Sexual Behaviour of International Backpackers in the Context of Travel

Sexual behaviour of international backpackers

in the context of travel in Australia

Caroline Egan

PhD

2009

Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy National Centre in HIV Social Research University of New South Wales

CONTENTS i

Contents

Contents i Tables and figures v Acknowledgments vii Declaration of originality ix Abstract x 1 Introduction 1 2 Literature review 7 Who is the topic of study? 7 Why study travellers? 7 What has been studied? 10 Where has travel sex research been conducted? 11 Clinic based research 11 Population based research 12 Research in context 13 What have they found? 15 Sexual activity 15 Alcohol 20 Condom use 23 Methodological issues 32 3 Theoretical perspectives 36 Time and space 37 Liminal concept 38 Liminoid concept 40 Visiting the “authentic” 43 Journey to the self 46 Communitas and belonging 47 Script theory 51 Conclusion 54 4 Methods 55 Introduction and approach 55 Data collection 58 Hostels 58 Observation and field notes 59 Timing of recruitment 60 Practicalities of research in hostels 60 Clinics 61 Backpacker survey 62 Inclusion criteria 62 Recruitment procedures 63 The Questionnaire 64 In-depth interviews with backpackers 70 Recruitment procedures 72 Interview content 73 Hostel staff interviews 75 Clinic staff interview 76 Recruitment procedures 76 Reflexivity 77 Analysis 78 Questionnaires 78 Interviews 79 Trustworthiness and credibility 81 table continues ii CONTENTS

5 Life as a backpacker? 83 Who is a backpacker? 83 Sample characteristics 84 In-depth interviews 86 Backpacking defined 87 The culture of backpacking 89 Road status 90 Solitary travel 91 Money 93 Travel length and gender 94 Hostels 95 Backpacker ghettos 96 Dorm life 98 Hostel hierarchy and hostel status 99 Work in Australia 102 Recreational backpackers 103 Motivations 104 Has backpacking transformed into one big holiday? 106 British backpackers 111 The road most travelled 114 Alcohol 115 Know thyself 116 Life lessons 117 Confidence to be me 118 Social confidence 120 Life skills 121 Comfort in cultural diversity 122 Backpacker communitas 123 Conclusion 126 6 Sex – Home and away 130 Sexual background 130 Sexual history prior to backpacking 130 Sun, sea, sand, and sex – in context 133 Sex expectations 134 Gender 136 Sex as play 138 Sexually charged atmosphere 139 Communitas within the time compressed context of backpacking 141 Conclusion 143 7 “Good for a laugh” – backpackers and sexual behaviour 145 The sexual script 148 Where do they meet? 149 Partner preferences 153 Competition 156 Negotiation of sex 157 Gender roles 159 Testing the waters 163 Sex: The thing “to do” 164 Location, location, location 168 Sexual practice and pleasure 175 Alcohol and sexual practice 176 Alcohol 176 Sexual practice 178 Oral sex 178 table continues CONTENTS iii

Sexual experimentation 180 Sex in Thailand 183 Change in behaviour? 187 Why the change in behaviour? 190 Conclusion 193 8 “I’ve done things here that I wouldn’t do normally” – condom use abroad 196 Intentions 198 Age 200 Casual sex 200 Partner type 200 Sexual experience 202 Condom use: home & abroad 204 Oral sex 209 Conclusion 210 9 Safe sex communication 212 Verbal and non-verbal safe sex strategies among consistent condom users 215 Sex: a process of attrition 221 Safe sex negotiation: A difficult challenge 225 Conclusion 227 10 Barriers to safe sex 229 Barriers to condom use 232 Characteristics of the situation 233 Heat of the moment – desire 233 Passivity, ambivalence, or resistance? 234 Alcohol 241 Sexual risk taking 242 Sexual assault 247 Poor recall of events 249 Personal perception of risk 251 Global assessment of risk 252 Individual assessment of risk 253 Too “fit” to be infected 255 Cultural familiarity 257 Knowing and therefore trusting 260 Oral contraceptive 264 Logistical problems: availability, accessibility, and affordability 269 Availability 269 Access 272 Affordability 273 Conclusion 274 11 Health Implications and Recommendations 276 Was sexual health a concern for backpackers during their trip? 278 STI history 279 Interviews with clinic staff 284 Reasons for seeking sexual health screening 284 Delaying the inevitable 286 Seeking an “all clear” 286 Perceptions of prevalence 288 Sexual health protection challenges 289 Knowledge 289 Pre-travel sexual health advice 289 Awareness and access to Sydney STI services 293 Assessment of need/limitation of funding 293 table continues iv CONTENTS

Non-English speaking travellers under-represented in clinics 295 Contact tracing 299 Recommendations 300 Conclusion 302 12 Conclusion 305 Major findings 305 Sexual attitudes and behaviour 306 Condom use and risk taking 307 Self and identity 308 Health implications 309 Limitations of study 309 Methodological issues 312 Backpacker health promotion campaigns 313 Future directions for backpacker health initiatives 313

Appendix A Hostel recruitment letter 316 Appendix B Backpacker information letter & consent form 317 Appendix C Accommodation service provider information & consent form 319 Appendix D Health service provider information & consent form 321 Appendix E Backpacker sex survey questionnaire (Women) 323 Appendix F Backpacker sex survey questionnaire (Men) 327 Appendix G Backpacker interview schedule 331 Appendix H Accommodation service provider interview schedule 333 Appendix I Health service provider interview schedule 335 Appendix J Code list 336 Appendix K Qualitative comments on backpacker questionnaires 339 Appendix L “Safe in the Sack” Backpacker Campaign 344 Appendix M Sydney Sexual Health Centre Study 350

References 352

TABLES AND FIGURES v

Tables and figures

Tables

Table 5.1: Age, home country, and education level of individuals backpacking in Australia, stratified by sex 85

Table 5.2: Interview respondents 86

Table 5.3: Travel identity of survey participants 87

Table 5.4: Current travel partners during trip 91

Table 5.5: Descriptors of travel experience for backpackers visiting Australia 95

Table 5.6: Individual backpackers’ motivations to travel, stratified by sex 105

Table 6.1: Age at first vaginal or anal intercourse, stratified by sex (n=522) 131

Table 6.2: Number of sex partners and casual sex experience prior to trip among backpackers visiting Australia, stratified by sex 132

Table 6.3: History of heterosexual practice prior to the trip of individual backpackers visiting Australia, stratified by sex 133

Table 6.4: Sexual expectations and intentions of backpackers visiting Australia, stratified by sex 136

Table 7.1: Proportion of backpackers who had sexual intercourse and number of new sex partners reported by backpackers during their trip, stratified by sex 146

Table 7.2: Number of backpackers (of those who had sexual intercourse on trip) who had sex with someone they just met or met recently, stratified by sex 147

Table 7.3: Descriptors of last sexual partner and frequency of sexual intercourse 147 with that partner, stratified by sex

Table 7.4: Descriptors of sex partners during trip, stratified by sex 153

Table 8.1: Consistency of condom use with last partner during trip, stratified by sex 199

Table 8.2: Backpackers’ condom use with new sex partners during trip, stratified by age (n=308) 200

Table 8.3: Descriptors of last partner and incidence of inconsistent condom use with last sex partner on trip, stratified by sex 202

Table 8.4: Descriptors of sexual risk taken at home by those who were inconsistent condom users while backpacking, stratified by sex 204

Table 9.1: Condom communication (condom users only), stratified by sex 212 table continues vi TABLES AND FIGURES

Table 10.1: The attitudes toward condoms of backpackers visiting Australia, stratified by sex 231

Table 10.2: Reasons for not using condoms consistently with last partner on trip, stratified by sex 232

Table 10.3: Perception of risk of HIV while abroad (inconsistent condom users only), stratified by sex 252

Table 10.4: Destinations perceived by backpackers to represent most risk of contracting HIV while travelling, stratified by sex 260

Table 10.5: Frequency of sexual intercourse with last partner on trip (consistent condom users only), stratified by sex 263

Table 10.6: Location preferred by backpackers visiting Australia to store/carry condoms, stratified by sex 270

Table 11.1: Health concerns during backpacking trip, stratified by sex 279

Table 11.2: STI/HIV diagnoses prior to, and during backpacking trip, stratified by sex 281

Table 11.3: Tally of sexually transmitted infection (STI) history prior to trip and consistency of condom use during trip 281

Table 11.4: Source of health advice received by backpackers visiting Australia, stratified by sex 292

Figures

Figure 7.1: Advertisement of inexpensive drink prices at “Sydney’s premier backpacker bar” in a free Australian backpacker magazine (2004) 151

Figure 7.2: Theme party advertisement for “Sydney’s Premier Backpacker Bar” – in popular Australian backpacker magazine (2004) 152

Figure 8.1: Condom use with last partner “just met” or “met recently”, stratified by sex 205

Figure 8.2: Consistent condom use prior to and during backpacking trip, stratified by sex 206

ACKNOWLEDGMENTS vii

Acknowledgments

My thanks and appreciation to Dr Juliet Richters for persevering with me as my supervisor throughout the time it took me to complete this research and write the dissertation, particularly when I decided to move back to Canada to complete my

PhD. Through her mentoring, it became a habit to strive to do better and I understood that excellence is not the end result, but rather a starting point on a journey that we’re challenged to exceed every day of our lives. This process has been full of ups and down and her words of encouragement and persistence in challenging me have made this experience very enlightening and rewarding.

A special thanks to my co-supervisor Professor Sue Kippax for showing me how to see the big picture when it was so easy to get caught up in the little details.

I am grateful to the backpackers, sexual health staff and hostel support staff who shared their memories and experiences.

I must acknowledge as well the many colleagues and fellow students who assisted, advised, and supported my research and writing efforts over the years. Especially, I need to express my gratitude and deep appreciation to my friends whose hospitality, sense of humour, knowledge, and wisdom have supported, enlightened, and entertained me over the many years of our friendship.

viii ACKNOWLEDGMENTS

I am deeply grateful to my parents, Dot and Pat Egan, for their unconditional support to pursue my interests, even when it took me so far away from them, and their guidance when I thought I might falter. My mother has been an inspiration to me and

I would like to thank her for all she is, and all she has done for me. My daughter Zara, whose laughter and beautiful spirit consistently helped me keep perspective on what is important in life. Last, but not least, I wish to thank George, for always supporting my dreams and aspirations, for believing in me when I didn’t believe in myself, for listening to my complaints and frustrations with never-ending patience, for giving me a reality check when I needed one, and for being the most caring and considerate partner I could ever hope for.

DECLARATION OF ORIGINALITY ix

Declaration of originality

I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research of others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project’s design and conception or in style, presentation and linguistic expression is acknowledged.

Signed: ______

Dated: ______

x ABSTRACT

Abstract

This study is the first to collect detailed empirical data on sexual practice among backpackers while exploring the material and social context of backpacking using an ethnographic framework. The theoretical concepts of liminality and sexual scripts were drawn on to analyse the findings. Backpackers were recruited from hostels in Sydney and Cairns; 559 backpackers (243 women, 316 men) completed an anonymous self- administered questionnaire. In addition, 25 in-depth one-to-one interviews with backpackers and 25 semi-structured interviews were conducted with sexual health and travel clinic staff and hostel service providers. Participant and non-participant observation in backpacker hostels also informed the analysis.

Drinking alcohol, often to excess, was central to the backpacking setting and was both a reason for and a post-facto justification of unprotected sex. The backpacking setting encouraged transient liaisons. More than half (55%) of backpackers had sex with someone new during their trip and for 71% of them it was with someone that they had just met that day. Twenty-five per cent of those with no expectations to have casual sex on their trip and 22% of those with no previous experience of casual sex had casual sex during their trip. More than half (53%) of those who had sex with a someone new did so while other people were in the room. Only 55% always used a condom with their last new partner. While most backpackers carried condoms and intended to use them, unprotected sex was common. Perception of risk was low: 78% of those who did not use a condom the last time they had casual sex on the trip perceived their risk of getting HIV to be “low” to “nil”. Three participants acquired HIV during their trip. ABSTRACT xi

The culture of backpacking encourages more sexually permissive attitudes but does not encourage condom use, especially for those who did not consistently use condoms at home. These findings highlight the need for more broad-based dissemination of information on STIs to young people, and for future sexual health campaigns to specifically target backpackers in the context in which they travel.

Introduction

This research investigates the areas of sexual behaviour and sexual risk in the context of backpacking. The significance of international travel for the global diffusion of sexually transmitted infections (STIs), including human immunodeficiency virus

(HIV), is widely recognised (Bröring, 1996; Hawkes & Hart, 1993; Hawkes, Hart,

Bletsoe, Shergold & Johnson, 1995; Melbye & Biggar, 1994; Mulhall, 1996). Although travel is not an independent risk factor of acquiring an STI, it has long been recognised that travellers are efficient vectors for the geographic spread of disease and have played a crucial role in the global epidemiology of HIV and other STIs. Travel and tourism enable sexual mixing of sexual networks that may not otherwise occur. Epidemiologists have stressed that exposure to infectious pathogens during travel greatly enhances the potential for dissemination of unfamiliar, genetically diverse and/or antibiotic-resistant strains of pathogens (e.g. Cossar, 1997; de Schryver & Meheus, 1989). Understanding the role of transient populations in the global diffusion of STIs is recognised as integral to HIV prevention world-wide, and has become very important as increasingly greater numbers of sexually active individuals come into contact with new sexual partners through domestic and international travel. The World Travel Organization, a United

Nations specialised agency, reports that since 1950, the average annual growth in tourist travel has been 6.5%. From international arrival data it is estimated that 846 million people travelled internationally in 2006 and it is expected this figure will increase to 1.6 billion by 2020 (World Tourism Organization, 2007). Therefore, travellers are of great public health interest. 2 CHAPTER 1: INTRODUCTION

Much of the sexuality literature on international tourists has been focused on short- term travellers. However, backpacking is one of the fastest growing tourism markets globally. Recent statistics estimate that 943 000 domestic and international backpackers travel to Australia each year (Palawatte, 2004). The number of backpackers travelling around Australia is growing annually. In 1995, backpackers represented 6% of international visitors to Australia (Buchanan & Rossetto, 1997), and by 2004 this figure increased to 11% (Palawatte, 2004). Yet, there is a paucity of sex research focused on long-term travellers (Arvidson et al., 1996; Bavastrelli et al., 1998; Black, 1997, 2000;

Black, Clift, & Wijesurendra, 1995; Cabada et al., 2002, 2003; Carter et al., 1997;

Egan, 2001a,b; Hawkes et al., 1994; Thomas, Bloor, & Crosier, 1997; Worm &

Lillelund, 1989). It is unclear in almost all studies done to date whether the long-term travellers referred to are young, budget long-haul travellers (backpackers) or expatriates, students, or workers. In addition, the definition of “longer” travel varied amongst the studies. Nevertheless, overall these studies have shown that length of travel time is typically associated with a higher likelihood of sexual intercourse with a new partner, failure to use a condom, and acquisition of an STI.

The atmosphere of transience and sexual availability frequently experienced in the context of travel, together with the increased availability and often excessive consumption of alcohol and drugs can facilitate sexual mixing and risk-taking behaviour. Literature currently available on travellers’ sexual conduct and STI-related risk practices is fragmentary, yet from the research reviewed, it is clear that travellers are identified as a group at risk. The context of travel represents both individual and collective sexual health risks. Therefore, the sexual health risks associated with travel carry significant implications for public health authorities with regard to the need for CHAPTER 1: INTRODUCTION 3

sexual health education, promotion, intervention, and services that target this transient population. However, travellers are a heterogeneous group. Research that explores the sexual behaviours and risk taking of specific populations in the context in which they travel is vital for the design, development, and effective implementation of future health campaigns that attempt to improve sexual health protection strategies utilised during certain travel experiences.

The context-specific research available is in its infancy, and has just scratched the surface of what issues might be explored with various travel populations. Yet little emphasis has been placed on the context itself for aiding in the construction of new sexual behaviours and risk taking. It is striking how little context-specific research has discussed in any detail the locations and venues where sexual connections are made, the popular spaces and places where sexual activity occurs, and what impact these settings have on sexual decision-making. Some researchers were content to describe specific destinations in the most general way; others offered details of particular resorts, airports or beaches where the data was collected. Only one study (Thomas,

2000) explored the contextual spatial circumstances on holiday that may limit or facilitate sexual activity and sexual safety. Clearly, the literature could benefit from further ethnographic observation and fieldwork in this area.

The main goals of this thesis are to: (1) explore the sexual behaviours of backpackers travelling in Australia; (2) to determine if, and how, this behaviour may pose public health risks; (3) and to examine the context-specific circumstances surrounding sexual decision making.

4 CHAPTER 1: INTRODUCTION

The structure of this thesis is as follows:

Chapter 2: A review of the travel and sexuality literature. First, a brief review of how the global health implications of sexual risk taking during travel were the catalyst for the medical community to conduct research investigating the sexual risks of travellers from the early 1990s. This is followed by an exploration of the focus of research conducted since then and the perspectives of the researchers involved, looking at where travel sex research has been conducted, the methodological approaches to research in this area, and the findings and limitations of these studies. This chapter will illustrate why context-specific research is so valuable when studying the sexual behaviours of travellers.

Chapter 3: Explores the significance of anthropological and sociological theoretical perspectives in research related to travellers, and how some of these theories are useful in interpreting data specifically on their sexual behaviour.

Chapter 4: A detailed look at the setting and methodology (quantitative and qualitative methods) of this thesis, including the research aim, design, and objectives. The processes of participant recruitment, data collection, survey/interview instruments and interview procedures are presented. The statistical and qualitative analysis performed and the related software used are also described.

Chapter 5: A detailed look at the context of backpacker travel. Themes generated from the following line of inquiry will be explored: Who are they? Why did they CHAPTER 1: INTRODUCTION 5

choose to backpack? What have they learned from their experience? How has backpacking affected their life, if at all?

Chapter 6: Findings related to the sexual history of survey study participants prior to and during their backpacking trip are the focus of this chapter. Sets out the travel context within which sexual encounters in Australia occur. Analysis of quantitative and qualitative data on the extent and characteristics of sexual behaviour among backpackers. This chapter describes how numerous factors influenced backpackers’ sexual behaviour while abroad. Furthermore, how the context of “recreational” backpacker travel and the culture of backpacking influenced many backpackers to adopt a more “recreational” sexual script while living in this context is discussed.

Chapter 7: Presentation of the quantitative results regarding sexual practice during the backpacker journey are followed by an in-depth exploration of the characteristics of individual sexual encounters while backpacking, including: locations to meet new sexual partners and locations available in this communal atmosphere to have sex with them; who they had sex with; how sex was negotiated; the pervasive consumption of alcohol within the backpacking community and its perceived influence on sexual decision making; and activities engaged in during sexual encounters with new partners.

Furthermore, backpackers’ reported changes in sexual attitudes and behaviour while abroad are highlighted. The egalitarian “backpacker sexual script” is discussed.

Chapter 8: Analysis of both statistical and interview data regarding backpackers’ condom use while abroad is explored in detail, including: intentions to use condoms 6 CHAPTER 1: INTRODUCTION

and consistency of condom use. In addition, this chapter describes how patterns of condom use practised at home are often continued in the travel context.

Chapter 9: Will show how backpackers communicated their desire to use condoms during their backpacking trip and the gender differences related to safe sex communication. Communication strategies used by backpackers to facilitate or discourage condom use are also explored. The findings highlight the challenge that safe sex communication poses for most backpackers.

Chapter 10: Barriers to condom use with new partners are discussed, including attitudes to condoms, characteristics of the sexual situation, perception of risk, oral contraceptive use, and logistic problems.

Chapter 11: The health implications of backpackers’ sexual behaviour are explored by reviewing their sexual health history before and during their trip and whether their sexual health was a concern during their trip. Following this, discussions with sexual health providers are featured for insight into the sexual health needs and the barriers to screening, diagnoses, and treatment in this travel population. These findings highlight the urgent need for incidence data on the sexual morbidity of backpackers.

Recommendations offered by health care providers conclude this chapter.

Chapter 12: Concluding comments on the importance of research in this area, the major findings, limitations of this study, and future directions for health initiatives are presented.

Literature review

Who is the topic of study?

The last 20 years have generated a growing body of literature on the sexual health and behaviours of travellers, which have been the topic of numerous reviews (Hynes, 2005;

Matteelli & Carosi, 2001; Memish & Osoba, 2003, 2006; Richens, 2006; Ward &

Plourde, 2006b). Travellers are a disparate group. The term has been used to include members of the uniformed services, seafarers, long-distance truck drivers, migrants, migrant sex workers, business travellers, international students, health workers, sex tourists, short-term holidaymakers, and long-term travellers or backpackers. Some of these travellers have been identified in the literature as “core groups” of particularly efficient transmitters of STIs, including HIV: female sex workers, truck drivers, seafarers and migrants (Mulhall, 1996). The purpose of this literature review is not to present an exhaustive review of research involving all of these types of travellers (for a detailed review see Ward & Plourde, 2006b) but rather to concentrate specifically on studies that directly, or indirectly, contributed to knowledge about backpackers’ sexual behaviour. Therefore, the literature discussed here focuses on people who travel for recreation and leisure.

8 CHAPTER 2: LITERATURE REVIEW

Why study travellers?

Much of the medical community in developed nations initially perceived HIV to be an imported problem. In the United Kingdom (UK), this reaction was fundamentally motivated by a striking increase from 4% in 1986 to 23% in 1991 in the proportion of reported HIV infections occurring among heterosexuals (Evans, Noone, Mortimer et al., 1992). This alarming data sparked interest among epidemiologists and the broader medical community, which set in motion a chain of events that would make travellers’ sexual behaviour a subject of research interest for various disciplines.

During this time, numerous case reports surfaced in the literature on HIV/AIDS diagnoses in heterosexual individuals who had engaged in high-risk behaviour in countries with high, or suspected high HIV prevalence (Ainsworth, Murphy, & Harris,

1991; Conway, Gillies, & Slack, 1990; Evans & McLean, 1991; Godley, 1991; Mitchell,

Band, Bradbeer, & Barlow, 1991; Murphy, Breuer, Chinn, Goldmeier, & Harris,

1989; Nandwani, Hawkins, & Barton, 1991; O’Farrell, Allen, & Gardner, 1991). Other reports from genitourinary medicine (GUM) clinics in or near London suggested that recent increases in HIV rates among heterosexuals were largely attributable to political refugees or immigrants originating from nations with high rates of HIV and AIDS. For example, two studies published in 1993 reported that individuals who engaged in heterosexual sex with persons from sub-Saharan Africa were at increased risk for contracting HIV (Radcliffe, Tasker, Evans, Bispham, & Snelling, 1993; Shah, Iatrakis,

Smith, Well, Barton, & Kitchen, 1993).

CHAPTER 2: LITERATURE REVIEW 9

A review conducted by the Centre for Disease Surveillance and Control (CDSC) in the

UK on travel, heterosexual intercourse and HIV-1 infection revealed that British-born citizens were also at risk of being infected with HIV during travel abroad. Over half of the HIV-1 infections (n = 971) and three quarters of the AIDS cases (n =219) reviewed were presumed to have been acquired in primarily WHO pattern I or II countries

(Noone, Gill, Clarke, & Porter, 1991). However, criticism in the literature cites that the

CDSC review was based on a flawed assessment tool, namely the AIDS Surveillance

Clinical Report Form. This tool did not enquire into the types of travel undertaken

(i.e., business, pleasure, or study), nor did it distinguish between immigrants/refugees, expatriate residents overseas for a protracted time, and UK-born citizens who travelled as holidaymakers. Further, heterosexuals who met the criteria of exposure to HIV risks abroad and in the United Kingdom were allocated to the “heterosexual exposed abroad” group, which clearly resulted in misleading findings (Hawkes & Hart, 1993;

Shah et al., 1993).

Thus, a debate ensued in the medical literature on what proportion of HIV cases was

“imported” into the United Kingdom by immigrants and refugees from HIV-endemic countries and what proportion was attributable to indigenous UK nationals who had acquired HIV while travelling abroad (Hawkes & Hart, 1993). Epidemiologists estimated that the risk of HIV associated with travelling abroad for heterosexual

United Kingdom residents, both workers and travellers, was 300 times greater than their risk of acquiring HIV in the UK (Feachem & Phillips-Howard, 1988).

