingo. Theirs is an acutely isolated experience, the exact opposite of an environment conducive to community-supported health messages.
Concentrating on the Dominican example, or the male sex workers specifically, does not translate easily to all locations where sex tourism is popular, but it does provide some insight into how those of us who would be sex tourists and those of us who work in health might think about how HIV goes unchecked in the international pleasure industry.
The HIV services that do exist in the Dominican Republic for men who have sex with men MSM are, by and large, rainbow-flagged programs aimed at local men who identify with the global markers of Western gayness—programs that bugarrones such as Antonio would not access.
Though the epidemic in the region began with MSM, HIV in the Dominican Republic is now considered a heterosexual epidemic, with only 10 percent of infections attributed to gay and bisexual men. In other words, as Padilla explains, evidence suggests that bisexuality is more pervasive in Latin America. Padilla offers an innovative intervention idea—a tour guide certification program perhaps run by a nonprofit or nongovernmental organization.
Since so many of the bugarrones and sanky pankies identify as tour guides, but are not formally registered, a certification program would give them a professional ID and a social legitimacy that would also help them economically.
Built into the certification program—but not labeled as HIV intervention—would be health education, including the distribution of sexual health supplies. The question of whether or not it is possible to be an ethical sex tourist is a difficult one. But as long as the industry thrives, there is a pressing need to make it ethical—and ensure the health of all involved. The answer then may not come from the governments.
Instead it may lie in the tourists themselves and, possibly, those like Drey who book their travel. Why not make the tourists who fuel the multi-billion dollar sex tourism industry more responsive to local realities of HIV and health?
What if an ethical sex tourist could book tours through companies that promoted health—of both clients and workers—and could, on an individual level, also help educate sex workers and ensure they had appropriate supplies for all safe-sex options? Additionally, they could boost the awareness of HIV among sex workers by discussing the available health care or a lack thereof should they contract HIV.
The same information should be, ideally, offered to anyone who books a trip for sex tourism. Realistically, their existence and livelihood depend on how they market themselves for the pleasure of others.
For many of them, stigma wraps their bodies in a cloak of contempt. For the sauna boys, the beach boys, the bugarrones and sanky pankies—men who choose to work in the pleasure industry because it pulls them up from poverty, supports their families and children and provides them with some of the material conveniences valued everywhere—ethical tourism may also instill in them some measure of self-sufficiency and self-worth in a culture that otherwise devalues them.
Indeed, it is too easy to assume that these men are irresponsible and that they deceive their families and themselves. Such judgments reinforce the stigma of their existence and the circumstances that have placed them in deeply compromised positions of economic survival.
Clearly, another critical component of fighting the spread of disease among sex workers is helping them escape the stigma inherent in the work they do. The bottom line is clear-cut: Sex tourism has built-in risk factors that require our attention because they impact the spread of HIV and other diseases worldwide.
Whether or not the idea of sex tourism is palatable to some, no one can deny its existence. And, as long as people are willing to pay to travel in search of sex, it is in the best interest of global public health that we no longer turn a blind eye to the booming industry. The world must make it a priority to ensure the health and safety of people who voyage to exotic lands for pleasure—and also the health and economic survival of those who service them.