Consequently, during the early to mid-1990s, clinic attendees with links to WHO pattern I or II countries, particularly sub-Saharan Africa, were identified as “at risk” and were targeted for HIV testing. While the over-representation of people exposed to 10 CHAPTER 2: LITERATURE REVIEW

HIV in these high-prevalence countries did indicate the relative risk to some categories of travellers, such as immigrants and refugees, this strategy was counterproductive in that it potentially diverted attention away from surveillance of clinic attendees who did not appear “at risk”, which probably resulted in underestimated rates of HIV acquired domestically in UK-born citizens (Hawkes, Malin, Araru, & Mabey, 1992).

What has been studied?

Research focused on the public health and sexual behaviours of travellers is grounded primarily in epidemiological and medical perspectives, which set out to measure patterns of sexual activity and risk taking during travel. The research has been predominantly directed at individual factors, such as knowledge related to STI/HIV transmission and prevention, attitudes, and sexual behaviour. In short, this research has been driven to answer the epidemiological questions of “who”, “what”, “where”,

“when”, and “how many”. Taken together, these studies have endeavoured to investigate: 1) the rate at which travellers meet new sex partners; 2) the frequency of sexual contact with these partners; 3) the consistency of condom use during new and concurrent partnerships; 4) whether sexual behaviour during travel was different from that in their home environment; 5) the common characteristics of those travellers who engaged in casual sexual activity and failed to use condoms consistently; and 6) the sexual health implications of engaging in casual sex during travel.

However, recent social research has offered a more interpretive perspective, which has attempted to build on the literature through the exploration of links between sexual behaviour and the sociology of tourism, the social psychology of tourist behaviour, and CHAPTER 2: LITERATURE REVIEW 11

the social construction of sexual behaviour in the context of a variety of travel settings.

These studies not only sought answers to many of the same questions above, but also focused on why sexual behaviour and risk-taking were so often associated with travel.

The diversity in backgrounds of these researchers has offered a broad range of perspectives, utilised a multiplicity of techniques in gathering data, and demonstrated greater depth of exploration in order to understand the social, psychological, cultural, and contextual factors that shape sexual decision-making during travel.

Where has travel sex research been conducted?

Most of the research on travel and sexual behaviour has been conducted in settings where travellers are easily accessible, including clinics, within the general population, and internationally in various travel contexts. The majority of research has been conducted in the UK, but other countries have also made significant contributions to the literature: Australia, Canada, United States, Peru, Denmark, Italy, Norway,

Sweden, Switzerland, Hong Kong, Japan, and Thailand.

Clinic-based research

Given that travel has been linked with STI transmission for centuries (Quétel, 1990), it is remarkable that research interest in sexual behaviour and travel has been relatively recent. The majority of research on travellers has been conducted post-travel in various clinic settings, including genitourinary (GUM) clinics (i.e. STI clinics), travel medicine and vaccination clinics, or hospital-based general practice clinics, primarily in the UK, as well as in other countries that also have lower HIV prevalence, including

Australia, Canada, Denmark, Italy, Norway, Sweden, and Switzerland. Clinic 12 CHAPTER 2: LITERATURE REVIEW

surveillance of STIs acquired while travelling has served as a useful indicator of the incidence and determinants of sexual activity and condom use among travellers, and of the extent to which these infections have been imported back to their home countries.

Knowledge of the pattern and frequency of STIs in popular travel destinations has also been useful in screening and managing STIs that are contracted by travellers who visited those countries. But clinic populations are not representative of the general population.

Population-based research

Few general population studies have assessed the frequency of casual sex and consistency of condom use among individuals who travel internationally. Like the clinic studies done to date, the majority of general population studies have been conducted in the UK (Bloor et al., 1997, 1998; Gillies, Slack, Stoddart, & Conway,

1992; Thomas, Bloor, & Crosier, 1997), but other population surveys have been conducted in Switzerland (Hausser, Zimmerman, Dubois-Arber, & Paccaud, 1991), and Denmark (Melbye & Biggar, 1994).

Clinic and general population surveys are limited by their methodology and until now have only measured knowledge, attitudes, patterns of sexual behaviour, and condom use. Despite these shortcomings, this literature is important, given that it provides a very broad picture of sexual behaviour in the general population. Both clinic and population-based research tends to examine an individual’s sexual behaviour in isolation, rather than placing it in the wider socio-cultural context in which sex occurs.

While supplementary general population surveys would be useful, and are long overdue, knowledge of the contextual factors that influence sexual conduct during CHAPTER 2: LITERATURE REVIEW 13

travel are scant. Therefore, the following literature on travel and sex is a response to requests from the wider research community for context-specific research that features key travel groups that prevention initiatives need to target, based on their sexual risk taking while abroad.

Research in context

It is clear that travellers are key players in the acquisition and global diffusion of STIs.

Yet the individuals who travel should not be considered a specific risk group but rather tourism should be seen as a specific situation that can lead to risky sexual behaviour in travellers, requiring specific AIDS prevention strategies (Bröring, 1996).

There has been a notable shift in focus in the literature toward understanding the context-specific circumstances that often surround, interact with, and influence a traveller’s sexual decision-making process. Many researchers have argued that holidays, particularly those governed by “the three Ss” – sun, sea, and sand – have become socially defined zones where casual, pleasure seeking, and hedonistic are appropriate

(e.g. Eiser & Ford, 1995; Shields, 1991). Not surprisingly, the research so far on the sexual conduct of young adult tourists in the context of their travel experience has been concentrated in “sun and sand” destinations reputed for their popularity with young holidaymakers or package tourists. Researchers have concentrated on both domestic and international tourists. Domestic tourists have been studied in the resort town of

Torbay, England (Eiser & Ford, 1995; Ford & Eiser, 1996a,b), in Australia for

“schoolies week” (Maticka-Tyndale, Herold, & Oppermann, 2003; Smith &

Rosenthal, 1997), and in North America for “spring break” (Apostolopoulos, Snmez,

& Yu, 2002; Maticka-Tyndale & Herold, 1997; 1999; Maticka-Tyndale, Herold, & 14 CHAPTER 2: LITERATURE REVIEW

Mewhinney, 1998; Mewhinney, Herold, & Maticka-Tyndale, 1995; Schwartz, Milteer,

Sheridan, & Hormer, 1999). International tourists have been studied in the British

Virgin Islands (Lett, 1983), Malta (Clark, Clift, & Page; 1993), Greece (Wickens,

1997), the Balearic Islands in Spain (Elliott et al., 1998), including Ibiza (Bellis, Hale,

Bennett, Chandry, & Kilfoyle, 2000; Bellis, Hughes, Thomson, & Bennett, 2004),

Costa Rica (Ragsdale, Difranceisco, & Pinkerton, 2006), Peru (Cabada et al., 2002;

2003), Thailand (Vorakitphokatorn, Pulerwitz, & Cash, 1998-1999), Tenerife (Batalla-

Duran, Oakeshott, & Hay, 2003), and Hawaii (Nemoto, Iwamoto, Morris, Yokota, &

Wada, 2007).

The only published sexuality research to date specifically on backpackers was my own study of backpackers visiting Canada, although there has been some other research conducted with backpackers regarding other health issues (Bellis, Hughes, Dillon,

Copeland, & Gates, 2007). In 2000, I conducted research to investigate the sexual attitudes and behaviour of international backpackers visiting Canada (Egan, 2001a,b).

Given that there had been no research published previously on the sexual conduct of this particular travel community, the intention of this study was to establish a baseline of information on backpackers’ sexual practices while away from home. This was a quantitative study utilising a self-administered survey. Backpackers were recruited in hostels in Toronto, Ontario, and Banff, Alberta, two popular destinations on the

Canadian backpacker circuit. A total of 273 men and 231 women aged 15-34 years, from 33 countries, completed the survey. Demographic and behavioural characteristics were collected and comparisons drawn between the backpackers’ casual sex and condom use practices at home and in the travel context. There were evident limitations that emerged in this study. A third of the sample did not expect to travel for CHAPTER 2: LITERATURE REVIEW 15

more than 30 days. It was also noteworthy that at the time of completing the survey,

59% reported having travelled for less than 30 days. The over-representation of short- term travellers probably affected the findings of this study. Yet, given that it was the first study to focus on backpackers, it made a contribution to the context-specific literature and serves as an interesting comparison point for this study.

What have they found?

Sexual activity

The percentage of travellers who had sexual intercourse with new partners while abroad ranged between 5% and 48%. Most clinic studies have reported significantly higher levels of sexual activity among travellers than the general population. However, the differences in methodological approaches in the literature make comparisons difficult. Bloor et al.’s (1997; 1998) representative study of 5,676 18- to 34-year-olds who travelled during the previous two years without a partner revealed that 7% (n=400) had sexual intercourse with a new partner during travel, whereas clinic investigations generally indicated that a quarter of travellers reported participating in casual sex

(Arvidson, Hellberg, & Märdh, 1996; Carter, Horn, Hart, Dunbar, Scoular, &

MacIntyre, 1997; Hawkes & Hart, 1993; Hawkes et al., 1995; Mendelson, Astle,

Mann, & Shahmanesh, 1996; Tveit, Nilson, & Nyfors, 1994). The difference between rates of casual sex in general population studies and clinic-based studies is probably attributable to clinic patients being a special non-random subgroup of travellers. In comparison, recent context-specific research conducted with British holidaymakers in

Ibiza, Spain, reported that 47% of those who went on holiday without a partner had sex (Bellis et al., 2004). 16 CHAPTER 2: LITERATURE REVIEW

Efforts by researchers to explain sexual activity during travel have led many to focus on the influence of the demographic characteristics and sexual history of travellers

(Arvidson et al., 1996; Barlow & Sherrard, 1992; Bloor et al., 1998; Carter et al., 1997;

Hawkes et al., 1994, 1995; Mendelsohn, Astle, Mann, & Shahmanesh, 1996). Overall, the quantitative survey data indicate that the individual characteristics most often associated with sexual intercourse with a new partner during travel include:

• Male

• Caucasian

• Young

• Travelling alone, or with a peer group that does not include a regular partner

• Single

• Gay men

• Early coitarche: age at first intercourse younger than 16 years

• History of casual sex before and after trip

• Higher number of lifetime sex partners

• Travelling for longer period

• Overland tour

• Previous patient in GUM/STI clinic

• Treated for STI in past 5 years

• Drug use (including alcohol)

Earlier studies found that men were more likely than women to report new sexual partners while away. However, more recent research has shown that women were just as likely as men, and more likely in some cases, to seek out sexual opportunities during travel (Batalla-Duran et al., 2003; Black et al., 1995; Maticka-Tyndale & CHAPTER 2: LITERATURE REVIEW 17

Herold, 1999; Wickens, 1997). A sample of travellers in the airport departure lounge in Tenerife revealed that 39% of women and 32% of men who responded had had sex with someone other than their regular partner during their holiday (Batalla-Duran et al., 2003). A qualitative study in 1996 of women aged 17 to 40 years explored the meaning of sex with new partners met during travel (Thomas, 2000). This study was based predominantly on the narratives of “package holiday” tourists. The findings challenge the view that women need “love and commitment” in order to enjoy sex.

This study also highlighted the complex and intricate nature of socio-sexual relations: women may have difficulty negotiating activities that bring them sexual pleasure or ensure their sexual safety. Research has consistently shown that sexual experience prior to travel is a significant contributing factor in sexual decision-making during travel. Established patterns of sexual behaviour at home can, and often will, be replicated in the travel environment. Therefore, a history of casual sex can predict casual sex during travel (Bloor et al., 1998; Egan, 2001b; Hawkes et al., 1995; Nemoto et al., 2007).

Overall, research focused on the characteristics and sexual history of the individual traveller ignored the potential impact of the holiday environment itself to explain sexual behaviour during travel. Further, determining such individual predictors is rarely useful for community-based or mass media health promotion campaigns. A growing body of social science research on young travellers, specifically in beach settings, has focused on exploring the influence of destination and travel culture on sexual behaviour. Recreational travel has developed a self-sustaining reputation as a socially sanctioned, collectively constructed space and time to escape conventional norms of behaviour. For some, this involves over-indulgence in sex, alcohol and drugs. 18 CHAPTER 2: LITERATURE REVIEW

Anthropologists view recreational travel as a “liminal” zone, where the rules and regulations that govern everyday life at home are temporarily relaxed or disregarded

(Lett, 1983). Similarly, social psychologists view the context of travel as a space associated with “situational” or “context-specific disinhibition” where one sees “oneself as a different kind of person when on holiday” (Eiser & Ford, 1995, p. 327). Both of these views have gained substantial representation in the literature and have often been used synonymously to better understand how travel itself may influence sexual behaviour (Apostolopoulos et al., 2002; Black, 2000; Lett, 1983; Eiser & Ford, 1995;

Ford & Eiser, 1996a; Thomas, 2005).

However, opportunity is not in itself a preface to behaviour, since

behaviour requires certain predispositions to action, the lack of other

inhibiting factors, and possibly, […] a willingness to “experiment”. (Ryan &

Robertson, 1997, p. 135).

Bellis and colleagues also revealed that the rate of partner change during travel might be significantly higher than at home. The number of new partners over the average 10- day stay in Ibiza was approximately the same as would have been accumulated in the six months prior to the holiday (Bellis et al., 2004). Another study of patients attending two Glasgow GUM clinics compared the weekly rate of new sex partner changes at home and during travel (Carter et al., 1997). The number of new sexual contacts during travel was significantly higher than at home. Clearly, studies indicate the probability of engaging new sexual partners is increased during travel, which suggests there is something about the context of travel that influences the development of more CHAPTER 2: LITERATURE REVIEW 19

sexual partnerships. Together, these findings support the notion that sexual activity is more likely while away from the home environment.

The mixing of different sexual networks, particularly with local populations in HIV endemic areas, has global sexual health implications. This has prompted researchers to gather more information from travellers about where and with whom they have sought sexual encounters. Earlier research only differentiated between locals and “others”, but more recent research has, albeit inconsistently, explored the nationality of new sex partners and whether they were also travellers or indigenous to the countries visited, and whether they were sex workers. The findings vary considerably, possibly due to the different methodological approaches employed, as well as the different sub- populations studied. Generally, GUM clinic participants report more sexual contact with locals than do other samples studied. Black and colleagues’ (1995) study of GUM clinic attendees found that 78% of sexual contacts were with locals. Unfortunately, the authors did not specifically report the partner preference of the significant number of

“long-term” travellers in the study. Carter et al. (1997) studied the sexual and condom use behaviours of travellers who attended a GUM clinic in Scotland and found that homosexual men more often reported sex with locals of the countries that they visited than heterosexuals. Heterosexuals demonstrated a preference to engage in sex with fellow travellers originating from the UK. It is unknown whether or not these travellers were sex tourists. Men in Bellis et al.’s (2004) study were more likely to have sex with foreigners who were not nationals of their travel destination. Similarly, my research with backpackers visiting Canada revealed that men were more likely to have sex with other travellers, particularly backpackers, whereas women reported more sexual contact with locals (Egan, 2001a). 20 CHAPTER 2: LITERATURE REVIEW

Besides having sex with locals, with sex workers, and with other travellers, tourists frequently have sex with migrant tourism workers while holidaying in resorts (Ford &

Inman, 1992; Hennink, Cooper, & Diamond, 2000; Hughes & Bellis, 2006). A survey of 386 migrant tourist industry workers in the English resort of Torbay reported that

74% of male tourism workers had had sex with tourists, and also reported high levels of risk behaviour with tourist partners (Ford & Inman, 1992). Most recently, Hughes and Bellis (2006) revealed that a considerable number of tourism workers in Ibiza were actually travellers who extended their stay in desirable tourist areas and worked in bars and nightclubs in order to fund the remainder of their journey. Comparisons were drawn between tourist populations and tourism workers: workers were more likely to have unprotected sex, and with a greater numbers of partners, than tourists. Because their stay in tourist resorts was much longer than the average tourist, much of the sexual activity occurred at the beginning of their employment rather than at a consistent level throughout. Frequent intoxication was an occupational hazard for tourism workers that stemmed from the ubiquitous availability and consumption of alcohol and drugs. Heavy drinking was so common, both for those who had casual sex and those who did not, that it was difficult for researchers to statistically measure the effect of alcohol on condom use. However, travellers who have participated in other research have agreed that alcohol was an important modifier of sexual behaviour and have claimed that it was either the main reason, or a significant contributing reason, for condom non-use while abroad (Egan, 2001a; Thomas et al., 1997; Lister & Robinson,

1993).

CHAPTER 2: LITERATURE REVIEW 21

Alcohol

A contentious yet enduring topic of research interest is the predictable association between travel, alcohol, sexual behaviour, and sexual risk taking. It has long been recognised that alcohol may influence sexual behaviour and risk-taking during travel

(de Schryver & Meheus, 1989). Alcohol and drug use during travel have been of great interest to researchers in recent years (Bellis et al., 2007; Elliott et al., 1998; Smeaton,

Josiam, & Dietrich, 1998). People tend to consume more alcohol when they travel, and the evidence of tourists’ alcohol and drug taking behaviour during travel in a variety of destinations affirms this (Malta: Clark et al., 1993; Torbay, UK: Eiser &

Ford, 1995). Recently, Bellis and colleagues (2007) conducted a study of alcohol, drug, and tobacco use by UK backpackers while visiting Australia. They found the proportion of backpackers who reported drinking alcohol five times or more per week increased from 21% in their home environment to 40% during travel in Australia. In practice, it is not surprising that many travellers have casual sex while intoxicated

(Thomas, 2000). Travellers are often under the influence of alcohol when sex occurs

(Cabada et al., 2003; Maticka-Tyndale & Herold, 1999; Nemoto et al., 2007). But it is unclear what constitutes being “under the influence” since most research has not measured alcohol intake prior to sexual encounters with new partners. Bloor et al.

(1997; 1998) attempted to fill this gap by drawing the links between frequency of alcohol consumption, level of intoxication and sexual behaviour during travel. They found that greater frequency of alcohol consumption and more instances of being “a little drunk” or “very drunk” during travel were associated with reports of sexual intercourse with someone new while abroad. In contrast, Black et al. (1995) found no clear relationship between a change in the levels of alcohol intake and the probability of having sex with a new partner on a trip. 22 CHAPTER 2: LITERATURE REVIEW

The association between drug and alcohol use and sexual activity may also be dependent on the setting in which the use occurs and the specific motivations for travel. Elliott et al. (1998), Bellis et al. (2004), and Hughes and Bellis (2006) conducted research on sexual activity and drug and alcohol use among travellers to the Balearic

Islands (i.e. Ibiza). Despite the research being done in the same archipelago, Elliott et al. (1998) found less of a relationship between alcohol use and sexual activity than

Bellis and colleagues did. “Ravers”, who often travel to Balearic Islands that market their vacation spots as “dance holidays”, were also a focus in Wickens’ (1997) ethnographic study of travellers to northern Greece. Three years of fieldwork informed her construction and development of a tourist typology based on tourist motivational and behaviour patterns in “Kalimerya”, a well-established seaside tourist destination. The raver was one of five types of tourist, one whose main motivation was to get a suntan, have sex, and get drunk. Unlike the “rave” tourists in Elliott et al.’s study, who were more interested in the dance and drug culture of rave parties, the ravers in Wickens’ study courted sexual health risks in their pursuit of sexual adventure. Wickens’ analysis of tourists suggests that they took “voluntary risks by

‘bracketing out’ the health dangers associated with promiscuous sexual behaviour” (p.

159). Instead of recognising that sexual decision-making is not necessarily a rational or thoughtfully measured process, this perspective assumes that these tourists consciously decided to gamble with their sexual health by not using condoms with new partners.

Apart from acknowledging the ubiquitous alcohol consumption among raver tourists in

Kalimerya and its influence on sexual decision-making, Wickens did not explore or acknowledge the condom use practices of the other types of tourists. Exploration in this direction would possibly have provided valuable insight into the social and cultural CHAPTER 2: LITERATURE REVIEW 23

factors that impeded or facilitated the use of condoms among tourists with different travel motivations from ravers.

One of the resounding themes in the literature is the concern over travellers’ alcohol and drug consumption, and its association with sexual risk-taking. Gagneux, Blöchliger,

Tanner, and Hatz’s (1996) study of 3,509 Swiss travel clinic attendees found that the most common reason cited by patients for not using condoms with a new partner on a recent trip was alcohol consumption. However, Maticka-Tyndale and Herold (1999) found no relationship between alcohol and condom use with new partners during a spring break holiday in Florida. Research from the UK conducted by Bloor and colleagues (1998) included individuals who had reported sexual intercourse with a new partner(s) during travel in the previous two years (N=400) and a weighted control group of those who did not have sexual intercourse abroad in the same time period

(N=5,276). The study confirmed an independent relationship between alcohol consumption and sexual risk-taking in the home environment, yet found no similar relationship during travel. Neither frequency of alcohol consumption nor reports of being “a little drunk” or “very drunk” while travelling were linked with whether condoms were used or not. The myriad of other influences on behaviour control during travel make it impossible to assume a causal relationship between alcohol, sexual behaviour, and condom use. These results reinforce that research considering the relationship between travellers’ sexual behaviours and condom use needs to be placed within the social and cultural context in which alcohol is consumed.

24 CHAPTER 2: LITERATURE REVIEW

Condom use

Concern over the risk of STI acquisition during travel has prompted researchers to examine what health protective measures are taken by travellers. Given that most heterosexual travellers subscribe to the hegemonic construction of sex as vaginal intercourse, condom use has been a key focus in the literature. According to most of the literature, the majority of travellers do not use condoms consistently. Rates of using condoms on every occasion ranged from 12% to 75% per sample, but many of the studies reporting these figures were likely to have been affected by selection bias. The majority of research investigating the prevalence of condom use in travel populations has been conducted in STI/GUM clinics, and therefore travellers with a history of sexual risk taking during travel were over-represented. In comparison, the results of

Bloor et al.’s (1997; 1998) study were more encouraging: 75% of the travellers in their general population sample used condoms consistently with new partner(s) met during travel. However, none of the published reports on the consistency of condom use published since this one have been as encouraging.

There is ample evidence to show that adequate knowledge of the transmission of HIV and other STIs and of risk reduction measures does not necessarily translate into personalised perceptions of risk or protective sexual health behaviours (Allard &

Lambert, 1992; Behrens & Porter, 1990; Lister & Robinson, 1993; Mulhall et al.,

1993b; Porter, Phillips-Howard, & Behrens, 1991; Vorakitphokatorn et al., 1998-

1999). Worm and Lillelund (1989) conducted a simple study on the sexual and condom use behaviours of travellers staying at a summer youth hostel in Copenhagen,

Denmark. This study is relevant to my research in that the participants most likely were backpackers, given that youth hostels are the most popular accommodation for CHAPTER 2: LITERATURE REVIEW 25

this type of traveller. On arrival at the hostel, each guest was provided with an envelope containing a condom and written information about HIV. A total of 1,229 hostel patrons, 731 men and 498 women (mean age 22.5 years) completed a self- administered questionnaire on their sexual behaviour and condom practices. The participants originated from 55 different countries. About one traveller in 10 (97 (13%) men and 42 (9%) women) reported “sexual contacts” while visiting Copenhagen.

Carrying condoms was much more common for men: 21% of men and 6% of women travellers always carried condoms, whereas 43% of men and 79% of women reported never carrying condoms in their luggage while travelling. No analyses were done to establish whether those who carried condoms were more likely to use them. Forty men

(41% of the men who reported sexual contacts) had sex with a Danish woman. Almost half of these men always used condoms, but none of the four women who had sex with

Danish men used a condom. The distribution of health prevention messages prior to the survey regarding condom use most likely biased the responses to this survey. In addition, “sexual contact” and “sexual relationships” were not clearly defined, which introduced a potential for participants to include those they were in a regular sexual partnership with, or with whom they were travelling. Clearly, the distribution of condom(s) at the beginning of their stay inflated the reported numbers of travellers who possessed condoms during their stay in Denmark. It is impossible to know if these travellers normally carried condoms when they visited other destinations during their journey. Further, the authors’ concern over importation of HIV into Denmark at this time is evidenced by the omission of survey items asking about condom use with non-Danish sex partners. Despite these shortcomings, this study did highlight how carrying condoms may facilitate their use during sexual encounters while travelling.

26 CHAPTER 2: LITERATURE REVIEW

The literature has focused on certain conditions that may facilitate condom use, such as intentions to use condoms, carrying condoms, and experience with condoms.

Mulhall et al. (1993b) conducted a cross-sectional study on HIV/STI knowledge, perception of risk, and intended sexual behaviour of young heterosexual Australians prior to extended trips to one or more destinations internationally. A survey was completed by 213 attendees who sought pre-travel medical advice at a private travel clinic. The sample had high condom use expectations, with 82% stating that they would use condoms on every occasion of sex abroad. Given backpackers’ preoccupation with budgeting, the restriction of this study sample to clients of a private

(fee-for-service) clinic may have affected the representativeness of these findings for the general backpacking population. No studies have compared casual sex and condom use intentions prior to travel with actual travel behaviour. However, other research has shown that assumptions about actual condom practices should not be drawn from travellers’ intentions. Maticka-Tyndale and Herold (1999) found that almost all (97%) of the young people surveyed in the context of their “spring break” holiday in Florida had intentions to use condoms with new partners during their trip, but only 72% of these tourists reported using a condom at last intercourse. Single-recent-event questions are thought to provide a better indicator of condom use behaviour than measures of “usual” behaviour, which perhaps are more subject to memory and social desirability pressure. But these findings offer little insight into the participants’ frequency of condom use, or the contextual factors that might have negatively influenced condom practices. Maticka-Tyndale and Herold consider that the high expectations and intentions to use condoms that prevailed in their sample were a reflection of the respondents’ positive attitudes and peer endorsement of condom use; thus condom use with new sex partners was a scripted part of the spring break holiday CHAPTER 2: LITERATURE REVIEW 27

experience. These findings may help explain why some travellers are more likely to carry condoms during travel than they would be at home.

Eiser and Ford (1995) reported that tourists in the resort town of Torbay in Devon were more likely to carry condoms on holiday than at home, but generally those who carried them at home were also likely to do so while travelling. Earlier work showed that carrying condoms was not very popular with women (Vorakitphokatorn et al.,

1998-1999; Worm & Lillelund, 1989). More recent qualitative exploration has offered insights into why such gender differences occur (Black, 1997). Finding a discreet place to carry condoms can be a challenge for women, particularly in hot vacation destinations where little clothing is needed or desired. In addition, some of the women in Black’s and other studies (Holland, Ramazanoglu, Sharpe, & Thomson, 1998;

Stanley, 2005) believed that carrying condoms could signify promiscuity or sexual consent. The findings also highlighted that the constitutive qualities of fun and spontaneity enjoyed during travel often preclude organised and deliberate efforts to carry condoms.

Not taking condoms on a trip has been found to be a good predictor of non-use among gay men (Clift & Forrest, 1999). Conversely, carrying condoms has been found to be a good predictor of condom use with new partners while abroad (Bloor et al.,

1998). Earlier research, however, produced less optimistic results, which suggests that carrying condoms and intending to use them with new partners do not automatically ensure their use.

28 CHAPTER 2: LITERATURE REVIEW

Interestingly, while travel has been found to increase a traveller’s propensity to seek out and have sex with new partners, several studies have found no evidence that the disinhibiting effect of travel extends to an increase in unsafe sex practices with these partners (Bloor et al., 1998; Maticka-Tyndale & Herold, 1997; Thomas et al., 1997).

Condom use or non-use practices generalise well across situations, specifically from the home environment to the travel environment. Non-use of condoms before travel has been associated with non-use during travel (Hawkes et al., 1995), and consistent condom use before travel is associated with consistent condom use during travel

(Bloor et al., 1998; Carter et al., 1997; Egan, 2001b; Thomas et al., 1997). In Thomas and colleagues’ study (1997), 51% of the people who reported a new sexual relationship on their most recent trip used condoms on all occasions, compared with

43% of those participants who reported sex with a new partner in the UK. This finding confirms those of Gillies et al. (1992) and Hawkes et al. (1994), and suggests that while condom use during travel does largely reflect condom use at home, condom use is more common in new sex encounters while travelling.

Analyses of condom use by gender, however, have consistently revealed disturbing findings in the literature: women are more likely to practise unsafe sex with new partners while travelling than at home (Egan, 2001a; Gehring, Widmer, Kleiber, &

Steffen, 1998; Thomas et al., 1997). My research with backpackers visiting Canada revealed that 73% of women reported using a condom during their last episode of casual sex prior to travelling, yet only 59% used a condom with their last casual sex partner during their trip. It has been suggested that travellers’ risk behaviour during travel might be shaped by the characteristics of their sexual partner(s). Both Thomas et al.’s (1997) and Bloor et al.’s (1998) studies found that women were less likely to use CHAPTER 2: LITERATURE REVIEW 29

condoms consistently, or at all, if their new sex partner was a fellow traveller from the

UK than if their partner was of a different nationality to their own. Maticka-Tyndale and Herold (1999) found no gender differences in condom use at last intercourse with their spring break sample, but it should be noted that they did not measure the characteristics of their participants’ new sex partners nor did they compare safe sex practices across the contexts of travel and home.

It has been found that women are also more likely than men to contract an STI the longer they are away from home (Ingham, Woodcock, & Stenner, 1991). Other researchers have drawn the association between length of travel, unsafe sex, and related sexual health morbidity (Arvidson et al., 1996; Bavastrelli et al., 1998; Carter et al., 1997). The studies conducted by Arvidson et al. and Bavastrelli et al. will be discussed here in detail as they appear to include a significant number of travellers who resemble backpackers, even though they are not identified as such.

Arvidson et al. (1996) investigated whether women who attended their family planning clinic differed with regard to their sexual risk behaviour and history of STIs according to their classification of journey type. Casual travel sex was defined as “any history of sexual intercourse with a previously unknown male on a foreign journey, that had not lead [sic] to a steady relationship” (Arvidson et al., 1996, p. 491). Of the original sample of 996 women, 276 (28%) reported that they had had sex with a new partner during one or more trips abroad. The remainder of the sample represented the comparison group. The women who reported casual travel sex gained these experiences in four different travel contexts: charter trips (n=167), business (n=82), education (n=21), and vagabond travel (n=31). “Vagabond” is a term that was used in 30 CHAPTER 2: LITERATURE REVIEW

the early travel literature and appears to be synonymous with backpacker. Arvidson et al. described this group of travellers as “those who had engaged in casual travel sex on far-away journeys and mainly were going with train and/or ferries” (p. 491). The mean age of the different travel groups ranged from 24.2 to 28.8 years, with vagabond travellers being the youngest. The findings suggest that the women with experience of casual travel sex, irrespective of type of journey, were different from the comparison group with regard to sexual behaviour characteristics and STI history. Participants in all of the travel groups, on average, had significantly more lifetime sex partners

(education: 24; charter: 21; vagabond: 21; business: 18) than the comparison group: 8.

Vagabond travellers were the only group to be significantly different from the comparison group. These travellers were the most likely to report an early age of first intercourse, were the least likely (out of all the groups) to report condom use “from the beginning of every intercourse” on their trip (7%), and consequently were the most likely to have a history of genital chlamydial infection (36%, n=11), or “any” STI (45%, n = 14). These findings suggest that individuals who go backpacking may be more risk- taking and adventurous than others prior to travel.

Bavastrelli et al. (1998) conducted a study in Rome, Italy, with 130 young, urban, sexually active participants who attended hospital-based clinics. These researchers attempted to assess the importance of travel as a risk factor for Chlamydia trachomatis infection. A total of 98 females and 32 males aged 14 to 25 years (mean age: 20.2 years) agreed to participate. Over half (58%) of the sample had travelled for purposes of holiday or work to Europe, North America, or Asia. While the researchers did not quantify the types of travel these young people pursued, they did ascertain that overall, the purpose of travel was to seek employment or to “travel on a small budget”. The CHAPTER 2: LITERATURE REVIEW 31

lifestyles of these young people while abroad closely resembled that of backpackers or vagabonds, i.e. they “lived in youth hostels or a cheap rooming house, or they camped out-of-doors” (p. 59). However, the authors noted that while this type of travel is similar to that observed in “vagabond” travellers in Arvidson et al.’s Scandinavian study above, they did not wish to “imply that such travellers are in any way irresponsible or disreputable” (p. 59). All of the “vagabond” travellers engaged in “casual sex” while away from home, although casual sex was not defined. The authors report that chlamydia was most frequently discovered among “vagabond” travellers, but the incidence of chlamydia within this group was not specified. Twenty-one per cent of the sample was diagnosed with Chlamydia trachomatis, with 24% of the females and 21% of the males who tested positive for chlamydia being asymptomatic. This finding is of great concern for two reasons: first, because there were likely many more travellers who were also asymptomatic and therefore did not attend a clinic for assessment and treatment; and second, it is likely these travellers unknowingly transmitted their infection to other sex partners. Casual sex with two or more partners in the last six months was recognised as a significant risk factor for acquisition of chlamydia, particularly for international travellers, and specifically for 14- to 19-year-olds.

Together, these studies suggest that young backpackers may be at a higher risk of STI acquisition than other young travel groups. However, there is little that can be gleaned from these limited quantitative studies to confirm why that is the case. There are few qualitative explorations of travellers’ sexual behaviour and condom use (Black, 1997;

1998; 2000; Elliott et al., 1998; Lett, 1983; Mewhinney et al., 1995; Ragsdale et al.,

2006; Thomas, 2000, 2005; Vorakitphokatorn et al., 1998-99; Wickens, 1997). It is clear from what is available that the social and cultural background of travellers, and 32 CHAPTER 2: LITERATURE REVIEW

the context specific to their travel destinations, can play a significant role in sexual decision-making. Recent literature that has tried to place the sexual behaviours and risk taking of travellers in a socio-cultural context has revealed that the constellation of possible influences seems infinite. Qualitative research has produced interesting findings related to the meaning of travel sex and what role risk plays in sexual decision- making. Further detail on this and other research related to my own findings is discussed in Chapters 5 to 11.

While some of the quantitative literature has tried to explore the psychological predictors of condom use, the qualitative research available has just scratched the surface in revealing the complex situational, cultural and social issues that often interfere with sexual safety. Qualitative research has underlined that sexual decision- making is often not a rational process, and cannot be viewed or understood independent of the context in which it occurs. Thus far, the research has emphasised that condom use can be facilitated or impeded, not only by individual factors (such as condom-use intentions, carrying condoms, and experience with condoms) and context- specific social circumstances (i.e. alcohol consumption, safe sex negotiation, perceptions of risk related to travel destination), but also by entrenched discourses surrounding safe sex, heterosexual sex, and gender. Further, given that consensual sexual intercourse is a dyadic process that requires a commitment from both parties, the challenges of ensuring condom use are often compounded, particularly for women who are dependent on men wearing them.

CHAPTER 2: LITERATURE REVIEW 33

Methodological issues

The methodological approaches adopted in the literature are extremely varied and therefore comparisons are difficult. None was strictly representative as the samples of travellers studied were so disparate, and it is impossible to enumerate or randomly sample this transient population. Much of the research conducted in this area has been fundamentally motivated by public health concern related to the sexual risk-taking behaviour of travellers, and the paucity of theoretical or conceptual frameworks exhibited in these studies reflects this. Most studies have only utilised quantitative methodologies that have relied upon, and have been limited by, pre-determined survey responses about sexual behaviour. Further, the time lapse between travel and study participation in the retrospective studies varied significantly, including: within one month of sexual intercourse with a new partner while travelling; three months; six months; and two years (Black et al., 1995; Carter et al., 1997; Hawkes et al., 1994;

Hawkes et al., 1995; Mendelsohn et al., 1996). Therefore, recall bias is a clear and likely possibility. The terms “sexual contact”, “casual sex”, “sexual encounter”, “sexual intercourse”, and “sexual partners” were mostly left undefined, particularly in the clinic studies.

Methodologically, clinic studies have some limitations. While clinics are relatively efficient in selectively recruiting participants, the travellers surveyed in clinics, particularly STI/GUM clinics, over-represent members of the general population with high-risk sexual lifestyles. Clinic attendees presumably have symptoms or strong reasons to believe that they may have been infected, or they would not have attended the clinic. Thus they may represent specific sub-populations who have sex with high- 34 CHAPTER 2: LITERATURE REVIEW

risk partners (such as locals of countries where HIV/STIs are endemic). Moreover, the majority of the clinic studies reviewed did not present demographic and behavioural characteristics of attendees, which are essential in order to inform targeted primary health prevention initiatives. Most of the clinic-based studies have been conducted in

London, which is not representative of all UK, or other international clinics. Catchpole et al. (1997) noted that London GUM clinics reported higher rates of patients diagnosed with STIs, including HIV, than other clinics in English cities. Furthermore,

Catchpole and colleagues found that in comparison to the general population, clinic attendees were younger and were more likely to report: more sexual partners; contact with sex workers in the past year; injection drug use; male-to-male sexual contact; a past history of STI(s); sexual intercourse abroad with a non-regular partner. They also were more likely to be diagnosed with an acute STI. Other research has found that the stigma associated with GUM clinics may be a barrier to women accessing their services

(Scoular, Duncan, & Hart, 2001), which may explain women’s under-representation in the GUM clinic studies. In addition, the clinic studies taken together have revealed that

Caucasians, English-speaking people, immigrants, and long-term travellers were over- represented; however, this literature does not specify whether these long-term travellers were backpackers, expatriates, or students.

The demographic characteristics and factors most frequently associated with travellers at risk of becoming infected with STI/HIV while abroad have been reproduced extensively in the quantitative literature. However, it is clear from reviewing the literature that some authors have made the dangerous assumption that these repeatedly cited situational (e.g. alcohol or drug consumption) and personal characteristics are causal rather than merely associated with sexual risk taking. Efforts have been made by CHAPTER 2: LITERATURE REVIEW 35

some researchers to construct risk profiles or tourist typologies based on the most commonly reported characteristics or individual psychological traits of travellers who may be exposed to STIs and transmit them to concurrent partners. This approach is misleading and is based on essentialist assumptions that do not take into consideration the “social” nature of a sexual encounter, as argued by Gillies and Slack (1996) in relation to travellers. Thus, “although the behaviour of some travellers puts them at higher risk of contracting STIs, there is no single profile of the “at-risk” traveller”

(Ward & Plourde, 2006b, p. 311).

The individual focus of much of the literature presumes that sexual decision-making is a rational process, and this perspective neglects to recognise that travellers’ attitudes and behaviour are constructed and negotiated within social and cultural contexts. The disparate social and cultural backgrounds of international travellers inevitably intersect with each other and with the social and cultural contexts in which they travel, and these dynamic interactions may have an impact on their sexual health behaviour and sexual morbidity while abroad. The importance of, and necessity for, context-specific research are explicit in Gillies and Slack’s statement: “the importance of context cannot be over-emphasised: it is crucial to interpretation of the limited findings available thus far on preventive behaviours during sexual intercourse with strangers on holiday” (1996, p. 146). There is a dire need for further qualitative context-specific exploration of sexual experience during travel because it is crucial to understanding the interactions between travel, the socio-cultural situation, the setting in which sex occurs, and the subjective meaning attributed to sexual experiences during travel. Such a detailed exploration is necessary in order for effective health promotion interventions to reach travellers and diminish their sexual risk taking while abroad.

Theoretical perspectives

Previous research has established that casual sex and sexual risk behaviour are common in the backpacking community (Chapter 2). Yet, it remains unclear why these patterns of sexual behaviour are so prevalent in long-term travel populations. The following summary of tourism theories may appear unrelated to the study of travellers’ sexual behaviour. However, sexual behaviour while backpacking cannot be understood in any meaningful way unless we first understanding what backpacking really is, why certain individuals are attracted to this form of travel, and how a backpacking journey affects an individual’s life or way of being.

The backpacking community is comprised predominantly of Western middle-class young people (and a small number of travellers who would be considered

Westernised, such as Japanese populations). Backpackers have been given an assortment of titles including: drifters (Cohen, 1972; Evans, 1978); nomads (Cohen,

1973); wanderers (Vogt, 1978); tramping youth (Adler, 1985); vagabonds (Elsrud,

1998), and long-term budget travellers (Riley, 1988). Despite the multiplicity of terms used in the literature, there is a consensus among researchers that the backpacker represents the non-institutionalised traveller, who is differentiated from the institutionalised mass tourist (Black, 1998; Cohen, 1972, 1973; Loker, 1993; Loker-

Murphy & Pearce, 1995; Neumann, 1992; Riley, 1988; Uriely, Yonay, & Simchai,

2002; Vogt, 1978). “The term ‘traveller’ denotes a form of identity consisting of a particular ideology and cultural identification which relates to long-haul travel as a way CHAPTER 3: THEORETICAL PERSPECTIVES 37

of life” (Black, 1998, p. 46-47). Backpackers share a common identity which is based on arrangements and practices by which travellers organise their journey: (1) travelling for longer periods of time, (2) flexible itineraries, (3) preference for travelling “off the beaten path”, (4) travelling alone or with a group of friends, (5) living on a shoestring budget, (6) visiting culturally “authentic” destinations and attractions, and (7) participation with, rather than observation of, locals of the culture being visited.

Despite these unifying customs, travellers are a heterogeneous group (Uriely et al.,

2002). The attributes, attitudes, motivations, and meanings that backpackers attach to their travel experience may be as varied among travellers as “the country of origin, the social background and the route they choose to travel” (Elsrud, 1998, p. 310).

Time and space

Backpacking is a rewarding journey that allows travellers to leave the constraints of institutional time behind. Elsrud (1998) found that “time out” was a common concept amongst the Swedish female backpackers that she interviewed. “Time out” for interviewees in Elsrud’s study symbolised a withdrawal from the routines and structures of everyday life in the Western world. Prior to mobile phones being so popular among the backpacking population, the rejection of clock-time was evident from the consistent finding by researchers that many backpackers neither wore nor carried watches while travelling (Dann, 1999; Elsrud, 1998; Neumann, 1992; Teas,

1988; Uriely et al., 2002). The concept of time out is very similar to van Gennep’s concept of “out of time” in The Rites of Passage (van Gennep, 1960).

38 CHAPTER 3: THEORETICAL PERSPECTIVES

Research examining the socio-sexual culture of travellers has not been firmly grounded in any specific theory. However, travel researchers have referred to the theoretical concept of liminality to provide some insight into why people are more willing to engage in casual sex experiences in certain social contexts, such as travelling (Black,

1998; Bloor, 1995;; Egan, 2001a; Lett, 1983).

Liminal concept

Victor Turner’s term of “liminality” was based on earlier seminal work by anthropologist Arnold van Gennep. Van Gennep analysed the ceremonies accompanying an individual’s “life crises” or calendrical rites in pre-industrial societies, which he termed rites de passage or rites of passage. Van Gennep distinguishes three phases in a rite of passage: separation, transition, and incorporation. The rites that occur in the initial phase separation demarcate an individual’s removal from the profane (constrained) world. This phase –

clearly demarcates sacred space and time from profane or secular space

and time (it is more than just a matter of entering a temple – there must be

in addition a rite which changes the quality of time also, or constructs a

cultural realm which is defined as “out of time”, that is, beyond or outside

the time which measures secular process and routines) (Turner, 1974b, p.

57).

During the next phase of transition, individuals travelling alone, or with acquaintances, pass over the threshold or limen and exist in a liminal state in the sacred (free) world.

In this intervening phase, ritual subjects pass through an ambiguous or marginalized CHAPTER 3: THEORETICAL PERSPECTIVES 39

period where the “rules of the profane world” don’t apply. In the transitional or liminal phase, individuals may experience an enhanced state of temporal and spatial suspension between two structured worlds:

The passing from one world to the next, from the aggregate of the familiar

to the fragmented composition of the ordinary and non-ordinary. The

physical surroundings may be familiar and/or the individual may be with

known companions; however, because of the unfamiliar symbolic and

spatial circumstances of the situation, the individual must assimilate both

with the familiar and the unfamiliar (Currie, 1997, p. 887).

The third phase, incorporation or re-aggregation, includes symbolic rites performed which represent the entrance into a new profane world, assuming a new, relatively secure, distinct position in society. Accompanying this final phase is a spatial passage from one geographical location to another. This spatial movement could be as simple as crossing a threshold, or as involved as a lengthy pilgrimage crossing many cultures and borders. Each passage in space covers the distance between two distinct areas, one associated with the pre-ritual or pre-liminal status, and the other with their post-ritual or post-liminal status (Turner, 1974b). In The Ritual Process, Turner (1969) applied van Gennep’s concept of rites of passage to pre-industrial societies. Like van Gennep,

Turner studies pre-industrial societies, such as the Ndembu tribe of Africa, utilising and applying the three conceptual phases of rites of passage. Turner was particularly interested in the liminal phase of the sacred world. Turner examines the ritual passage of individuals from one status to another within a society, for example, from non- citizen to citizen, from bachelor to husband and from child to (sexually mature) adult, 40 CHAPTER 3: THEORETICAL PERSPECTIVES

etc. Liminal initiates must experience the “dark”, “anti-structure” that is cultivated in the liminal phase before individuals are considered to be deserving of their new positions in society. They are stripped of all identifying characteristics which represent their structured lives (such as identity, clothing, status, etc.) (Currie, 1997).

Expectations of the initiates’ behaviour are altered, former rights and obligations are suspended, leading to an inversion of structured behaviours (Currie, 1997; Turner,

1974b).

Liminoid concept

Turner further expanded and adapted van Gennep’s work by attempting to apply the concepts of rites of passage to post-industrial societies. He surmised that the symbols of liminality found in rites of passage would only exist “within relatively stable, cyclical, and repetitive systems” (Turner, 1974b, p. 62). Due to fundamental distinctions between the pre- and post-industrial eras, while subcultures in large societies may experience a modern day rite of passage, they will not exhibit the traditional liminal experience but rather a metaphorical experience (Turner, 1982). The key difference between the two eras is associated with the level of obligation imposed on individuals living in that time period. In pre-industrialised societies, a journey between profane and sacred work was compulsory, whereas in post-industrial societies the distinction between work and play/leisure is voluntary. So, Turner coined the term liminoid which “resembles without being identical to ‘liminal’” (1974b, p. 64), to describe the freely chosen ludic (playful) phenomena that are characteristic of post-industrial societies. Huizinga (1950) regards play as the fundamental characteristic of human beings – to be human is to play.

CHAPTER 3: THEORETICAL PERSPECTIVES 41

Play is a free activity standing quite consciously outside “ordinary” life as

being “not serious”, but at the same time absorbing the player intensely

and utterly. It is an activity connected with no material interest, and no

profit can be gained. It proceeds with its own proper boundaries of time

and space … it promotes the formation of social groupings which tend to …

stress their difference from the common world by disguise or other means.

(Huizinga, 1950, p. 12)

Liminoid spaces are arenas that possess liminal attributes without the ritual associations.

In contrast to liminality, liminoid experiences are generally emphasized in

societies with organic rather than mechanical solidarity; they are generally

associated with leisure activities rather than calendrical rites; and they

generally center upon activities that involve participation and idiosyncratic

symbolism rather than upon activities that involve collective participation

and collectively held meanings (Lett, 1983, p. 45).

A “rite of reversal” is a recognised liminoid activity that is celebrated in many social settings and cultures, including backpacking. Symbolic of the anti-structure that is sought in liminoid spaces, rites of reversal are transitional sanctioned periods “during which the social hierarchy is inverted [and] customary rules of moral conduct are suspended” (Norbeck, 1971, p. 51). Some examples of ritual reversal currently celebrated in the world are the Gay and Lesbian Mardi Gras in Australia or the Grand

Carnival in Brazil. In these examples, it is not just that someone dresses differently and 42 CHAPTER 3: THEORETICAL PERSPECTIVES

therefore acts differently from normal, instead these are examples of how participants in an event or during travel, regardless of socio-economic background, share a common connection to what brought them together in the same place and that in that time and space they embrace their different roles from everyday society. Other examples of ritual reversal behaviour can be found within travel cultures such as: charter yacht tourism (Lett, 1983); spring-break holidays (Mewhinney et al., 1995);

Mediterranean dance holidays (Elliott et al., 1998; Wickens, 1997); seaside vacations

(Eiser & Ford, 1995;; Shields, 1991), and backpacking (Egan, 2001a). While away from home, people on these holidays take time out from their structured lives, wilfully engaging in socially permitted and approved behaviours which appear to reject or disregard the legitimacy of the institutionalised statuses, roles, morals, regulations, and norms of ordinary home life (Lett, 1983). In short, these are examples of liminoid spaces.

Aberrant behaviour is often a product of existing in a liminal or liminoid space, which represents significant concerns to sexuality researchers because the potential for risk- taking behaviour is increased (Black, 1998). In my study of backpackers travelling to

Canada, the casual sex and condom non-use behaviours of people who had no experience with these activities prior to travel appeared to be examples of inversionary sexual behaviours that occurred in the unstructured, liminoid space of backpacking.

Thus, liminoid theory may offer useful sensitising concepts that could aid the exploration and analysis of the data gathered in this study of backpackers.

In comparison with other liminoid travel cultures, it has been argued that backpacking provides a different “time out” experience from that of shorter rites of passage. Taking CHAPTER 3: THEORETICAL PERSPECTIVES 43

time out in a literal sense suggests emptiness or timelessness, which ignores the constitutive qualities of the travel experience. In the words of Elsrud (1998), “The long-term budget traveller can be said to engage in a more profound, but also less obvious ‘time out’, as it is a long period away from the […] everyday structure, but also a period filled with other structuring devices, including time” (p. 312). Freed from the normal constraints of structured home life, backpackers may have a different perception of time. To summarise, Elsrud argues that taking a time out from the external presence of clock time and the duties associated with contemporary living affords freedom for backpackers to existentially exist “in time”, in a sense gaining their

“own time”. In a search for content to fill their own time, backpackers can be creative with personal expression and structuring of movements while travelling within the liminal “time frame” of the journey.

Visiting the “authentic”

Many backpackers are pre-occupied with the pursuit of an “authentic” travel experience. MacCannell introduced the concepts of authenticity of tourist motivations and experiences to sociological studies over two decades ago with The Tourist (1976) and the article “Staged authenticity” (1973). Since then these concepts have been a recurrent theme of study and heated debate (Bruner, 1989;; Cohen, 1979; Hughes,

1995; Selwyn, 1996; Wang, 1999). MacCannell (1973) argues that Westerners who are unable to achieve satisfaction and authenticity in their own industrialised culture seek authenticity in places believed to be more original or genuine. While there has been extensive misuse of the conventional concept of authenticity by tourism researchers in the past, its use “is relevant to some kinds of tourism such as ethnic, history or culture 44 CHAPTER 3: THEORETICAL PERSPECTIVES

tourism, which involve the representation of the Other or the past” (Wang, 1999).

Thus, this concept is of central importance to backpacking research.

In an effort to escape modern institutionalised society, backpackers search for the novel pre-modern Other cultures that are left to be “discovered”. It is a commonly held belief among long-term travellers that they pursue and achieve more authentic travel experiences than mass tourists holidaying in resorts (Black, 1998; Neumann,

1992; Uriely et al., 2002). Boorstin (1964) has strongly supported this distinction between tourists and travellers, maintaining that contemporary tourism is comprised of contrived experiences based on “pseudo events”, which are the result of the commodification of culture and the related sameness of tourist experiences. The authenticity of places visited is important to backpackers. According to Desforges

(1998), “travellers face the anxiety that the places they visit are not ‘really’ different, that they are not the ‘real’ India or the ‘real’ Peru” (p. 180). Through travel writing, tourism advertising, and the “primitivisation” of the Other through the media, travellers are misled to believe that they are setting off on a journey back to find cultures and places “frozen in time”. In Beezer’s words, “landscapes are aestheticised and given a density of meaning: forests are ‘primeval’ and to be ‘penetrated’, land is

‘untamed’; deserts are ‘arid’ and ‘austere’” (1993, p. 127).

Yet, all too often backpackers follow the same well-trodden global travel circuits leading them to gaze at the same tribal dance ceremonies and other staged events offered for tourist consumption. Bruner notes, “once the tourist infrastructure is in place, the traveller can hardly avoid the well-trodden path of the tourists” (1991, p.

247). Moreover, if backpackers are successful enough to reach and engage with a CHAPTER 3: THEORETICAL PERSPECTIVES 45

culture untouched by Western influence, their presence and interaction within that culture sets in motion the very inauthenticity that travellers are trying to avoid.

Ironically, in their eagerness to escape Western consumerism, backpackers unwittingly precipitate the exploitation and corruption of a “timeless” Other. The trails that backpackers carve pave the way for tourism super-powers to create and establish fashionable alternative tourism locales.

Interestingly, much of the literature published in the late eighties and nineties suggested that the consumption of the Other was principally through the tourist gaze

(Urry, 1990). Tourists and travellers wandered to foreign destinations to gaze at the

Other through bus windows or camera lenses. This implies that the culture of the

Other is routinely objectified by the tourist and traveller. Researchers of long-term budget travellers argue that, while this may be true for the tourist, this is an inaccurate portrayal of the backpacker (Black, 1998; Desforges, 1998; Elsrud, 1998). For backpackers, authenticity in travel is not only found in visiting historical, natural, and original cultures and tour objects, but more importantly, authenticity is sought through tour experiences (Wang, 1999). The thrill of backpacking is fuelled by the heightened sensual experience of travelling in pre-modern landscapes: tasting ethnic foods; smelling the dew in the morning; feeling the arid air or dust on the skin or the aching muscles after a challenging hike; hearing foreign languages or the whistle of the train you are going to catch. To suggest that travellers’ experiences are restricted to gazing is to suggest that they travel in a semi-anaesthetised state. The “gaze” does not acknowledge the importance of the body. This idea will be picked up later when looking at the importance of authentic intimate experiences between backpackers.

46 CHAPTER 3: THEORETICAL PERSPECTIVES

Journey to the self

Some theorists suggest that backpacking can be an odyssey of self discovery and understanding. Backpackers’ pre-occupation with discovering their ‘true self’ suggests that awareness and knowledge of the self are lacking in their lives at home. It has been argued that the young independent traveller’s quest for an authentic self is a reaction to the ambivalence of existential conditions in modern societies (Wang, 1999). I would argue that this may be a response to urban living rather than just modern life. Most backpackers have spent much of their lives institutionalised in school and college systems. It has also been argued that travellers seek to transcend their insincere, serious, utilitarian lives by travelling back in time to a mysterious place with romanticised promise of adventure, simplicity, spontaneity, risk, and freedom to find their ‘true self’. Thus, backpacking travel acts as a liminoid zone, where the “cultural and symbolic boundaries … demarcate the profane from the sacred” (Wang, 1999). In essence, the work, responsibilities, and ‘inauthentic public role’ representative of the

Western travellers’ lifestyle at home are temporarily abandoned in favour of the freedom, leisure, and discovery of the authentic self (Wang, 1999).

To summarise, several of these authors see backpacking as an effective means of searching for authenticity of the Other, either through objects and/or cultures. Further, the toured objects, experiences, or cultures, can act as a powerful medium for long- term travellers to discover their “true self” while existing in an existential state of

“being” in the present. However, the achieved state of existential authenticity not only aids the backpacker quests for authenticity of themselves, but also between themselves in engaging with each other. I draw on these notions of authenticity in later chapters in my analysis of backpackers’ sexual behaviour. CHAPTER 3: THEORETICAL PERSPECTIVES 47

Communitas and belonging

In a Turnerian sense, communitas (one of the characteristics of liminality) is the unmediated pure personal interaction between individuals who confront each other in an atmosphere free from status distinctions. Turner argues that “the bonds of communitas are undifferentiated, egalitarian, direct, [and] non-rational” (Turner,

1974a, p. 46-47). “In communitas, structures fall apart, and differences arising out of institutionalized socioeconomic and socio-political positions, roles, and status disappear” (Wang, 1999, p.364). Turner identified three distinct forms of communitas, which he named spontaneous, ideological, and normative communitas

(Turner, 1974a). The bonds of spontaneous communitas are apparent in the liminoid context of backpacking. According to Turner, there is a “magical” quality that emanates from the subjective feeling of “endless power” experienced with “ludic mutual understanding on the existential level” (1974a, italics added).

By being kindred spirits together in the “here and now”, backpackers achieve a sense of social solidarity. In the mood of spontaneous communitas, backpackers interact with “honesty, openness, and lack of pretensions or pretentiousness”, they “feel that it is important to relate directly to another person as he presents himself in the here-and- now, to understand him in a sympathetic (not empathetic – which implies some withholding, some non-giving of the self) way, free from the culturally defined encumbrances of his role, status, reputation, class, caste, sex, or other structural niche”

(Turner 1974b, p. 79). Other liminoid qualities that support the mood of communitas are the anonymity and uniformity characteristic of the backpacking environment. Teas, who spent four years in Nepal observing backpacker behaviour, points out that:

48 CHAPTER 3: THEORETICAL PERSPECTIVES

anonymity is achieved as the individual is thrust together with others who

“know nothing of one’s past or future”, “occupations, past intellectual

pursuits, and aspirations for the future are seldom topics for discussion”,

and “people introduce themselves by their first names only”. Further,

“symbols of the traveller vary from peasant style clothes, purchased in a

foreign country, to jewellery, especially rings, bracelets, and amulets,

typically with a prayer or magical inscription […] everywhere the most

desirable clothes and jewellery are those adopted from the peasant or

nomad […] thus, it is apparent that, among youthful travellers, a certain

“fashion consciousness” prevails (Teas, 1988, p. 36–40).

Neumann’s study, which focused on backpackers’ narratives of hiking in the Grand

Canyon, reflects the spirit of communitas. One interviewee stated: “you meet a lot of people … because you’re out of your own environment. In certain instances you’re out of your social and class structure and you can meet people you wouldn’t normally meet … you put yourself in a situation where you have a chance to meet those people who wouldn’t come to your environment” (Neumann, 1992). In short, the inclusive ambience of communitas encourages backpackers to be open and friendly to each other in an authentic way. Being caught up in the existential state of “mutual understanding” that is characteristic of communitas describes a “flow”-like state of

“being”.

Flow may induce communitas, and communitas may induce flow (Turner, 1974b).

Existing in a state of existential authenticity or “being” is quintessential to the flow experience. Turner quotes Csikszentmihalyi’s definition of flow: CHAPTER 3: THEORETICAL PERSPECTIVES 49

Flow denotes the holistic sensation present when we act with total

involvement … a state in which action follows action according to an

internal logic which seems to need no conscious intervention on our part

… we experience it as a unified flowing from one moment to the next, in

which we feel in control of our actions, and in which there is little

distinction between self and environment; between stimulus and response;

or between past, present, and future (1974b, p. 87).

However, “the difficulty for many is that flow is reached without planning. It is an experience of pleasure and intensity, but it is also ephemeral” (Neumann, 1992, p.

189). The theory of flow, developed by Csikszentmihalyi (1975), has been pivotal in research of recreational activities, such as ocean cruising, mountaineering, rock- climbing, soccer, hockey, chess, long distance swimming, handball, white water kayaking, and white water rafting. There are numerous artistic activities where getting caught up in the flow is integral to the enjoyment gained from these experiences, such as playing musical instruments, singing, and painting. The theory of flow is particularly useful to understand behaviour during sex. I will explore this idea in Chapter 12 when looking at “getting caught up in the heat [or flow] of the moment” as a barrier to condom use.

Ryan (1997, p. 33) eloquently summarised the seven indicators of the frequency

and occurrence of “flow” described in Beyond Boredom and Anxiety:

a) the perception that personal skills and challenges posed by an activity are in balance b) the centring of attention c) the loss of self-consciousness d) an unambiguous feedback to the persons’ actions e) feelings of control over actions and environment 50 CHAPTER 3: THEORETICAL PERSPECTIVES

f) a momentary loss of anxiety and constraint; and g) feelings of enjoyment or pleasure

However, there are four prerequisites for the experience of “flow”:

a) participation is voluntary b) the benefits of participation in an activity are perceived to derive from factors intrinsic to participation in the activity c) a facilitative level of arousal is experienced during participation in the activity, and d) there is a psychological commitment to the activity in which they are participating.

During moments of flow, people become intensely engaged in meaningful experiences and there is a “merging of action and awareness. A person in flow has no dualistic perspective: he is aware of his actions but not of the awareness itself” (Csiksentmihalyi,

1975, p. 38). A spontaneous transcendence of self is often experienced by backpackers travelling alone or in communitas. As a result, “travel brings people into a world of unpredictable possibilities that can reveal new ways of knowing the self” (Neumann,

1992, p. 200).

Knowing the self in the “space” of the present, offers unique opportunities to create memories of the self. As noted by Urry, Bachelard presents a view of “memory as irreducibly embodied” (1996, p. 437). The memories that we create through travel, and other activities, are “physically inscribed” in all of us. In keeping with this notion, it could be argued that the sense of intimacy achieved through symbolic moments while backpacking such as a feat of endurance, a special person met, a passionate interlude with a local or another traveller, a natural wonder witnessed, a photograph taken, or a flavour savoured become embodied in the present. Through the emergence of time these embodied moments of the present will not only become meaningful memories CHAPTER 3: THEORETICAL PERSPECTIVES 51

and representations of the self in the past, but will also be valuable investments for the self to be interpreted in the future.

Upon returning home, the visual images of photographs are interwoven with the travel narratives to reminisce about the journey. The reconstruction of self upon returning home is realised through external narratives, such as telling stories of the experiences and places visited during their trip. Desforges draws on Giddens in emphasising the significance of story telling in “gaining a sense of self and in orienting social practices”

(1998, p. 192). Reminiscence through the sharing of memoirs of the backpacking experience allows individuals to revisit and relive the present moments that have faded into the past. Remembering through story-telling sparks a re-awakening of the body.

The knowledge, emotions, sensations, sights, tastes and sounds frozen in the emerging present of the liminoid space of backpacking are thawed and rediscovered upon recollection with others. The sense of belongingness, intimacy and awareness of the self while travelling can be relived through telling stories. However, the meaning that backpacking has for returned travellers is greatly dependent on their individual interpretations of their memories. Backpackers construct the memories of their cultural and personal voyage through the photographs that they take and the stories of their travelling experiences recorded in their diaries. These memories act as a door to the self, unlocked with the key of internal and external narratives.

Script theory

I interpreted the material gathered in this study through a social constructionist lens.

This thesis will illustrate how the subculture of backpacking served, for many of the 52 CHAPTER 3: THEORETICAL PERSPECTIVES

participants, as a protected space in which to explore and express established or new sexual behaviours, identities, and sensibilities. This study provides further evidence supporting the constructionist view that sexual behaviour undergoes flux and change in new contexts, and is as much a product of culture as it is of “nature” (Gagnon &

Simon, 1974; Weeks, 1987). As will be revealed in later chapters, many young people viewed their time backpacking as a way to resist the dominant discourses and social expectations that they were subjected to in their home environment. Collectively, this resistance and dedication to a new, more intense, level of sexual expression meant that backpackers experienced the environment as valuing creativity and human agency.

While backpacking, most of the respondents appeared to experience a shift in how they framed their sexual experiences. Indeed, as noted by Vance (1999), the relationship between sexual acts and the subjective meaning attached to these acts was not fixed, but rather changed and often became more permissive and relaxed while living as a backpacker. For example, previously accepted expectations of privacy during sex were often discarded in this subculture (Chapter 7)

Sexual scripts theory is a useful as a framework for investigating how sexual situations come about, i.e. the cues (verbal and non-verbal) initiating sexual behaviour. Social norms with regard to sexual behaviour can be expressed and maintained through shared sexual scripts (Simon & Gagnon, 1984, 1986, 1987). Sexual scripts are mutually shared conventions and patterns of sequential interaction that guide individuals to respond to each other’s cues and actions in sexual scenarios. Simon and Gagnon distinguish between three interrelated levels of sexual scripts: cultural scenarios, interpersonal scripts, and intrapsychic scripts.

CHAPTER 3: THEORETICAL PERSPECTIVES 53

Cultural scenarios are derived from a variety of social and institutional sources (family, schools, media, peers, religion) and provide general guidelines regarding every aspect of sexual behaviour, including the who, what, where, when, why and how of sexual interactions.

Interpersonal scripts draw heavily on the individual’s interpretation of these cultural scenarios. Scripts at this level represent the individual’s effort to put their understanding of the cultural scenarios, the social context, and their own desires and motivations into action. Interpersonal scripts are unique to the individual given that they are based on their own socialization, life experiences, and motivations in any given circumstance (Simon & Gagnon, 1986). Therefore, individuals may experience different interpersonal scripts in response to the same cultural scenario, despite being part of the same culture or community. Rehearsal of the interpersonal scripts derived from the social performance of cultural scenarios serves to shape individuals’ attitudes, values and beliefs, and thus, interpersonal scripts act as the link between societal norms and individual attitudes.

Intrapsychic scripts are the internalization of the meanings and symbols believed to be inherent in these shared cultural scenarios. This final realm consists of the motivational elements that produce a commitment to engage in a sexual activity, such as desires and fantasies (Gagnon & Simon, 1974).

We shall examine whether sexual scripts were embedded into the backpacking environment itself or were universally practised in the backpackers’ cultures of origin; and if there were common scripts followed for sexual practice and sexual decision 54 CHAPTER 3: THEORETICAL PERSPECTIVES

making. One of the key questions employed during the analysis of the data is: Did backpackers’ interpersonal scripts represent only minor variations of dominant cultural scenarios or were backpackers forced to write their own intrapsychic scripts in order to navigate their way through sexual situations with new sexual partners in this context

(Simon & Gagnon, 1999)?

Conclusion

This chapter has examined theoretical approaches from anthropology and sociology.

Taken together, these theoretical concepts will be used in the thesis as a framework to examine the nature of the backpacking culture and the sexual behaviour that occurs.

This will be the focus of this study.

Methods

Introduction and approach

This study explores the sexual attitudes and behaviours of international backpackers visiting Australia – in context. Within a broadly empirical social constructionist framework it addresses the following questions:

• What is backpacking and how does this differ from travelling as a tourist?

• What meaning does backpacking have for backpackers?

• How does the backpacking experience affect the ways in which backpackers

see themselves?

• What changes occur in backpackers’ behaviour (sexual and related behaviour)

during the course of their journey?

• In what ways does backpacking affect the sexual health of backpackers?

Models of sexual behaviour that address the social context, rather than just individual behaviour, have greater explanatory power. Therefore, rather than rely solely on self- administered questionnaires as in much previous research, I used qualitative methodology to explore the effects that travel in the backpacking community had on sexual behaviour. The research design included both anonymous self-administered questionnaires and in-depth personal interviews. Previous research on the sexual behaviour of travellers has found a high degree of consistency when combining qualitative and quantitative approaches (James, Bignell, & Gillies, 1991). 56 CHAPTER 4: METHODS

The data were collected through:

• an anonymous self-administered survey of the sexual behaviour of backpackers

• face-to-face semi-structured interviews conducted in the socio-cultural context

with international backpackers, specifically those staying in hostels.

• face-to-face semi-structured interviews with key informants who provided

services to backpackers in hostels (hostel managers) and health clinics

(counsellors, nurses, and medical doctors).

• field notes taken during and after episodes of participant observation.

The purpose of the ethnographic elements of the research design was to achieve a holistic perspective of the backpacking subculture. Through “cultural interpretation”, ethnographers strive to understand the multiple realities that “insiders” of the culture possess. “The insiders’ perception of reality is instrumental to understanding and accurately describing situations and behaviours” (Fetterman, 1998). Analysis of the qualitative data provided the best means to gain insight and understanding into why some individuals’ social and sexual behaviour changed while backpacking.

Ethnographic studies can be either micro or macro in nature (Fetterman, 1998). In a macro study, an ethnographer is interested in the large picture of how a culture or social group functions on a daily basis. My study focused primarily on the micro level, specifically the intra- and inter-personal behaviours of backpackers. In particular, the development and meaning of backpackers’ sexual interactions and sexual risk-taking were explored.

CHAPTER 4: METHODS 57

Whether administering questionnaires or doing in-depth interviews, it is beneficial to collect data in the travel context where social and sexual behaviour occurs rather than later after travellers have returned home. First, the participants are less likely to suffer from recall bias and are therefore more likely to provide accurate responses regarding new sex partners and sexual risk-taking. Second, the researchers are able to observe and experience the travel environment at first hand. This offers the ethnographer the opportunity to weave the rich narratives of the participants with the researcher’s field notes.

In both the backpacker interviews and the service provider interviews, the recruitment of participants proceeded until theoretical saturation was reached (Strauss & Corbin,

1998). According to Strauss and Corbin (1998), theoretical saturation is “the point in category development at which no new properties, dimensions or relationships emerge during the analysis” (p. 143).

The study was approved by the Human Research Ethics Committee, University of

New South Wales (approval number 02094). All potential participants were informed that both the survey and interview involved disclosure of their sexual behaviour, and I assured them that their responses would be anonymous and confidential (see

Appendices B-D).

58 CHAPTER 4: METHODS

Data collection

Hostels

Data collection in the natural environment of a culture or community is central to ethnographic research. Youth hostels are the environmental setting where backpackers are most likely to interact with each other (Murphy, 2001), so youth hostels were chosen as the primary sites for recruiting research participants. The selection of hostels was based on their popularity with the majority of backpackers who visit Sydney, New

South Wales, and Cairns, Queensland, Australia. Sydney was the principal location for recruitment because 83% of backpackers visit Sydney during their trip to Australia

(Buchanan & Rossetto, 1997). Target hostels were short-listed based on location in popular backpacker zones. Hostels in central and inner Sydney were enumerated on the basis of a list compiled from the Lonely Planet travel guide (O’Byrne, 2000), the

Yellow Pages business telephone directory (category: Backpackers Accommodation), and advertising at both Sydney Central train station and Sydney Airport. Cairns also independently attracts large numbers of backpackers, so approval was obtained from all Cairns hostels that had appreciable numbers of backpacker clients. Fieldwork and interviews were conducted at these hostels as well as in a public park on the Esplanade where hundreds of backpackers congregate every day to socialise and soak up the sunshine.

A list of 36 possible hostels for data collection purposes was compiled and managers of these hostels were contacted by telephone in June and July 2002. I was successful in contacting 32 hostels (the remaining four reportedly closed their business). Seventeen hostels agreed to participate, and the remainder stated the following reasons for not CHAPTER 4: METHODS 59

participating: 1) don’t want to disrupt or inconvenience the backpackers; 2) undergoing renovations of their hostel, 3) or simply were not interested (no reason stated). Those that expressed interest in the study at this time were then sent by fax or mail an information letter about the study and a consent form (Appendix A). Written permission was obtained from Sydney and Cairns hostel managers allowing me to recruit backpackers and hostel staff. The size and location of the participating hostels were recorded, in addition to the nationality of hostel patrons that I had contact with.

Upon review, there were no clear unifying characteristics among those that agreed to participate in this study.

Observation and field notes

In keeping with the principles of ethnographic fieldwork (Fontana & Frey, 1998), this study included both continuous participant observation and interviews. The first two weeks of research focused only on observation. I stayed in different hostels in Sydney overnight during this time to become familiar with the physical setting, daily routines, and staff of the hostels. In addition, I observed the interaction patterns and rituals of backpackers staying in the hostels. During the 12 days of data collection in Cairns I stayed exclusively in hostels. In Cairns, participant observation of hostel guests was carried out in the participating hostels, at the beachside park where hundreds of backpackers congregated every day, and at a popular backpacker bar. During my stay in Cairns I spent more than 10 hours a day just watching the interactions among backpackers.

Throughout the course of the study, I recorded my observations and personal reflections in a field diary. Writing descriptive memos in the diary provided an outlet 60 CHAPTER 4: METHODS

to capture “portraits of the informants, a reconstruction of dialogue, a description of the physical setting, accounts of particular events, and activities” (Cresswell, 1994, p.

152). I also recorded my own personal thoughts, insights, biases, and emotions in the diary.

Timing of recruitment

Questionnaire and interview data was collected from a convenience sample of backpackers over a 12-month period from August 2002 to April 2003, and from

September 2003 to December 2003. By December 2003 the survey data collection was complete, but the backpacker and service provider interview data collection period extended until the end of summer in March 2004. The four-month break in data collection from May through to August, 2003 was driven by seasonal flux in hostel occupancy rates in Sydney. The number of backpackers arriving in Sydney increases dramatically as summer approaches. Peak backpacker travel in Australia occurs during summer months from September until April. Hostel managers concurred with this observation: hostel occupancy in Sydney drops 60% to 75% by mid-April, when most backpackers who intend to stay in Australia make the pilgrimage to Byron Bay for the annual Bluesfest music festival.

Practicalities of research in hostels

Some backpackers stay at a hostel for several weeks or months and use it as their home base (Chapter 5). Travellers’ extended occupancy at the hostels reduced the turnover of hostel clientele and had the potential to severely affect my ability to recruit significant numbers of “fresh” participants for the study. When recruitment of new CHAPTER 4: METHODS 61

participants was not achievable with frequent visits to the hostels, I limited my visits to the participating hostels to once a week during the data collection phase of the study.

Hostel “veterans” also develop a status of seniority and take on the role of gatekeepers within the hostel community. It was clear that hostel veterans often informed new guests of my outsider status as a researcher, and their endorsement of my research, or lack of interest in it, greatly swayed potential participants’ willingness to participate. Out of concern for any perception by the veterans that I was an intruder in their temporary home, I avoided spending overly extended periods at the hostels. Fortunately, this strategy was well received, and numerous veterans were enthusiastic in their public endorsement of the study and encouraged new arrivals to take part.

The majority of the observations, survey completions and interviews with hostel managers and backpackers were conducted during the evenings. The backpackers spent most of their time during the day sightseeing, sun tanning or engaging in

“adventure” activities. During the periods of data collection process, I situated myself in the common living areas of hostels (the living room, front porch, and back patio) and at the beachfront park on the Esplanade in Cairns. I approached hostel patrons and beachside backpackers who stood alone or in groups and asked them if they were interested in participating in the study.

Clinics

Sydney was the primary location for recruitment of sexual health service providers because it is Australia’s largest city and has several public clinics available to backpackers. In addition, it was anticipated that travellers who sought medical 62 CHAPTER 4: METHODS

screening or treatment for STIs after travelling through other areas of south-east Asia would do so upon arrival in Sydney, since it is the most popular port of entry into

Australia. Medical clinics and sexual health centres in Sydney were enumerated based on professional recommendations and a list compiled from the Yellow Pages

(category: Clinics).

Initial contact with a representative of the clinics, most often the director of medicine at the clinic, was made by telephone. During these phone conversations I explained the intention of the study and determined whether the clinics serviced large numbers of backpackers. The six clinics that provided services to large numbers of backpackers and demonstrated interest in participating in the study were emailed the study information letter (Appendix D). Medical directors disseminated the study information and request for research participation to other clinic staff. Doctors, nurses, and counsellors who were interested in participating in this study contacted me by email to schedule a time for an interview.

Backpacker survey

Inclusion criteria

The survey participants were required to fulfil the following inclusion criteria: (1) identified as a backpacker; (2) were aged between 18 and 35 years; (3) were not travelling with a romantic/sexual partner from home; (4) had been travelling for at least two weeks; and (5) could read and understand English. Even though long-term CHAPTER 4: METHODS 63

travellers were the subjects of this research, a few individuals who had been travelling for a shorter period of time (as little as two weeks) were also included.

Recruitment procedures

The purpose of the research was communicated to potential participants both orally and with a printed information sheet. Voluntary self-administered completion of the questionnaire was indicative of consent to participate. The recruitment of survey participants seemed at times almost effortless. Freed from the normal constraints of work or study commitments, most backpackers appeared to revel in the freedom of limitless time to engage in whatever activity they wished. I found that my request for survey participants captivated their attention, and in only a few hours I was often able to recruit 75 or more survey respondents in some of the larger hostels.

Pressure towards conformity with group behaviour was evident during the survey data collection. If one group of backpackers was observed completing a survey, then inevitably other backpackers would approach me and ask to take part. Sometimes every person in the common room proved eligible and participated in the survey. This resulted in a visual display of dozens of bright orange and blue questionnaires scattered around the room; the cacophony normally produced by a room full of backpackers was frequently reduced to a rustling of paper while they completed the survey. Solitary backpackers appeared to view it as an interesting experience, while backpackers who were approached as a group tended to snigger and joke about the topic and agreed to complete surveys as a form of group entertainment (even though the questionnaires were completed individually). Many backpackers said that having participated in a sex 64 CHAPTER 4: METHODS

survey was a “good story” that they were eager to share with others. Taking part in the study was viewed as yet another novelty they were keen to add to the memories of their backpacking adventure.

I asked participants to complete their questionnaire in an area isolated from other people so as to avoid visual or conversational breaches of confidentiality. I positioned myself a respectful distance away from the participants to ensure privacy during survey completion and yet was available to answer any queries that arose. The survey took between 20 minutes and an hour to complete. Participants returned their completed surveys in sealed plain envelopes.

The questionnaire

The self-administered questionnaire used in this study was based on that used in my preliminary study of backpackers visiting Canada (Egan, 2001a). It used several items adopted from questionnaires used in other studies of tourist sexual behaviour (Bloor et al., 1997; Herold & Mewhinney, 1993; Maticka-Tyndale et al., 1998). This strengthened the content validity of these measures, although slight modifications to some of the adopted items were made to accommodate the context of the long-term budget travel subculture. Separate questionnaires were developed for men and women so that questions related to specific sexual acts could be more explicit and gender appropriate. Several sexuality researchers reviewed the draft questionnaire and commented on content relevance, clarity of wording, question sequence, design, and validity. Adjustments were made on the basis of their comments. The questionnaire was printed (on blue paper for men and orange paper for women) and pre-tested on CHAPTER 4: METHODS 65

47 backpackers. These pilot survey participants were asked to give feedback on the appropriateness and relevance of the questions. On the basis of their comments, several items from the questionnaire were removed and minor adjustments were made to the format and wording of the remaining items. (see Appendices E & F for full text of questionnaire).

The questionnaire included items regarding demographic data, sources of pre-travel advice, travel identity, motivations for travel, and trip characteristics. It also covered sexual expectations, sexual behaviour, condom use, and drug and alcohol use before and during the current backpacking journey, perceived risk of HIV/STIs, individual history of HIV/STI testing or diagnoses, and potential factors that may have influenced sexual behaviour and condom use during the current trip. In addition, survey participants were invited to write additional information in a comments section at the end of the survey (Appendix K).

Standard demographic measures were used to gather descriptive data regarding age, marital status, home country, and education. During analysis the open responses for age and home country were compiled into categories. Questions regarding the survey participants’ travel identities and descriptors of their travel style, time length, and trip preparation taken together provided a picture of whether the participants in this survey should be considered backpackers. Insight into backpackers’ motivations to travel was sought through a question about the most important reason for the respondent’s trip, with the response options Education, Culture, Adventure, Party, Escape/Be a different person, Relaxation, and Rite of Passage/Expand horizons. (Responses to these questions are reported in Chapter 5). 66 CHAPTER 4: METHODS

Next, the sexual history of study participants before their trip was examined, including: age at first intercourse; lifetime number of sex partners; casual sex experience, and experience of sexual practices (e.g. oral, vaginal, or anal sex). Questions about casual sex asked whether the respondents had had sex with (1) someone they had just met that day or evening (adopted from Herold & Mewhinney, 1993), and (2) someone they had met within the previous three days (revealed in my previous research to be a common occurrence) (Egan, 2001a). In the results chapters these categories are referred to for convenience as (1) someone just met and (2) someone met recently.

Logically, sexual partners just met should be a subset of those met in the previous three days, but respondents appeared to interpret the “met recently” category as excluding those “just met” on the same day. It is of course possible that sex with someone met recently could lead to a long-term relationship, but it was assumed that backpackers would regard sex with someone they had met recently while travelling to be a once-only or temporary liaison, at least at the outset.

Lifetime partners prior to trip response options were categorised for ease of analysis.

Sexual intercourse was clearly defined on the questionnaire as anal or vaginal penetration.

The questionnaire also asked about respondents’ expectations about sex during the trip, with response options ranging from “expected to have sexual intercourse with someone new” to “I intended to have no sexual activity on this trip”. Two of the response options were adapted from a study of spring-break travellers (Maticka-

Tyndale et al., 1998). Responses to these questions are presented in Chapter 6. CHAPTER 4: METHODS 67

Sexual behaviour while backpacking that breaks usual behavioural norms was identified with two questions about having sex while other people were in the room.

This data is discussed in Chapter 6.

Survey participants were asked whether they engaged in either vaginal or anal sex with someone new during their trip. Participants who reported sex with someone new on this trip were asked to complete further questions about sexual behaviour while travelling. Given that the vast majority of survey participants reported heterosexual experiences, the findings presented in the remainder of the chapters are restricted to responses about heterosexual sex.

The next section of the questionnaire was focused on the last sexual partner that respondents had while abroad. Accurate recall of events surrounding a sexual encounter is more likely when the questions are restricted to a single event or sex partner (Johnson et al., 1994, p. 36). In addition, participants were asked to define by category who their sex partners were, not just the last one – travellers from their own country, travellers from other countries, or locals of the country visited.

As part of the overall measure of sexual expectations during the trip discussed earlier, intentions to practise safe sex during the trip were also measured. Respondents were asked to agree or disagree with the following statement: “I expected to have safe sex

(use a condom) if I had sexual intercourse”. Consistency of condom use was measured on a five-point scale from always to never, adopted from Maticka-Tyndale et al. (1998).

68 CHAPTER 4: METHODS

In order to ascertain whether the backpacking environment affected condom use, several questions were asked about condom use before and during the trip, using

Likert response categories (see questionnaire in Appendix E & F). It would not have been practical to ask about condom use with all partners before the trip, so an overall measure of “safe sex” before the trip could not be achieved. Respondents were asked about consistency in condom use with the last sex partner during the trip. Results on consistency of condom use are presented in Chapter 8.

Casual sex and condom use prior to the trip were measured by asking participants about their condom use with someone they had just met, whereas the same information about their behaviour during the trip was gathered by cross-tabulating responses to the questions “Was this someone you had just met or met recently during this trip?” and “The last time you had sexual intercourse during this trip, was a condom used?”.

Participants who reported sex with a new partner during their trip were asked who initiated communication (if any) about condom use the last time they had sexual intercourse. The findings about condom communication are presented in Chapter 9.

Participants’ attitudes to condoms were measured with a 14-point condom attitudes scale using items adapted from a questionnaire used in a European Commission study

(Bloor et al., 1997). Survey participants who did not always use a condom with their last sexual partner were asked the reasons for condom non-use. The response options were based on the common reasons offered for condom non-use by backpackers visiting Canada (Egan, 2001a). Respondents were asked whether they carried CHAPTER 4: METHODS 69

condoms, and if so, where (on their person, in their luggage, etc.). Findings are presented in Chapter 10.

Perception of sexual health risk was measured by asking survey participants to rate their “chances of getting HIV/AIDS” during their trip using one of six response options from “No chance” to “Very high”. This questionnaire item was adopted from

Maticka-Tyndale et al. (1998). The results are presented in Chapter 11. Awareness of

HIV prevalence in various regions was measured by asking participants to pick up to three destinations where they thought people would be most at risk of contracting

HIV. The responses are presented in Chapter 11.

In order to compare awareness of sexual risks with other issues, respondents were asked about other things that might concern them during their trip (sickness/diarrhoea, sun/skin damage, violence/robbery etc.)

The questionnaire also asked whether respondents had ever been diagnosed with an

STI before or during the trip, and whether they had received any health advice, including advice specifically on HIV/AIDS. (Chapter 11).

Results of survey items that measured the level of experience with risk taking activities

(except for measure related to getting drunk), drug use and intravenous drug use prior to and during the trip are not presented in this thesis due to limitations of space (see

Q20, 34, 21, 35, 22, 36 in Appendix E & F). Further, preliminary analysis revealed that backpackers were far less likely to participate in taking drugs while abroad than 70 CHAPTER 4: METHODS

they were at home, and that alcohol was the preferred intoxicant of choice for backpackers travelling in Australia.

In-depth interviews with backpackers

Individual interviews (rather than, say, focus group discussions) were conducted with backpackers due to the highly personal and sensitive nature of the research topic.

Because the interviews were conducted during the participants’ trips, the backpackers’ level of self-reflection and assessment regarding the meaning of their trip may have differed from their assessment after the trip. However, interviewing backpackers during their journey made it more likely that they would give accurate and rich perspectives rather than potentially romanticised reflections, influenced by repeated telling of their backpacker narratives.

The recruitment, moderation, and analysis of the interviews were my sole responsibility. This was beneficial for two reasons. First, it has previously been established that women in particular are more comfortable with female than male interviewers (Weiss, 1994), especially when discussing sexual issues (Catania, 1989).

Second, having only one interviewer lent to a more consistent structure and level of interaction with each individual. However, the survey and interview data on sexual behaviour collected from men may have been exaggerated given that the research was conducted by a female researcher (Johnson & Delamater, 1976).

My original intention was to invite interviewees also to complete the self-administered questionnaire as a means of ensuring that demographic characteristics would be CHAPTER 4: METHODS 71

available for all interviewees and so that I could compare the consistency between their written and spoken responses. Conducting the interviews before administering the questionnaire would have reduced the likelihood for participants to limit their responses in the interviews in order to make them consistent with what they had written on the questionnaire forms. However, time constraints in the backpackers’ daily schedules made it difficult for them to participate in both the interview and the questionnaire, so this approach proved to be impractical. In each hostel, I always conducted the in-depth interviews before recruiting survey respondents, to avoid potential contamination of responses that might result if in-depth interviewees discussed the research topics with survey respondents.

As an ethnographer, I was dependent on the information gathered from participant observation to make the appropriate judgments on which backpackers to interview in order to explore the areas of research interest (Fetterman, 1998). Informal strategies were used to acquaint myself with key players in the backpacking community. Making these acquaintances provided valuable opportunities for introductions to potential participants. Participants were informed that the purpose of the research was to explore the meaning that this backpacking journey had for them and the interpersonal connections that developed while backpacking. Participants were required to read and sign a consent form prior to the interview. Volunteers were informed of the anticipated length of the interview and that it would be audiotaped, would involve some intimate sexual detail, and would be confidential.

72 CHAPTER 4: METHODS

Recruitment procedures

Participants for in-depth interviews were recruited in the same manner as that employed when recruiting survey participants. Interview participants were required to fulfil the following inclusion criteria: (1) identified as a backpacker; (2) were aged between 18 and 35; (3) were not backpacking with a romantic/sexual partner from home; (4) had been travelling for at least two months; (5) could understand and speak

English. Restriction (4) was imposed so that respondents had enough travelling experience to be able to offer their own insights into backpacking culture.

Recruiting respondents was significantly more difficult than recruiting survey participants. Not surprisingly, people were less eager to disclose the personal details of their sexual encounters in a face-to-face interview. In total, 25 backpackers (14 men, 11 women) participated in semi-structured interviews of between 45 and 120 minutes in duration. Upon receipt of written informed consent, I encouraged the interviewees to choose the location where they would be most comfortable; my only stipulation was that it be within the hostel. Since there were few private spaces available in the hostels, it was often a challenge to find a location. When we spoke in a dorm room, interviewees would ask their roommates not to enter the room during the interview.

On one occasion the interviewee caught acquaintances listening through the dorm room door.

Participants were asked immediately after each interview whether there were any questions or concerns about the interview they wanted to discuss. A list of counselling services was offered to all study participants in case they unexpectedly experienced CHAPTER 4: METHODS 73

anxiety or any other untoward effects as a result of sharing their stories, but all participants declined this offer.

Interview content

The interviews were semi-structured, consisting of a series of open-ended questions to guide the discussion (Appendix G). A list of generative questions simply acted as a guide for the interview, wherein a mental checklist evolved once key topics were covered (Patton, 1990). The areas covered in the checklist were elicited from what

Strauss and Corbin (1990) refer to as “theoretical sensitivity”, or a combination of pertinent literature, professional experience, and personal experience. Therefore, my personal experience with backpacking and previous research with backpackers visiting

Canada greatly contributed to my direction of inquiry in the interviews. The areas included in the interviews were:

• What makes the backpacking unique, or different from other forms of travel?

• How does backpacker travel affect an individual’s process of self-awareness and

discovery?

• Do backpackers perceive a change in themselves, such as their personal

outlook on life and their behaviour?

• Is there a common script for sexual interaction while backpacking? Would this

be reflective of sexual scripts at home or be more specific to backpacking?

• The who, what, when, where, how and why of sexual activity and condom use.

• How does the physical setting influence sexual encounters and decision-

making?

• What are the conditions that facilitate or impede condom use?

74 CHAPTER 4: METHODS

Other important topics not explicitly outlined in the interview guide emerged from the interviews and these topics provided new insights into the backpacking culture. In accordance with the grounded theory approach (Glaser & Strauss, 1967; Strauss &

Corbin, 1990; 1998), I supplemented additional directions of inquiry in order to provide further insight into the themes that emerged during the ongoing process of analysis of the narratives.

The interviews began with a series of general questions to open the interview and establish rapport with the participant, including, for example “How long have you been travelling?”, and “What countries and other Australian cities have you visited?”. In my experience these are the most common questions all backpackers ask each other, so I anticipated that the interviewees would be most comfortable to start with this type of question. Establishing rapport with the interviewee was essential to the interview process because the participants were more likely to disclose personal information if they felt comfortable. Whenever additional information was needed, more probing and follow-up questions were used. This technique offered greater depth and breadth for responses (Rothe, 1994). Since the study was conducted in a “natural setting” for backpackers and service providers, I believe that self-reports were as realistic as possible. It is important to emphasise that many of the questions developed in the interview guide were included in order to fill some of the gaps noted in the literature.

The interview guidelines were pilot tested with five backpackers before data collection.

The pilot project was done to gain feedback on the wording, order, and appropriateness of the interview questions to backpackers. Only minor changes were made to the semi-structured interview format as a result of this pilot.

CHAPTER 4: METHODS 75

Hostel staff interviews

Hostel managers and staff were targeted as potential study participants because they had an ongoing relationship with and exposure to the behaviour of backpackers. Initial permission was sought from hostel owners or managers in order to gain access to the hostels as recruitment sites, so hostel managers were already familiar with the purpose of the study when they were invited to participate personally as interviewees. The most convenient and practical time to approach hostel staff was during the afternoons when backpackers were away from the hostels. Hostel staff was eligible for interview if they had personal experience of providing services to backpackers within the last six months.

Face-to-face semi-structured interviews with hostel managers and staff focused on their views of:

• The norms, rituals, and rules of backpacking culture

• The influence of the context of hostels and the backpacking environment in

general on sexual behaviour

• Perceived influences on sexual behaviour while backpacking

• Perception of the prevalence of casual sex and condom use among

backpackers in hostels

• Popular locations to engage in casual sex within hostels and adjacent areas.

I also sought to identify “gatekeepers” within hostels who might control access to restricted areas providing privacy for sexual activity. 76 CHAPTER 4: METHODS

Interviews with seven hostel staff took place in Sydney. They were conducted in the hostels and lasted between 20 minutes and an hour.

Clinic staff interviews

Interviews with eighteen health professionals sought informed opinions on the sexual health care needs and incidence of STIs among backpackers who attended clinics.

Recruitment procedures

Before the interview, clinic employees were required to read the information sheet and sign an interview consent form (Appendix D). Participants were informed of the anticipated length of interview, and that the interview would be audio-taped and transcribed verbatim for later analysis; they were assured confidentiality, and told that a brief summary of results of the study would be distributed to the participating clinics upon completion of the study. Clinic staff was eligible for interview if they had personal experience of providing health care services to backpackers within the last six months.

Interviews with 18 clinic staff took place in Sydney. They were conducted in the clinics and lasted between 20 minutes and an hour. At one clinic, to save time, the staff requested a focus group (five staff participated: 3 nurses and 2 doctors) that I facilitated at the clinic. Interview transcripts with clinic staff have been de-identified, yet the type of health care professional, the interviewee number is clearly detailed following each excerpt (e.g. Doctor: #1/D1)

CHAPTER 4: METHODS 77

Reflexivity

Because qualitative researchers obtain their data primarily through personal observations and direct interaction with study participants, they can often develop intense personal involvement with their work (Friedman, 1991). As a result, reflexivity is an inherent part of the research process. It is necessary for investigators to identify and reflect on their assumptions, value systems and biases from the outset of the study

(Cresswell, 1994). Rather than being detrimental, my personal experience of being a former “insider” of the backpacking culture is arguably an asset to this research project

(Cresswell, 1994; Fontana & Frey, 1998; Friedman, 1991). Not only did my backpacking experience provide me with a heightened level of comfort with, and insight into, this community, it also saved time that would usually be needed for preliminary groundwork to become familiar with norms and unwritten rules of the subculture being researched.

Over the decade before this project, I had undertaken several backpacking journeys that lasted from a month to a full year. Thus I was familiar with the challenges and issues faced by backpackers. My knowledge and previous experience of being an

“insider” of the backpacking community helped me recruit, engage, interact with, and be sensitive to the needs of participants in this study. The knowledge gained during my own yearlong experience living as a backpacker, primarily in Australia, was helpful in establishing rapport to inform my research. I believe my own recollections of experiences while backpacking positively influenced my ability to ask relevant questions and draw out rich narratives of study participants’ experiences. As a result, the interviews offered valuable insight into the meaning that their experiences held for 78 CHAPTER 4: METHODS

them. There were numerous occasions when I perceived that the participants’ awareness of my backpacking experience encouraged them to forge ahead with detailed descriptions of their backpacking experiences, taking comfort in a shared understanding of the unexpected frequency of new and exciting experiences, and the impact this setting can have on social behaviour and sexual decision-making.

However, there were potential issues of bias that I need to address. My “insider” status put me at risk of making assumptions about respondents’ realities. For instance, my own backpacking observations and experience may have shaped the direction of exploration and/or topics addressed during the interviews. Further, my familiarity with the context of backpacking may have also introduced an element of personal bias.

Finally, the backpackers who volunteered to be interviewed were not representative of all young people who travel as backpackers. The interview data triangulated with the convenience-sample survey data is probably nonetheless representative of backpackers. This prevents the voice of a few interviewees dominating the analysis because they will be tested against the survey findings.

Analysis

Questionnaires

Case numbers were used to identify the survey respondents. SPSS 14.0 statistical computer software program was used for statistical analysis. In addition to descriptive statistics, including frequencies and means, correlations and cross-tab chi-squares were also generated. In the text and tables all percentages have been given to one decimal CHAPTER 4: METHODS 79

point for consistency. This does not indicate degree of accuracy, as in most cases the confidence intervals around the proportions reported would be greater than 1%.

Interviews

Interviews were tape recorded and transcribed verbatim. An accredited transcriber was hired to transcribe the audiotapes of the interviews, and efforts were made to preserve the vernacular and communication styles of the interviewees, such as pausing, laughing, or whispering. I checked the draft transcripts while listening to the original tape of the interview to ensure accuracy and corrected errors in spelling and transcription.

Interviews were de-identified according to the National Centre in HIV Social Research guidelines. Interviewees’ real names were replaced by pseudonyms and all other references to identifiable places or persons were altered to ensure anonymity. In the following chapters, my points of conversation during the interviews are displayed in italics. Qualitative comments made at the end of the survey are referenced with the survey number from which they originated.

The grounded theory approach, originally developed by Glaser and Strauss (1967), and further developed by Strauss and Corbin (1990; 1998), was used to analyse the backpacker narratives. The value of this method for qualitative data analysis rests with its ability to reach beyond the descriptive level and to strive for theory development grounded in the data.

In accordance with the grounded theory and ethnographic approach, data analysis for this study was completed simultaneously with data collection, data interpretation and narrative report writing (Cutcliffe, 2000; Cresswell, 1994; Glaser & Strauss, 1967). 80 CHAPTER 4: METHODS

“This recursiveness is an essential component of grounded theory methodology and allows the researchers to confirm, disconfirm, alter, discard, and add hypotheses; in sum, to allow findings to emerge from the data” (Helmeke & Sprenkle, 2000, p. 473).

The use of qualitative data analysis software (NVIVO 2.0), as well as providing occasions for new insights, offered the practical benefit of increasing efficiency, accuracy, speed, and complexity of qualitative data analysis (Glesne & Peshkin, 1992).

First, the responses recorded on the interview transcript were open-coded according to topic areas based on a line-by-line analysis. Through a process of constant comparison between and within the coded data, I was able to identify categories reflected in the narratives (Appendix J) (Seale, 1999). Simultaneously, while categories emerged from the open codes, a conceptual process of axial coding was established. During axial coding, conceptual categories developed that served to summarise the themes emerging from the analysis of the data. For example, responses from interviewees that disclosed that they had personally had “scares” of pregnancy or impregnating their sex partner at home acted as facilitators to using condoms on every occasion at home and therefore subsumed a position under the category of “facilitators to condom use”.

These larger concepts and themes are not shown in the code list in Appendix J.

Reflecting on the memos written in the field diary, the patterns highlighted during interviews and the themes uncovered, prepared for the final stage of data analysis: selective coding. During selective coding, I no longer tried to analyse explicit statements, but rather “read between the lines” in order to try to understand how the categories were related to one another.

CHAPTER 4: METHODS 81

Trustworthiness and credibility

In an effort to establish “trustworthiness” and credibility of the data, the following strategies were used:

(1) Triangulation or multiple methods of data collection including semi-

structured interviews with backpackers and service providers, participant

observation, and a survey by self-administered questionnaire.

(2) Time: Qualitative and quantitative data were collected over a period of 16

months. By spending so much time in the field I was able to become

familiar with the participants who stayed in the same hostel for long

periods. These key players greatly facilitated my recruitment of survey and

interview participants in the hostels. Participants were more comfortable

and willing to trust me with their stories because of my connections with

key players in the hostels and this trust and comfort probably resulted in

more honest and comprehensive narratives of travel and sexual experience.

(3) Reflexivity: By being continually alert to my own subjectivity before the

study and during the data collection and analysis, I limited the risk of

finding only what I wanted to find, rather than what was actually there.

(4) Declaration of limitations: There is more than one way of knowing, which

introduces the distinct possibility that the data could have been interpreted

differently by another researcher. This unavoidable limitation of qualitative

research is considered throughout the chapters where relevant.

(5) Detailed report: So as to project the real voices of the backpackers and

service providers who participated in this study, I have accented the 82 CHAPTER 4: METHODS

findings presented from Chapters 5 to 13 with the respondents’ rich and

detailed narratives.

Life as a backpacker

Who is a backpacker?

The term “backpacker” is widely used in Australia, New Zealand, and Southeast Asia.

Other descriptors used include “independent”, “budget”, or “alternative” traveller.

Researchers have closely followed the evolution of the alternative tourism movement.

Cohen (1972) first used the term “drifters” of the 1960s for non-institutionalised tourists who sought to escape conventional tourism and immerse themselves in host societies, unlike their institutionalised counterparts. These youth were mainly middle- class tourists who were later referred to in the literature by a multiplicity of terms: nomads (Cohen, 1973); youthful travellers (Teas, 1988); wanderers (Vogt, 1978); tramping youth (Adler, 1985) and long-term budget travellers (Riley, 1988). The contemporary backpacker is quite different from the “drifters” of the late 1960s and early 1970s. While most backpackers would emphatically deny this, they have become consumers of mass-market tourism, albeit “alternative”. Ironically, contemporary

“backpackers” have unwittingly become fully entrenched in, rather than separate from, modern mass tourism.

The backpacking industry is greatly influenced by homogenising forces, but backpackers themselves are anything but homogeneous. During my interactions with 84 CHAPTER 5: LIFE AS A BACKPACKER

backpackers their heterogeneity was evident in not only their demographics, but also in their reasons, purpose, and motivation for travel, trip length, and the way their trip had been organised. On any given evening at a local Australian pub, there was an assortment of individuals sharing backpacker travel stories. Examples included gap- year travellers, Israelis about to embark on, or recently released from military service, university students on semester break, blue-collar workers on temporary leave, mainstream holidaymakers, and well-educated Westerners often at a crossroads in their lives. Other researchers have noted these character observations (Riley, 1988;

Sorensen, 2003). It is hard to imagine how all of these individuals comfortably fit within the distinct travel category of “backpackers”. A first step in this exploratory study was to determine how the study participants defined themselves.

During the course of this study, the quantitative and qualitative findings together revealed three dominant themes related to the participants’ experience of travelling as a backpacker. These themes include: 1) the importance of the backpacker ideology; 2) the recreational nature of the Australian backpacking experience; and 3) the discovery of the self. This chapter will present the quantitative and qualitative findings related to these themes.

Sample characteristics

A total of 604 travellers were invited to participate in the study questionnaire, and 563 agreed. The survey sample was reduced to 559 after grossly incomplete surveys were removed. The sample consisted of 316 (56.5%) men and 243 (43.5%) women who completed the survey (Table 5.1). They ranged in age from 18 to 36 years, with an average age of 23 years. Almost the entire sample had never been married (99.4%) and CHAPTER 5: LIFE AS A BACKPACKER 85

the majority had either partially or fully completed a university education (66%). There were 23 countries represented in the survey sample; 311 (58%) backpackers originated from the UK. The remainder of the sample was comprised of travellers who originated from North America (9.6%), central Europe (15.2%), northern Europe (8.9%), Ireland

(4.3%), Australia/New Zealand (3.1%), Israel (0.9%), and South Africa (0.4%). For

45%, this was their first major trip away from home without their parents.

Table 5.1: Age, home country, and education level of individuals backpacking in Australia, stratified by sex Mena b Womena b Total n (%) n (%) n (%) Age categories (n = 555) < 20 51 (16.3) 58 (24.0) 109 (19.6) 20–24 153 (48.9) 134 (55.4) 287 (51.7) 25–29 84 (26.8) 45 (18.6) 129 (23.2) 30–35 21 (6.7) 5 (2.1) 26 (4.7) 36–37 4 (1.3) 0 4 (1.3) Marital status (n = 558) Single – never married 312 (98.7) 242 (100.0) 554 (99.4) married 1 (0.3) 0 1 (0.2) Divorced 1 (0.3) 0 1 (0.2) Separated 2 (0.6) 0 2 (0.4) Home country (n = 540) UK: England, Scotland, 175 (58.1) 136 (56.9) 311 (57.6) Wales Central Europe: Germany, 53 (17.6) 29 (12.1) 82 (15.2) Netherlands, France, Switzerland North America: Canada, 28 (9.3) 24 (10.0) 52 (9.6) USA Northern Europe: 14 (4.7) 32 (14.2) 48 (8.9) Sweden, Norway, Finland, Denmark Ireland 15 (5.0) 8 (3.3) 23 (4.3) Australia/New Zealand 13 (4.3) 4 (1.7) 17 (3.1) Israel 2 (0.7) 3 (1.3) 5 (0.9) South Africa 1 (0.3) 1 (0.4) 2 (0.4) Education ( n = 556) < 12 years 5 (1.6) 1 (0.4) 6 (1.1) 12 years 69 (21.9) 65 (27.0) 134 (24.1) Some college/university 71 (22.5) 51 (21.2) 122 (21.9) Completed 142 (45.1) 105 (43.6) 247 (44.4) college/university Completed post-graduate 28 (8.9) 19 (7.9) 47 (8.5) a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in the table. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed. 86 CHAPTER 5: LIFE AS A BACKPACKER

In-depth interviews

The backpackers interviewed (N=25) (Table 5.2) in this study were educated and primarily middle-class youth who were students on a gap year between high school and university (n=3), taking a break from their university studies (n=2), had already completed training in a trade (n=9), or had obtained a university degree (n=11). Many were at one of life’s junctures: recently graduated from high school or university; recently ended a relationship; unhappy in their job at home and hoping to change professions upon their return. For all but three interviewees, this was their first extended travel experience, and for the majority, their first time away from home without parental supervision.

Table 5.2: Interview respondents

Pseudonym Age Country of origin Length of travel Mark 25 Scotland 10 months Anita 26 England 6 months Joe 23 England 3 months Liam 22 Scotland 6 months Russell 28 Ireland 18 months Sylvia 36 England 6 weeks Calliope 19 England 4 months Oscar 25 England 5 months Bobby 23 Wales 3 months Siobhan 25 Ireland 2 months Mona 24 England 15 months Maya 22 Canada 2 months Bianca 23 England 7 months Stella 22 England 2 months Lucas 20 Germany 6 months Julia 23 England 3 months Martin 19 Scotland 5 months Anika 20 Denmark 5 months Nathan 21 England 4 months Scott 25 England 3 months Andrew 27 Ireland 9 months Alexandra 22 Netherlands 4 months John 26 England 3 years Stephen 31 England 6 years Nick 36 England 2 years CHAPTER 5: LIFE AS A BACKPACKER 87

Backpacking defined

The study participants predominantly identified themselves as backpackers (Table

5.3); however, as noted in other research, a few preferred to call themselves travellers

(Riley, 1988; Errington & Gewertz, 1989; Desforges, 1998). Yet, a considerable proportion of the survey sample did not describe themselves as either a backpacker or a traveller: 22% of the survey sample thought of themselves as either holiday makers/vacationers or tourists. These findings suggest that numerous individuals who stay in hostels may do so in order to save money while travelling for shorter tourist holidays. These findings bring attention to the inconsistencies among young travellers regarding the definition of a backpacker. My interactions with hostel patrons highlighted that many young people who would fit the definition of a backpacker were unfamiliar with the term. Thus, some survey respondents may have misrepresented themselves in their responses to this particular question.

Table 5.3: Travel identity of survey participants

Mena Womena Totalb n (%) n (%) n (%) Travel identity (n = 558) Backpacker/Long-term traveller 267 (84.5) 203 (83.9) 470 (84.2) Tourist 37 (11.7) 34 (14.0) 71 (12.7) Holiday maker/Vacationer 25 (7.9) 27 (11.2) 52 (9.3) Business traveller 4 (1.3) 1 (0.4) 5 (0.9) a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in the table. b Total percentages sum to more than 100 given that a few respondents identified more than one response to this question.

When the respondents in this study were asked to define a backpacker, many offered the same ambiguous descriptors of travel style that are consistently noted in the research; they usually identified other backpackers by assessing their travel style preferences.

88 CHAPTER 5: LIFE AS A BACKPACKER

[A backpacker is] someone who basically goes away for as long as possible,

lives out of a bag, sleeps in hostels mostly and tries to do everything on the

cheap really … and has a lot of fun as well. [Liam, 22 years, Scotland]

Liam’s statement revealed the fundamental basis of the backpacker persona. His perception was that backpackers subscribed to the preferred travel ideology. It could, therefore, be deduced that these travel style characteristics are symbolic- representations of membership in the backpacking community. Backpackers implicitly and explicitly disassociated themselves from the tourist label and thereby fostered a distinction between “us” and “them”. For these backpackers, it was clear who belonged in their travel community and who did not. For the participants in this study, the backpacker was both an individual perception and socially constructed identity. As

Sorensen (2003) notes, “‘backpacker’ is more a social construct than a definition” (p.

852).

These youth preferred to be identified as travellers rather than tourists. As Julia observed:

People either prefer to be referred to as backpackers or travellers rather

than tourists … I mean, I don’t mind people calling me a tourist, but I did

notice it in Thailand, people were like “Oh, we are travellers, we are not

tourists”. [Julia, 23 years, England]

CHAPTER 5: LIFE AS A BACKPACKER 89

The perceived distinction between tourists and travellers was embraced and perpetuated by these like-minded individuals who shared the same travel philosophy.

Sorensen (2003) notes:

with varying degree and intensity, these individuals [backpackers] connect

to a shared frame of reference whether this is a matter of identity,

philosophy, sense of belonging, or sentiments of shared values, and their

partitioned and fractioned interaction produces meaning, which influences

norms, values, conduct and other elements of the social being (p. 849).

This shared frame of reference reinforced to backpackers that they belonged to a community. The findings of my study suggest that the backpacking community’s norms, conduct, and behaviour have evolved. Sorensen (2003) suggests that this evolution is a symptom of backpacking being a travel culture, wherein the category of the backpacker is continuously being recreated.

The culture of backpacking

The findings of my study indicate that backpackers play an active role in the evolution of the culture of backpacking. It is impossible to simply explain backpackers’ social and sexual behaviour by their background, norms, and values at home or by the liminal nature of travel. The behaviour of backpackers did not occur in isolation, but rather was influenced, in part, by the socially constructed culture of backpacking that they submersed themselves in for extended periods of time. As such, social constructionism appears to be a relevant framework to interpret the experience of the contemporary backpacker travelling in Australia. Sorensen developed the concept of 90 CHAPTER 5: LIFE AS A BACKPACKER

backpacker travel as a culture during his 23 month ethnographic fieldwork study.

According to Sorensen (2003): “culture, rather than fixed structures of unification and subsumption, is conceived of as negotiable, manipulative, and changeable systems.

Consequently, the individual is ascribed an active role, as someone who produces culture rather than just representing it” (p. 855).

Even though there were no “fixed or permanent societal institutions” embedded into the backpacking culture, the transitory nature of backpacking and the constant interactions and communication network among backpackers ensured that the socially constructed concepts, that are unique to the backpacking culture, would be passed on from experienced backpackers to the novice. The backpacking community was on the move, so their culture travelled with it.

Road status. Evidence of an individual’s commitment to the backpacker ideology was rewarded with recognition and heightened status among backpackers, colloquially referred to as road status. Simply put, the longer you travelled on the least amount of money, the more status you acquired. Other symbols of road status included travelling off the beaten track, enduring personal discomfort and “roughing it”, getting the “best” and/or “local” price, adventurous pursuits, and dangerous encounters. Sorensen

(2003), defined road status as follows: “In total, it comprises hardship, experience, competence, cheap travel, along with the ability to communicate it properly” (p. 856).

The effect was that a process of hierarchy acknowledgment developed wherein backpackers’ conversations implicitly communicated their status.

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Most initial interactions between backpackers began with questions like “How long have you been travelling?”, “Where have you travelled?”, and “How much did you pay?”. This line of questioning helped construct their sense of travel identity, not only for themselves but also as a culture. By sharing with other backpackers their testaments of hardship, bargain finding and discovery of paths less travelled, their experiences were converted into road status, and this status was culturally reinforced wherein other backpackers who heard the stories strove to emulate this culturally endorsed behaviour. Road status was highly valued among backpackers, as numerous studies have shown (Riley, 1988; Teas, 1988; Errington & Gewertz, 1989; Pryer, 1997;

Sorensen, 2003).

Solitary travel. Backpackers often travelled alone and preferred it this way (Table 5.4).

Forty per cent of survey respondents reported travelling alone at the time of the survey; men were significantly more likely to report this than women (men 50%, women 28%; p < 0.01). Women travelled more often with friends of the same sex (men 41%, women 58%; p < 0.001), or with a boyfriend that they came on the trip with (men 5%, women 10%).

Table 5.4: Current travel partners during trip Mena Womena Total b n (%) n (%) n (%) Current travel partner(s) Friend of the same sex (n = 557)*** 128 (40.8) 140 (57.6) 268 (48.1) Alone (n = 558)** 158 (50.2) 67 (27.6) 225 (40.3) Friend of the opposite sex (n = 557) 30 (9.6) 28 (11.5) 58 (10.4) Boyfriend/Girlfriend who came on trip 16 (5.1) 24 (9.9) 40 (7.2) (n = 557)* Boyfriend/Girlfriend met on trip (n = 557) 9 (2.9) 7 (2.9) 16 (2.9) Brother/Sister (n = 557) 7 (2.2) 5 (2.1) 12 (2.2) Wife/Partner (n = 557) 2 (0.6) 0 2 (0.4) Other (n = 557) 4 (1.3) 3 (1.2) 7 (1.3) a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in the table. b Total percentages sum to more than 100 given that at the time of the survey numerous respondents were travelling with several different types of travel partners */**/*** represent statistically significant differences between men and women at p < 0.05, 0.01, and 0.001 levels respectively. 92 CHAPTER 5: LIFE AS A BACKPACKER

Many backpackers started their journey with a friend or romantic partner but often chose to part ways. As this backpacker claimed, solitary travellers were more likely to initiate and be receptive to fresh connections with others in their community.

Yeah, but I mean I’m really glad I did it on my own because I think I’ve

experienced the whole experience differently … it’s better to be out here

on your own, because you meet people on your own. There’s nobody here

that has – you know, everybody starts afresh, totally fresh opinions of

things. So you have to earn all your trust and your friendships and

everything like that. It’s really good but I think, to be honest, the main

thing – the main best part of it – was that I don’t have to do what anybody

else wants me to do. [Martin, 19 years, Scotland]

Travelling alone ensured a level of anonymity, freedom, and self-reliance that was unfamiliar to most young people. Social connections with other backpackers were intense and fleeting, adding to the temporariness of the environment. Distant from the security of their circle of friends at home, most young solitary backpackers were unrestrained in their efforts to establish social connections, and actively pursued any social opportunity or travel experience that came their way. The majority of them spent most of their time socialising with other backpackers and travel groups were quickly forged. But, just like their travel plans, their travel partners were subject to rapid change. The intense social environment of backpacking fostered rapid connections and friendships that might last days, months or even years, yet often dissolved just as quickly. This relaxed and flexible travel style fostered the perception CHAPTER 5: LIFE AS A BACKPACKER 93

among backpackers that they were more “laid back”, “open to new things”, and “not so uptight” as mainstream tourists.

Money. In order to travel for an extended time, it was necessary for backpackers to live frugally. Even though many of the youth who travelled as backpackers were from middle class or privileged backgrounds, they chose to travel on a shoestring budget to demonstrate their level of sacrifice, hardship, and commitment to travelling as long as possible as a “real backpacker”. One’s ability to live “on the cheap” with regard to their choice of clothes, food, and lodging acted as a barometer of their experience as a backpacker and subsequently was closely tied into their status within this travel culture.

Expensive clothing brands were conspicuously absent, since this would be counter to their commitment to the backpacker ideology.

In keeping with their unencumbered and carefree travel style, necessity dictated that they possess very little clothing while travelling. According to Russell, who had been travelling for one and a half years at the time of the interview, the longer the travel experience, the fewer the clothes you carried.

I only have one shirt and am scruffy, I got one shirt and that is the one I

always wear, I could buy new clothes but I just can’t be arsed.

[Russell, 28 years, Ireland]

Russell’s professed disregard for his appearance concealed the fact that travelling with few clothes and looking dishevelled was part of his purposeful pursuit of road status.

Solidarity among the members of the backpacking culture was reinforced through the 94 CHAPTER 5: LIFE AS A BACKPACKER

policing and identification of impostors in their community. An easy target was anyone who dared to display symbols of wealth.

Travel length and gender. The survey findings revealed that there was an association between trip length expectations and gender (p < 0.001) (Table 5.5). Generally, men expected to travel for a longer time than women, most notably for more than a year

(men 20%, women 8%). Women also appeared to organise their travel plans in advance more often than men (p < 0.001). During their trip, men were more likely to make impromptu travel plans to do things the same day (men 25%, women: 14%), whereas women were slightly less impulsive and preferred to make their travel plans within days or weeks of the next travel destination. Women also reported knowing their date to return home more often than men (men 54%, women 69%; p < 0.001).

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Table 5.5: Descriptors of travel experience for backpackers visiting Australia

Mena b Womena b Total n (%) n (%) n (%) First major trip away from family 128 (40.8) 124 (51.2) 242 (45.3) (n = 556) Trip length expectations (n = 559)*** Less than 1 month 2 (0.6) 10 (4.1) 12 (2.1) 1 month 5 (1.6) 7 (2.9) 12 (2.1) 2 months 12 (3.8) 18 (7.4) 30 (5.4) 3-6 months 92 (29.1) 89 (36.6) 181 (32.4) 7-11 months 64 (20.3) 38 (15.6) 102 (18.2) 1 year 67 (21.2) 55 (22.6) 122 (21.8) More than 1 year 62 (19.6) 20 (8.2) 82 (14.7) Do not know 12 (3.8) 6 (2.5) 18 (3.2) Trip length at time of survey (n = 558) 1 month or less 43 (13.7) 47 (19.3) 90 (16.1) 1-3 months 101 (32.1) 89 (36.6) 190 (34.1) 3-6 months 97 (30.8) 70 (28.8) 167 (29.9) 6-12 months 59 (18.7) 32 (13.2) 91 (16.3) 1-2 years 13 (4.1) 1 (0.4) 14 (2.5) 2-3 years 0 1 (0.4) 1 (0.2) Over 3 years 2 (0.6) 3 (1.2) 5 (0.9) Know their date to return home (n 169 (53.7) 167 (69.3) 336 (60.4) = 556)*** When were travel plans made? (n = 547)*** Before leaving home 83 (26.8) 61 (25.7) 144 (26.3) Weeks before the next travel 45 (14.5) 48 (20.3) 93 (17.0) destination Days before the next travel destination 81 (26.1) 87 (36.7) 168 (30.7) Same day/not planned 77 (24.8) 32 (13.5) 109 (19.9) Not applicable 24 (7.7) 9 (3.8) 33 (6.0) a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in the table. *** represent statistically significant differences between men and women at p < 0.001 level. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Hostels. In an effort to stay true to their travel identity and their budget, backpackers in

Sydney and Cairns “roughed it” by staying in youth hostels where there were up to 12 beds per dormitory style room. A mental picture of the spatial layout of youth hostels is important in order to appreciate how this setting can facilitate or impede sexual behaviour among backpackers. The different spaces and rooms that make up hostels often acted as “action spaces” (Goffman, 1967) after hours, and were a central feature of the sexual stories told by backpackers.

96 CHAPTER 5: LIFE AS A BACKPACKER

Hostels can be as small as one bedroom containing several beds located in a private residence, or as grand as the flagship YHA hostel in central Sydney, which boasted 10 floors, including a swimming pool on the roof, and a restaurant and bar on the ground floor. The configurations of living spaces varied considerably, but generally the allocation of living areas in hostels paralleled what would normally be found in a residential home: reception area, recreation/living room, kitchen, communal dorm- style bedrooms and a few private double bedrooms, toilets and showers (either gender- segregated or shared), and a laundry. Some hostels also had areas at the back for barbecues or other social activities.

At the hostel entrance or reception area backpackers could seek information, check in, and book sightseeing tours. This was usually the key area of security for the hostel; individuals not staying at the hostel did not have access beyond this point. The recreation area was usually a TV room with several couches and chairs for large numbers of backpackers to congregate. This was where most backpackers could be found reading about their next destination, exchanging stories and sharing travel advice, writing postcards to friends and family at home, using internet terminals, or gathered for the weekly movie night. In the early hours of the morning this was a popular place to have sex.

The communal kitchen was a hub of activity. Long kitchen tables served a dual purpose: a place to eat and a place to convene socially. Some larger commercial hostels also had a restaurant and bar area offering affordable meals and beverages.

CHAPTER 5: LIFE AS A BACKPACKER 97

The majority of hostel interiors were simple in design, and general wear and tear that occurred through the years was frequently evident. The tired-looking furnishings, the challenges of communal living and travellers’ severe budget constraints served to validate the perceptions held by backpackers that they were different from tourists because they experienced hardships and living conditions the average tourist would not willingly tolerate.

Backpacker ghettos. The majority of hostels were located in “backpacker ghettos”.

These were areas that have been carved out as popular spots for backpackers to congregate, socialise, and live near the convenient amenities that have popped up to accommodate the growing backpacker population (Riley, 1988). In Sydney, the greatest concentration of ghettos was located in the city, close to the central train station, and in the popular beach suburbs of Bondi, Coogee, and Manly. In Cairns, most hostels were situated along the Esplanade in front of the seashore and in the city centre. The significance of the backpacker industry in Australia was evidenced by the sheer number of backpacker beds in Sydney. According to Sydney city council,

Sydney’s central business district has 43 hostels and the city beaches have 26 as well as numerous illegal backpacker lodgings (Ryan, personal communication, 2004).

The backpackers living in these locales had ample opportunity to interact with the local population, but generally preferred to use backpacker amenities. Backpackers lived together in hostels and ate there most nights of the week. Even though they often socialised in pubs or clubs frequented by locals, they tended to go out in large groups, which limited the likelihood for them to engage with the “other” that they travelled so far to meet. This is an important example of a way in which the backpacking culture 98 CHAPTER 5: LIFE AS A BACKPACKER

has evolved. At the outset, experiencing Australian culture may have been an anticipated part of the backpacking adventure, but for contemporary backpackers, their interaction with Australians was superficial at best.

Dorm life. While the backpacking experience has become more commercialised and structured over the years, there are still some challenges that backpackers expect and embrace as symbols of their sacrifice. Dorm room living is one of these challenges and has become a benchmark of the “true” Australian backpacker experience. Bunk beds, shared toilets, and showers were standard in hostels and usually were unisex. For most interviewees, this was a new experience that challenged their expectations and boundaries of personal space and privacy. Anika reflected on how living in a hostel had affected her as a person.

I think I’m a bit more tolerant now. You need your own room, you need

your own space […] But now I’ve been living here with two Irish guys in a

room for five nights out of six; it’s just … you know, you accept it because

we’re all a bit different. [Anika, 20 years, Denmark]

Hearing roommates snoring, talking in their sleep, or having sex became an accepted part of the dorm room experience. Living in this environment meant that no person was able to escape the vicissitudes of living in a shared space. Backpackers often did not have the financial resources to stay in a more expensive room that would offer privacy, and if they chose not to stay in the dorm rooms then they would run the risk of being perceived by other backpackers as not a “proper” backpacker. The dorm CHAPTER 5: LIFE AS A BACKPACKER 99

environment encouraged them to be respectful, tolerant, and accepting of their fellow roommates.

Occasionally backpackers were victims of petty crime, such as being robbed, but theft was generally not a significant problem amongst backpackers. Because backpackers travelled only with what they could carry in their backpacks, every backpacker felt somewhat vulnerable. To have possessions stolen would have a detrimental impact on their most prized possession, their travel experience. As a result, the vulnerability that backpackers shared brought them together and reinforced the necessity to respect each other’s property.

Hostel hierarchy and hostel status. Unlike road status, hostel status was attained from staying in a hostel for a long period of time. Backpackers who did not have much travel experience were preoccupied with attaining hostel status in an effort to distinguish themselves from newcomers. Individuals high in the hostel hierarchy were afforded this distinction because of their knowledge regarding popular backpacker enclaves and hot spots. Several of the backpackers I interviewed held an esteemed position in the hostel hierarchy and were recognised as the people with whom to socialise. In their view, the period of time spent in the same hostel, not the time nor distance travelled, dictated how much hostel status and respect they garnered. This distinction entitled these individuals preferential treatment from other backpackers and hostel staff. As one backpacker put it, a person’s heightened status in a hostel “is not something that is talked about, but more seen”. Those high on the hierarchy “got the best bed” or “the best hob” for cooking, etc. Ironically, their heightened hostel 100 CHAPTER 5: LIFE AS A BACKPACKER

status was a positive outcome of their inexperience with budgeting their trip time and finances.

For most backpackers, Sydney was the first stop on their Australian adventure, and in a way acted as a probationary period for them to learn the skills they required to sustain themselves on their journey. These skills included 1) learning how to access the backpacker communication network that was instrumental in gaining information on routes less travelled and backpacker enclaves; 2) how to live on an extremely low budget; 3) where to earn money through employment when necessary; and, 4) to become intimately familiar with the backpacker philosophy and ideology. Many of those interviewed were slow to progress through this probationary period.

The backpackers visiting Sydney tended to be more interested in the social rituals of their own travel culture than in “other” cultures. Those that occupied the highest position in the hostel hierarchy acted as gatekeepers to backpacker social events.

Members of the inner circle of the hostel would often invite a group of between twenty to thirty backpackers to go out socialising together. The advantage of socialising with the prestigious few who had stayed in a hostel the longest is that they could make introductions to other backpackers, facilitate friendships, and give advice on what to do and where to go. This inner circle also tended to be more successful in meeting new sex partners than other backpackers who occupied a lower position in the hostel hierarchy.

Most of the backpackers who stayed in hostels in Sydney had an extremely active social life and consumed copious amounts of alcohol. Backpackers reported that they CHAPTER 5: LIFE AS A BACKPACKER 101

went out to pubs and bars together to drink and socialise almost every night of the week. These frequent drinking sessions facilitated an intense networking process, albeit inebriated, between newcomers and experienced backpackers. Their enjoyment in making new friendships and bonding with potential travel partners gave inexperienced backpackers confidence in their ability to make new friends and interact with people from different cultures. Unfortunately, over the course of drinking and bonding with each other, most of their money was spent. Many backpackers discovered that even though they now had the confidence to travel and explore new cultures, they had insufficient money to do so.

Consequently, they were forced to find work much earlier than anticipated. The alternative of returning home was not an option for most backpackers for fear of the humiliation they anticipated by disclosing the real reasons why their “journey of a lifetime” was severely curtailed. Therefore, most of the backpackers who travelled to

Australia ultimately stayed in the same hostel for longer periods of time, some as long as six months – a far cry from the intrepid adventure traveller. One backpacker, who had not left Sydney since beginning his journey five months earlier, shared his perception and experience of hostel hierarchies.

When I first came here, it was like after a few good nights I sort of figured

out who was who and it’s not that I judged anybody on it. It’s just that

when you figure out who’s who, you realise how it works and how the

hierarchy works and, although there’s no set hierarchy, there is hierarchy.

It’s like an unspoken thing – do you know what I mean? The hierarchy

system works in the way that, if you’re here a long time, I think generally 102 CHAPTER 5: LIFE AS A BACKPACKER

the longer you stay in a place like a hostel, the more liked, but the more

respect you get. [Martin, 19 years, Scotland]

With every young and naïve backpacker that was drawn into the expensive Sydney lifestyle, the number of backpackers vying for a position in the hostel hierarchy grew.

Within each hostel that participated in this study, it was common to witness groups of ten to fifteen backpackers that were recognised by newcomers as those with hostel status. However, this quest for hostel status did come with an obvious price. Many backpackers expressed disappointment that their travel experience lacked the element of “adventurous spirit” that fellow backpackers considered to be attributes unique to the serious backpacker.

Work in Australia. Most backpackers either planned, or were forced, to utilise their working holiday visa to its fullest and obtained employment during their stay in

Australia. The survey results revealed that 62% (men: 66%, n = 205; women 56%, n =

134) of respondents were planning to or were already working to earn money during their trip.

Many backpackers who had white-collar employment backgrounds in their home environment often worked in blue-collar positions while travelling. They were pleasantly surprised by their work experiences while travelling and proved that they could “do it on [their] own”. Thus, working with Australians became an integral part of their Australian backpacking experience. Discussions with backpackers about their

Australian work experiences were mostly positive. They often stated that they were challenged in new and different ways compared with their work environment at home. CHAPTER 5: LIFE AS A BACKPACKER 103

All of these discussions were laced with a sense of boredom, restlessness, and urgency to continue with their travels. All the backpackers were oblivious to the realisation that through local work experiences they unknowingly achieved a new level of authenticity in their Australian travel experience. Unlike time spent seeking out “authentic” experiences in other “culturally rich” yet poverty-stricken countries, while working in

Australia backpackers transcended their role as consumer and became producers in their construction of “real”, direct, and meaningful encounters with hosts.

Recreational backpackers

They’re not scroungers, penniless layabouts, permanently high or rip-off

merchants. If I had to define my belief in travel it’s that if you’ve been

some place and staying in the local Hilton, you’ve probably not been there

(sorry Conrad). Tourists stay in Hiltons, travelers don’t. [They] want to see

the country at ground level, to breathe it, experience it – live it. This

usually requires two things the tourist can’t provide – more time and less

money (Wheeler, 1982, p. 22).

This section attempts to offer insight into the personal characteristics of backpackers visiting Australia. The topics covered during the interviews included: 1) what appeal backpacking had for them; 2) what motivated them to embark on the trip; 3) what their expectations were prior to travelling; 4) what their travel experience had been like up to that time; 5) their feelings regarding their trip so far and how it measured up to their expectations; 6) how the trip had impacted them as a person; and 7) what they learned from their travel experiences thus far. This section will explore themes derived from 104 CHAPTER 5: LIFE AS A BACKPACKER

the interviews and field observations, and discuss how they relate to the traveller’s quest for authenticity, as reflected in the quote above: “to see the country at ground level, to breathe it, experience it – live it” (Wheeler, 1982).

Motivations

Young people are motivated to embark on a backpacking trip for a variety of reasons.

Overwhelmingly, the participants in this study wanted to be free from the constraints of their scheduled daily lives, to get away from the dreary weather at home, to meet new friends, and primarily, to have fun. Australia was a desirable destination in their journey because it has a warm climate, is popular with other backpackers, it is an

English speaking country, and there are many affordable and convenient tour options.

Further, employment is possible because of the Australian Working Holiday visa.

Each of the 25 backpackers who were interviewed for this study had a key motivation to travel: “have a laugh” by seeking fun and entertainment and to “see the sights” (10); discover the “other” (6); escape from their work environment (2); escape from their home town, with full intentions to return (2); discover themselves (2); seek a new home

(1); and escape home to emigrate to Australia (1). Similarly, survey respondents reported that adventure was the most important reason for travelling as a backpacker

(Table 5.6). Clearly, these motivations reflect a diverse group of backpackers. Almost all of them expressed a desire to see different cultures, yet an equal number admitted that they had spent far too much time in Sydney and other locations, getting caught up in the backpacker party scene. Several expressed disappointment in not achieving their travel expectations. Consequently, a major theme of the interviews was the CHAPTER 5: LIFE AS A BACKPACKER 105

interviewees’ personal realisation that they had not devoted enough time to explore the cultures they had visited during their trip. Mona, who had been travelling for 18 months to several continents, said of her trip:

Well, if I am going to be absolutely honest, it’s been just one big, long

holiday. [Mona, 24 years, England].

Table 5.6: Individual backpacker’s motivations to travel, stratified by sex

Motivations to travel Mena c Womena c Total (n = 556)b n (%) n (%) n (%) Adventure 117 (37.0) 108 (45.0) 225 (40.5) Rite of passage/Expand horizons 49 (15.5) 36 (15.0) 85 (15.3) Escape/Be a different person 44 (13.9) 26 (10.8) 70 (12.6) Party 29 (9.2) 9 (3.8) 38 (6.8) Relaxation 10 (3.2) 13 (5.4) 23 (4.1) Culture 12 (3.8) 7 (2.9) 19 (3.4) Education 7 (2.2) 3 (1.3) 10 (1.8) a316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in table. b15% or respondents reported multiple answers. c Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Numerous hours of observing daily hostel life routines, coupled with testimonies from backpackers and hostel staff, provided a representative picture of a typical backpacker’s day in a Sydney hostel. A backpacker’s daily routine would often start between nine and eleven in the morning. Sometimes they would rise earlier if they had booked a tour or had a job to go to, but overall, backpackers admitted to being “a lazy lot” and were often recovering from an excessive consumption of alcohol. Many would spend the rest of the day recovering from a hangover or by sun tanning on the beaches, sightseeing in the city, shopping, lazing around the hostel, reading, or playing cards.

Backpackers often reunited at dinnertime to eat a cheap meal they prepared in the hostel kitchen, took a nap, and then got ready to go out for the evening to drink alcohol and socialise with a large group from their hostel.

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The Australian backpacking experience for those in this study was mainly recreational.

Backpackers were primarily interested in meeting other backpackers, making sexual connections, participating in a variety of entertaining activities, and seeing the highlights of Australian tourist attractions. Responses to the Tourism Research Australia questionnaire support these findings. This survey asked backpackers what they most commonly did while visiting Australia: “in 2004, popular activities amongst backpackers were shopping, going to the beach, and going to pubs, clubs and discos”

(Heaney, 2005, p. 1). The following comment aptly describes the general perception backpackers had of the Australian backpacking scene.

Backpackers in Australia are more kind of on the scene of going out and

getting drunk every night and drinking all night long and sleeping all day,

kind of thing. And doing all that kind of stereotypical parachuting and

surfing – in Australia; that’s what I think. [Sylvia, 26 years, England]

Has backpacking transformed into one big holiday?

Pursuit of novel, culturally exotic, and adventurous experiences is supposedly a hallmark of the universal backpacker (Riley, 1988). However, this study has revealed that the interests of contemporary backpackers visiting Australia are changing and their interests appeared to be more commonly aligned with those of conventional mass tourists.

A lot of people at home who haven’t travelled have this perception that it

[backpacking] is a big challenge, this big life-altering challenge, but I don’t CHAPTER 5: LIFE AS A BACKPACKER 107

think it is so much now. Maybe it was ten years ago […] I don’t know. It’s

fun, definitely fun, but more one big holiday. [Bianca, 23, England]

The findings indicated that Australia definitely attracted young travellers who wanted to

“see a bit of the sights”, “find work”, “have a laugh” with new friends met during their trip, and drink until they were “off their face”. For most of the interviewees, their trip represented a first time away from home without parental supervision. The consequent sense of isolation and loneliness backpackers felt from travelling alone or with relative strangers made them susceptible to over-indulgence in the social scene to which backpackers tend to gravitate.

Kontogeorgopoulos (2003) expressed the opinion that “the degree to which a particular place or ‘culture’ harbours authenticity thus correlates directly with the degree of difference from ‘Western’ life” (p. 183). The voiced reason why backpackers were so committed to living in an authentic backpacker style was because this is where the distinction between backpacking and mainstream tourism ends. Although they all endured hardships to live in a non-institutionalised style of travel, regardless of their travel motivations or intentions, the majority of the backpackers engaged in recreational activities of institutionalised tourism. In reality, their travel behaviour in

Australia was less culturally exploratory and more recreational than they intended it to be.

The abundance of recreational types of travellers in my study sample is in stark contrast to that in Noy’s (2004) study, which explored the narratives of 40 young

Jewish Israeli backpackers. Noy described these Israeli backpackers as fitting more 108 CHAPTER 5: LIFE AS A BACKPACKER

closely with Cohen’s (1979) experimental, experiential, existential, or humanist types of travellers. Unlike backpackers visiting Australia, the interviewees in Noy’s study successfully sought adventure and authenticity in the “exotic” non-Western destinations. However, regardless of the divergent journeys that the participants of

Noy’s and this study took in their travels, the personal growth in both groups ultimately culminated in a deeply meaningful exploration and unveiling of the self.

This cultural evolution raises the question: Do backpackers behave differently when they arrive on Australian shores, or does Australia attract the type of person who prefers a recreational backpacking experience? The answer is a complex one, and in short, it may be a bit of both. Some backpackers were drawn to Australia because of the cultural similarities it shares with their home country; these travellers were looking for a home away from home, but in a more temperate climate. Others engaged in what they disparagingly described as tourist behaviour while in Australia, because it was perceived to be consistent with the Australian backpacking experience. However, their behaviour did not always reflect their attitudes and behaviours in other destinations.

They anticipated a varied travel experience, dependent on their destination. While travelling in Thailand, some backpackers were more receptive to learning about the local culture and appreciated its differences from their own. That is not to say that they were “on a quest” for the “other”, or that they did not get high at “full moon parties”.

Rather, their travel experience was more balanced and open to new experiences than their Australian experience. Sylvia perceived her behaviour to reflect that of different classifications of travellers, dependent on what country she travelled to, and whether or not she was employed.

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In Asia, I was more like a backpacker, because I was popping on [moving

from place to place] quite regularly, but probably here [Australia] more as

a tourist. You know kind of getting the sights but here to work really.

[Sylvia, 26 years, England]

Length of travel time and being a backpacking veteran appeared to influence travellers’ propensity to distance themselves from touristic pursuits. Several backpackers interviewed near the end of their trip appeared to be less interested in following the hordes on pub crawls, saying that they eagerly participated in those more “frivolous” activities at the beginning of their trip but could not physically sustain the period of intoxication for more than a few months. Martin recalled how he was caught up with the drinking culture of backpacking and decided he needed to decrease his partying as it predisposed him to depression and poverty.

But when you’re out here, drinking a lot, you know, doing all the drugs, all

the partying, all of the fun that you have – yeah, so wild – once you’re

soberish, you go “whoa”. You know? You go “Jesus! I need to slow down

a bit and start living a normal life again for a little while”. I’m tired of the

partying slightly because, for one thing, I can’t afford it any more. Also, it

does bring you down a little bit. [Martin, 19 years old, England]

To summarise, the recreational mode of travel was by far the most popular within this sample, at least while they were in Australia. Their change in behaviour or orientation to the “other” was often influenced by the destination they travelled to, how long they had travelled, and whether this was their first time backpacking. There were probably 110 CHAPTER 5: LIFE AS A BACKPACKER

other reasons for their disengagement from cultural pursuits. The marked lack of interest in seeking “authentic” experiences with the “other” may have been a result of the contemporary backpacker being realistic about finding authenticity. In contrast to the findings of other research, there was no evidence of self-deception among the backpackers interviewed. They recognized that they engaged in “pseudo-events”; what

Boorstin would view as, trivial, superficial, frivolous pursuit of vicarious, contrived experiences (1964, p. 77). Decades of commercialisation and tourism that have successfully drawn international visitors to Australia have also limited the possibility for the intrepid traveller to discover untouched areas of Australia that promise a glimpse, let alone interaction, with an authentic “other”. Instead of spending money for admittance to watch a staged performance of Australian culture, most backpackers preferred to socialise with each other and learned vicariously about other cultures through their sharing of travel narratives and cultural backgrounds.

I have been meeting fantastic people I would never have met in my life if I

had never backpacked. And you are seeing people from different

countries all the time, so you are getting all these kind of things and you

are taking it in and you are coming out a new person because you are

learning all these new things. You know what I mean, you are picking up

certain advice from people, you just seem to take it in and you learn it.

Through all these different countries it is amazing to see how different

people are. People just seem to be totally different but it is amazing how

people just seem to come together […] Yeah, so that definitely is the most

amazing part of it, is meeting all these different people from different

countries. [Liam, 22 years, England] CHAPTER 5: LIFE AS A BACKPACKER 111

Furthermore, not only did the behaviour of many of the backpackers interviewed suggest a lack of eagerness to discover the cultural history of Australia, but surprisingly, many of the British interviewees talked about their enjoyment in discovering the familiar comforts of home while travelling in this country.

British backpackers

Australia has been recorded as a Briton’s top destination to emigrate (Ford, 2007), and

Australia grants citizenship to Britons more than any other nationality. Over 10,000

British immigrants become Australian citizens each year (Australian Bureau of

Statistics, 2008). The vestiges of Australia’s British heritage can be found in Aussies’ fondness for traditional British fare, language and lifestyle. The following quote reflects the views many British backpackers voiced of their travel experience in Australia.

I find in Australia, so many [British] people come to Australia to actually

backpack because, even though it’s got some great areas and shore all

around it, it’s still basically England … It’s exactly the same thing. You’re

not seeing a different culture, really. Maybe with the Aboriginal side you

are … but somewhere like here [Sydney] is just like living in the middle of

London. [John, 26 years, England]

Perhaps due to their travel inexperience, their personal lack of social confidence, or an ethnocentric attitude, several British backpackers voiced a preference for social interactions with individuals of their own nationality rather than with backpackers of other cultures.

112 CHAPTER 5: LIFE AS A BACKPACKER

It’s easier to sort of chat and have a bit of banter and the same types of

things to talk about – definitely. And it’s easier to just hang around with

people from your own country, so you end up in this big group of English

people. It’s the way it just seems to work out. [Mona, 24 years, England]

As Mona’s statement suggests, many British backpackers gravitate to each other and form cliques. Given the popularity of backpacking among British young people, their significant presence in Australian hostels was quite overwhelming and exclusionary to backpackers of other cultures. Thus, while backpackers prided themselves on being brave and adventurous enough to travel vast distances to other cultures, the reality was that many of those “adventurers”, particularly British, found comfort in the reminders of home and did not stray far from it for the duration of their excursion. However, there were a few British travellers who were irritated by being surrounded by reminders of home during their stay in Australia. Stella expressed her desire for a more culturally diverse experience than she found during her time in Australia.

I am not finding Australia very different from home really, apart from the

weather. I found Asia more interesting because it was more different. I feel

like I could be at home like the way I am here. [Stella, 22 years, England]

Most of the young people who embarked on a backpacking trip had high hopes of a

“real” backpacking experience. Yet once they departed from their home environment, some of these well-intentioned, and inexperienced, travellers became anxious and lonely in new and “exotic” surroundings. They craved the familiar, and as the following quote indicates, their discomfort with the “other” culture often drove them to search CHAPTER 5: LIFE AS A BACKPACKER 113

for backpacker areas where they were certain to find other young travellers who looked and sounded familiar, and enjoyed the same food they did. Bobby reflected on his short time in Thailand.

When I first went to Bangkok, it was really strange, I just kind of was in the

middle of Bangkok with no one around who spoke English. [There were]

no backpackers and I was like, really depressed and Bangkok is a dive to

be honest, scabby dogs and rats in open sewers, [it] stinks. It did depress

me so I got drunk and then I went to Koh Samui, and that is full of

backpackers and I felt a lot more homey. But those two days in the

beginning … really hell. Then I got here and I knew a couple of people

who were over here and I hooked up with them. So once you get settled

you are fine. [Bobby, 23 years, England]

The solitary nature of his travel combined with the foreign language, food, sights, and smells unsettled Bobby. Instead of embracing differences from his own culture, he turned inward until he could surround himself again with other backpackers, particularly those of his own culture. Ironically, insulating himself with fellow travellers only reinforced his ethnocentricity and limited any possibility for him to learn more about the cultures he was visiting. This backpacker was not unlike the stereotypical

British tourists who flock to the seaside villages along the southern coast of Spain and expect easy availability of British food, drink, and company. Bobby needed the familiar comforts of his homeland in order to have the relaxing, enjoyable, recreational trip he was seeking.

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The opinions of British travellers and their related experiences may seem over- represented in this chapter; however, these findings reflect that the majority of the sample for this study was comprised of backpackers from the UK, primarily England.

It is not my intention to focus on or criticise British backpackers’ travelling experiences. The strong British presence in Australia did have an impact on their personal experiences as well as on backpackers from other cultures.

All backpackers, regardless of cultural background, frequently sought out other travellers from their own culture, particularly when they were new to a hostel and had little travel experience. This was not surprising because when travelling alone, it is a relief to find someone to talk to who shares the same language and immediately relates to your cultural background. It was also clear that more experienced backpackers, who had visited more countries, made more trips, and spent more time travelling, were more confident in seeking out experiences that promised cultural diversity. Perhaps this was why “real” backpackers, such as those with a lot of road status, were reputed to have more “real” or “authentic” experiences while travelling. “Real” backpackers usually travelled for a longer period of time, six months to a year or longer, and therefore successfully passed through the probationary period experienced in the initial stages of the backpacker journey in Australia. Some took longer than others, but most backpackers eventually found different cultures they once described as “strange” and “stinky”, to be interesting and appealing.

The road most travelled

Previous research has suggested that even though backpacking should be considered another form of mass tourism, it should be recognised as a unique subcategory based CHAPTER 5: LIFE AS A BACKPACKER 115

on backpackers’ desire to travel in an adventurous and authentic way to “backstage regions” (Pearce & Moscardo, 1986, p. 126), which are seen as unfamiliar, and potentially risky (Carter, 1998). This may be true for those who choose to venture to third world or developing nations, but was not an accurate portrayal of most backpackers who visited the eastern shores of Australia. The vast majority visited the major cities along the east coast, including Sydney, Melbourne, Brisbane, and Cairns, with several stops at tourist-friendly seaside communities along the way. Due to the significant distance and cost of travel to the west coast, fewer backpackers travelled to

Western Australia. Some did take a token trip to more remote destinations in

Australia such as Uluru, Kakadu, Darwin, or Tasmania, but tourism figures reflect minimal popularity in comparison to the main epicentres (Palawatte, 2004).

Alcohol

The majority of backpackers interviewed shared the same proclivity for booze-fuelled fun and entertainment, regardless of travel destination. Whether it be at “full moon parties” in Thailand, smoking an opium pipe with tribal natives in Vietnam, or at a pub in New Zealand, the backpackers in this study spent much of their time travelling in an

“altered state”. Russell also voiced his disappointment with himself for not exploring

New Zealand while he lived there.

We were in New Zealand; we ended up staying in Auckland for 10

months, because I was working there. We never actually got to see the

South Island. We were travelling around a little bit, but even with that, we

were just getting to the towns and booking into a hostel, go straight to the

pub, were up the next day, go to another hostel, get ready, go straight to 116 CHAPTER 5: LIFE AS A BACKPACKER

the pub. So we weren’t actually doing anything or seeing anything. You

know? That would be it really, you know? [Russell, 28 years, Ireland]

It is important to acknowledge that if this research had been conducted in a place associated with a more culturally “authentic” representation of Aboriginal cultural history, like Uluru in the centre of Australia, the study sample would have been more representative of backpackers who were inclined to seek a culturally rich experience.

However, the generalised popularity of alcohol-oriented social engagements among backpackers would indicate that even backpackers who seek culturally rich experiences are likely to succumb to the social pressures to party in other locales on their journey, since it is natural to want to make friends and fit in when travelling alone.

Know thyself

We shall not cease from exploration

And the end of all our exploring

Will be to arrive where we started

And know the place for the first time

(T.S. Eliot, 1993)

This section concentrates on understanding the meaning that participants derived from the backpacking experience. When asked what their backpacking trip offered them, and what they had learned, overwhelmingly, this loquacious group of travellers talked about how distinctly positive their travel experience had been, which most often generated unexpected and valuable self-awareness and confidence in knowing and CHAPTER 5: LIFE AS A BACKPACKER 117

accepting their “true self”. Regardless of whether they followed the international trend of seeking culturally authentic experiences (albeit socially constructed), or behaved as though they were on “one big holiday”, these young people found the opportunity to become self-reliant and time to explore their “real” selves.

Life lessons

A striking consistency among the stories was the cathartic effect that the backpacking journey had on backpackers’ sense of wellbeing. The extended time away from home and the new challenges these young people faced acted as a catalyst for self-discovery.

Most denied any major self-transformation. Instead, the changes the backpackers noticed sprang from the confidence that they felt in who they were and their abilities to

“do it on their own”. For many young adults, the backpacking experience was a “rite of passage”. The journey served as a means for them to prove to themselves, and to everyone they knew or encountered on their journey, that they could be resourceful enough to sustain their travels and not return home earlier than planned. The following excerpt from my interview with Mark further illustrates the pride that many backpackers felt regarding their accomplishments during their journey.

It will be over ten months that I have been travelling. I have built up a lot

of confidence. When I went to Germany I couldn’t speak the language so

it was difficult, but now I do so that is all right. My parents will see a big

change when I get home. I can tell a friend I left home myself and that to

me was a challenge in itself. And so, I have built in confidence knowing

that I can do this and I can go anywhere and do anything, don’t have to ask 118 CHAPTER 5: LIFE AS A BACKPACKER

my parents for any money. It has blown me up something silly, you know.

I was thrown into the deep end and now I can look after myself. I will

always recommend it to anybody. [Mark, 25 years, Scotland]

Confidence to be me

The total freedom experienced while backpacking gave them newfound confidence.

They were able to assert their true identities and believe in themselves more than they ever had previously. The following comments echo those of many backpackers in this study:

I haven’t changed but I have the confidence to be who I always was, if that

makes sense … but it [backpacking] gives you so much more time to think;

about who you are and stuff like that. And having to constantly meet new

people gives you that confidence to just totally be yourself, so I haven’t

changed much because I have just become more myself.

[Anita, 26 years, England]

I’m definitely less uptight about things. My mood swings are gone. I think

so, yes, or maybe I’m more the person, actually that’s what it is! I’m more

the person that I am since I’ve come travelling […] At home you’ve got all

these boundaries, blah, blah, blah, people telling you who you are, what

you are and stuff. [While backpacking] You just couldn’t give a shit, you

know? You might never see some people again in your life whereas at

home people […] You’re always concerned about what other people think. CHAPTER 5: LIFE AS A BACKPACKER 119

Whereas here, you’re not really, you’re just concerned about yourself.

[Siobhan, 25 years, Ireland]

As these quotes reflect, once thrust into a hostel’s intensive social setting, these young individuals realised that they were no longer defined by their social status, family name, or circle of friends. Instead, they were judged on their personality, opinions, and markers of “road status”. The clear liminal boundaries of travel combined with the independent and often solitary nature of the backpacking experience released them from the trappings of their ordinary “public self”. This protected space and time enabled young backpackers to explore, discover and embrace their unique qualities, and enjoy who they really were. Part of the reason why this space was so safe for backpackers to show their “true self” was because many of the stereotypes that were commonly held as truths were dispelled in this setting. For Anita, one of the central lessons she learned during her backpacking experience was “not to judge a book by its cover”.

It’s the people thing again, I suppose. It’s just tolerance, I suppose, like not

judging people straight off. That’s a big one actually. Sometimes you see

people and think “oh, yeah, there’s another stereotypical …” and then you

speak to them and they’re fine, really nice people. So you do sometimes

make a first judgment and you’re completely wrong.

[Anita, 26 years, England]

Thus, while many backpackers judged each other based on their road status, the judgment of others based on social class, personality, and culture was discouraged. 120 CHAPTER 5: LIFE AS A BACKPACKER

One backpacker expressed it this way; “you’ve got all these different people, but when you are out here [backpacking], everyone is the same”. Infused with a spirit of tolerance, understanding, and acceptance, the confidence of these inexperienced young people was lifted and their friendships multiplied. Once invigorated with confidence in their “true self”, the acquisition of heightened social confidence quickly followed and was instrumental in their ability to form fast friendships.

Social confidence

Initial feelings of isolation and loneliness sparked rapid and intense new connections among backpackers. As Julia [23 years, England] observed: “you don’t have much time together, so you pretty much jump into it straight away and become friends [….] a lot of people travel alone and so they want to meet people straight away”. These budding friendships could last a few days, weeks or months. Occasionally, a few friendships could endure beyond the journey and be maintained via email. Calliope reflected on the friendships she made during her four-month journey:

I’ve made quite a few [friends backpacking]. You forge good friendships

when you’re travelling because everybody’s in the same boat. You tend to

meet a lot of people – you know, you’ve travelled. You meet a lot of

people that become your friends. My best friend, Jo, she’s gone to New

Zealand. She left yesterday. I was really upset when she went – three weeks

in New Zealand.

Your best friend from home? CHAPTER 5: LIFE AS A BACKPACKER 121

No, from here. Because I’ve stayed in [this] hostel for so long [three

months], it’s … we’re all like family here, you know … as good as friends at

home. [Calliope, 19 years, England]

The vibrant backpacker social scene, coupled with the passionate desire to share their emotions and stories with like-minded individuals, was fertile ground for intense bonds of friendship (and sexual partnerships, see Chapter 7) to grow. Backpackers often expressed with pride that they had made “so many friends” since travelling, some friendships being with people that they could not “ever imagine being friends with at home”, and yet were “still great people”. Mona made a comparison between her previous short holidays and her current backpacking trip. During her holidays it was about “seeing things” yet while backpacking it was “an experience” of meeting people.

She stated “people mean a lot more to me now than they used to”. A sense of mutual understanding and acceptance was fostered in this community. This non-threatening environment cultivated loyal and trusting relationships in a relatively short period of time. As Calliope suggests, the relationship that she formed with the “best friend” she made during her trip, was just as valuable to her as friendships at home that may have taken years to nurture to the same intensity and depth. That being said, superficial connections did abound in the backpacking community and served to bolster young travellers’ social confidence by adding the illusion that they “have so many friends”.

Life skills

Beyond the social confidence, backpackers also talked about the confidence that they gained in their practical life skills, such as employment acquisition, time planning and 122 CHAPTER 5: LIFE AS A BACKPACKER

financial management. The backpacking experience taught them essential life skills and how to sustain themselves independently.

I have learned to cook, [and] I have learned how to put stuff away […]

which I never did before [laughs]. [Liam, 22 years, Scotland]

While it may be surprising to some that many of these young adults were not familiar with putting their clothes away or cooking a meal, it does offer insight into their indulgent Western upbringing. In a sense, they have been sheltered from the rigours of daily life and through this trip reached a new level of understanding and appreciation for the skills that are essential to independently function well in society. In addition to learning practical life skills, these backpackers also achieved something that could take a lifetime for others to learn: cultural awareness and appreciation.

Comfort in cultural diversity

Backpackers tried new experiences, interfaced with different personalities and interacted with cultures that they may not have had the opportunity to meet or interest in at home. Even though many of the backpackers stayed in Sydney longer than anticipated, their exposure to different nationalities fostered a sense of cultural sensitivity and awareness within the backpacking community. As a result, they became more open-minded and tolerant in new situations and experiences with new cultures.

My interviews with Russell and Lucas explored why backpacking encouraged them to be more “open to new cultures”.

CHAPTER 5: LIFE AS A BACKPACKER 123

Broadened my mind a bit … definitely, yeah. To be honest with you,

there’s a pretty strong thing between the British and the Irish, like you

don’t mix with them. But I’d say, since starting travelling, I’ve mixed with a

lot of English people and they tend to be - just be the same as us, really.

It’s good in that sense. Beforehand I wouldn’t have even talked to them.

[Russell, 28 years, Ireland]

I have known so many different ways of life, so many different people

from all over the world … not just Australians. And it is interesting to talk

to them. For example, the Netherlands; they are next to Germany but I

have never talked to them, I have met so many Dutch people on this

journey, I have never met a Dutch in Germany though.

[Lucas, 20 years, Germany]

As many of the young travellers attest, the camaraderie, goodwill, and sense of community that was constant in this subculture inspired its itinerant members to become more accepting of others, regardless of cultural background. Eating, socialising, travelling, and sleeping with like-minded young travellers helped dispel preconceived prejudicial views that were entrenched in their cultural history and home.

Backpacker communitas

The social interactions and discovery of the “real self” inspired the majority of backpackers to consider and reassess their personal and professional future.

Numerous backpackers reported that they did not want to return home and “be the 124 CHAPTER 5: LIFE AS A BACKPACKER

person I used to be”. For many the “blinders” were removed to reveal potential and limitless opportunities in their future endeavours.

[Backpacking] made me realise that there are so many things I could do.

It’s mainly broadened my horizons [….] It’s made me think a lot more,

that there’s a lot more opportunities than I had realised.

[Anita, 26 years, England]

Overwhelmingly, the backpackers in my study disclosed stories of positive changes.

This sentiment, together with the development of self-awareness, may be a testament to the powerful, transformative, and self-illuminating properties of the backpacking experience. However, the magnitude of these positive views may have been exaggerated by the absence of negative stories. Voicing a dislike of backpacking within the backpacking culture was discouraged by risk of alienation.

The spontaneous formation of relationships and egalitarianism that characterised the backpacking culture was strikingly similar to Turners’ touristic communitas (Turner &

Turner, 1978). Based on his previous work with pilgrims, communitas occurs in a liminal space “outside or on the peripheries of everyday life” (Turner, 1974a, p. 47), free from the obligatory economic, political, or social tasks of ordinary life. As Wang notes, inter-personal authenticity is inspired in an atmosphere of communitas, where

“unmediated, ‘pure’ inter-personal relationships” are formed among those who interact as “social equals based on their common humanity” (Wang, 1999, p. 364). In such an atmosphere, backpackers were relieved of the pressures of social status pervasive in their inauthentic “public” life. United in their expression of their true CHAPTER 5: LIFE AS A BACKPACKER 125

selves, backpackers in this study existed in communitas and shared travel stories, helpful tips, and “unspoiled” travel paths.

Giddens (1990) has argued that the predictability of daily work and dreary routines at home often raises barriers to self-realisation and can ignite “feelings of loss”. The findings of this study indicate that while travelling, the backpackers existed in a liminal space where the rules, obligations, trials, and tribulations of their daily lives were suspended. Backpackers expressed relief from the monotony and constraining boundaries imposed on their everyday lives. This permitted them to indulge in leisure activities which enabled them to reconnect to their “true” selves as opposed to their

“public” selves performed in their home and work environments. Numerous writers have argued that there is a strong connection between place and the self

(Kontogeorgopoulos, 2003; Lafrant, 1995; Lafrant, Allcock & Bruner, 1995; Noy,

2004; Wang, 1999; White & White, 2004). As Neumann (1992) notes in his study of

American hikers in the Grand Canyon, Nevada, “part of the promise of travel is to live and know the self in other ways” (p. 183). The liminal nature of travel over an extended period contributed to the backpackers’ temporal transformation in self. In short, through their backpacking activities, they reached a state of existential authenticity.

In existential authenticity, the focus is more subjective than objective in nature.

Existential authenticity is focused on “real” experiences that motivate and inspire travellers to find their “true selves”. This is contrary to object-related artefact authenticity or history-related cultural authenticity. In an environment where their culture is constantly evolving and transforming, backpackers look to each other and 126 CHAPTER 5: LIFE AS A BACKPACKER

within themselves for “real” experiences that break from the routine of their daily lives.

This might include sun tanning on Bondi Beach, meaningful interactions with the

“other”, or “intensely authentic, natural, and emotional” exchanges with new friends made in the backpacking or local community (Wang, 1999, p. 359, 364). This was substantiated by the backpackers in this study who believed that during their trip, they were much more authentic and that their expression was more spontaneous, free and honest than in their usual everyday life.

Many of the backpackers in Noy’s (2004) study had expectations to experience change in themselves as a result of their travel, yet the backpackers in my study often expressed pleasant surprise at their heightened self-realisation. The reasons behind this difference cannot be explored within the limits of this study; however, it may suggest that the backpackers visiting Australia are indeed different from those who are primarily attracted to the arduous trials experienced during travel in impoverished nations. Regardless, the backpackers in both studies experienced a generalised improvement in their disposition. The self-changes were similar and included feelings of happiness, confidence, open-mindedness, tolerance, and flexibility.

Conclusion

Although backpackers visiting Australia today do not closely resemble the intrepid travellers of decades past, the backpacking culture continues to be a distinct and recognisable category of non-institutionalised tourism. Backpacking is a travel culture with its own norms, values, rules of conduct, communication networks, and hierarchies. Backpackers voluntarily subject themselves to harsh conditions and live CHAPTER 5: LIFE AS A BACKPACKER 127

“on the cheap” so they can travel for longer periods and enhance their road status.

Whether on or off the road, hierarchical status is coveted and shapes backpackers into a mould of what is acceptable and respected in the backpacker environment. The backpacking culture is dynamic and ever changing. The travel expectations and norms of behaviour of backpackers travelling in Australia were a clear departure from the traditional backpacker’s quest for novelty, variety, and exoticism. The shift from being transitory to being stationary for much of their time abroad indicates that the

Australian backpacking experience has evolved and become more recreational rather than exploratory. This is partly a result of the pulling factor of hostel hierarchies and young backpackers’ pursuit of acceptance and respect by their peers.

Fear of never having their travel dreams actualised encouraged many backpackers to find whatever employment they could to finance the remainder of their travels. While their probationary period was often extended beyond the limits of acceptability for a

“real” backpacker, their financially draining stay taught these young travellers valuable life lessons. Almost all backpackers eventually left Sydney. Ultimately, backpackers took pride in the realisation that they were able to continue on their journey for road status, even if there were a few potholes along the way.

While the backpackers shared a common bond in their adherence to travelling in the traditional backpacker style, they were heterogeneous in their motivations, attitudes, and behaviours while travelling. The contemporary backpacker’s preference for “fun” as opposed to “real” experiences may simply reflect the consumer-oriented culture to which these privileged young Westerners have been exposed. Further research would help clarify whether this is a current trend among most backpackers travelling 128 CHAPTER 5: LIFE AS A BACKPACKER

internationally or whether this tends to be a common trait among those specifically visiting Australia.

Backpacking in Australia appeared to act as a catalyst for self-discovery and change.

The real growth that the backpackers experienced was found within themselves, rather than through their consumption of toured objects, collection of photographs, and other representations of “cultural capital” (Munt, 1994). Some believed that they experienced a metamorphosis in their identity and others believed that their journey brought them full circle to unveil their “true” self. The backpackers generally felt less judgmental and more free, tolerant, patient, flexible, social, and most of all, confident, both in knowing who they “really” were and regarding their newly acquired life skills.

The changes experienced by the backpackers in this study often centred on their exposure to the unfamiliar characteristics of living “authentically” as a backpacker in communitas, rather than through their foreign surroundings and cultural exploration.

Despite most backpackers admitting that they spent too much time drinking, and consequently not experiencing the culturally authentic, almost all reported an increased level of self-awareness.

These themes are intricately woven with backpackers’ sexual experience while backpacking. The following chapters will offer insight into how the sexual behaviours of backpackers was connected to their culture, their recreational travel style in

Australia, their path of self discovery, and how their experience of authentic intimate CHAPTER 5: LIFE AS A BACKPACKER 129

communication with others affected their ability to behave in a rationally self-protective manner during casual sex.

Sex – Home and away

Sexual background

Backpackers were asked about their sexual behaviour before travelling in order to gain perspective on their pattern of sexual behaviour during travel – whether their sexual behaviour and condom use were consistent with their practices before travel, or involved new practices and changed risk behaviour.

Sexual history prior to backpacking

316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in the tables. Correlations and chi-squares were generated to explore the survey participants’ sexual history prior to departing on their backpacking trip. These findings were examined, controlling for gender. Of the survey sample, 97.5% primarily identified as heterosexual (96% of women; 99% of men). This is consistent with my study of international backpackers visiting Canada (heterosexual 94%; bisexual 3%; gay 1.0%; lesbian 0.6%) (Egan,

2001b). These findings reflect that heterosexual travellers prefer hostels. The most frequently reported age of first anal or vaginal intercourse was 16 years for women

(28%) and 17 years for men in the survey sample (23%) (range: 10–31 years; mean age:

16.6 years; median age: 16.0 years; n = 522) (Table 6.1). However, 14% of men and CHAPTER 6: SEX – HOME AND AWAY 131

10% of women became sexually active earlier and reported first sexual intercourse by the age of 14 years.

Table 6.1: Age at first vaginal or anal intercourse, stratified by sex (n = 522)

Men Women Total

n (%) n (%) n (%)

10–12 years 3 (0.9) 0 3 (0.6) 13–14 years 39 (13.1) 23 (9.8) 61 (11.7) 15 years 36 (12.1) 41 (18.3) 77 (14.8) 16 years 62 (20.8) 63 (28.1) 125 (23.9) 17 years 67 (22.5) 46 (20.5) 113 (21.6) 18 years 43 (14.4) 28 (12.5) 71 (13.6) 19-31 years 47 (16.0) 25 (10.7) 72 (13.8)

Over half of the survey sample reported between two and 10 sex partners (men 52%, women 59%). However, men were twice as likely to report having had over 20 sex partners in their lifetime (men 19%, women 9%). Men were also significantly more likely to report having had an experience of sexual intercourse with someone they had just met that day or evening (men 61%, women 45%; p < 0.001) or recently (in the past three days), (men 47%, women 34%; p < 0.01) (Table 6.2).

Just over 93% of all survey participants reported giving or receiving oral genital stimulation (fellatio or cunnilingus) (Table 6.3). While the vast majority of survey participants had experience with vaginal intercourse, less than a third had experience with anal intercourse, with men more likely to report it than women (men 35%, women 27%; p < 0.05). Only 3% of the sample reported no sexual intercourse or oral sex experience prior to their trip. As in other studies, women were more likely than men to have engaged in same-gender sexual experimentation (Grulich, de Visser,

Smith, Rissel, & Richters, 2003). While only a small portion of the female sample identified as bisexual (2.9%) or lesbian (0.8%), several more women reported some 132 CHAPTER 6: SEX – HOME AND AWAY

sexual experience with other women (oral genital stimulation (3%), hand genital stimulation (3.5%), or vaginal penetration (1.4%)). In contrast, only 1% of the men identified as bisexual and even fewer identified as gay (0.3%). Furthermore, only a small portion of the male heterosexual sample reported giving or receiving oral genital stimulation (0.4%) or hand genital stimulation (1.0%) with other men.

Table 6.2: Number of sex partners and casual sex experience before trip among backpackers visiting Australia, stratified by sex

Men Women Total

n (%) n (%) n (%)

Lifetime sexual intercourse b partners (n =550) ** 0 12 (3.9) 17 (7.1) 29 (5.3) 1 22 (7.1) 24 (10.0) 46 (8.4) 2–5 94 (30.2) 89 (37.2) 183 (33.3) 6–10 68 (21.9) 51 (21.3) 119 (21.6) 11–20 56 (18.0) 39 (16.3) 95 (17.3) 21–50 42 (13.5) 16 (6.7) 58 (10.5) 51–100 10 (3.2) 3 (1.3) 13 (2.4) 101+ 7 (2.3) 0 7 (1.3) Sex just met ever (n = 529) ***a, c 188 (62.9) 107 (47.8) 295 (56.4) Sex met recently ever 145 (48.5) 81 (36.3) 226 (43.3) (n = 522)**a, d a only those who had a history of sexual intercourse prior to their trip were requested to respond to questions regarding sex partners “just met” or “met recently” prior to trip. **/*** represent statistically significant differences between men and women at p < 0.05, 0.01 and 0.001 levels respectively. b sexual intercourse defined on questionnaire as anal or vaginal intercourse. c “Sex just met” defined on questionnaire as sexual intercourse with someone met that day or evening. d “Sex met recently” defined on questionnaire as sexual intercourse with someone met within the previous three days. e Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

CHAPTER 6: SEX – HOME AND AWAY 133

Table 6.3: History of heterosexual practice prior to the trip of individual backpackers visiting Australia, stratified by sex

Men a Women a Total History of sexual practice n (%) n (%) n (%)

Giving oral sex (fellatio or cunnilingus) to 285 (92.8) 223 (94.5) 508 (93.6) partner (n = 543) Receiving oral sex from opposite sex 291 (93.9) 221 (92.9) 512 (53.4) [fellatio/cunnilingus] (n = 548)

Vaginal intercourse (n = 549) 295 (95.2) 221 (92.5) 516 (94.0) Anal intercourse (n = 519)* 102 (34.8) 60 (26.5) 162 (31.2) * represent statistically significant differences between men and women at the p < 0.05 level. a Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Backpackers’ median age of 16 at first intercourse was consistent with that found among participants in the British NATSAL 2000 survey (Wellings et al., 2001) and among Australian technical college students (Grunseit & Richters, 2000). The numbers of sexual partners reported by backpackers in this study were marginally higher than those reported by participants in the NATSAL 2000 survey. In the UK survey, 31% of men and 19% of women aged between 16 and 34 reported more than 10 sexual partners over their lifetime (Johnson et al., 2001), compared to 37% of men and 24% of women who participated in this study.

In the following chapters, these findings will be compared with the findings of both the surveys, and the interviews regarding backpackers’ sexual behaviours while travelling and will be explored in detail.

Sun, sea, sand, and sex in context

If you look at Australia in particular as a travel destination, I think that

people come from Europe and it is thought of as a fun and exciting

destination, lots of beaches, lots of natural outdoor activities and it is

almost like a cigarette ad. When they are out they are wearing their 134 CHAPTER 6: SEX – HOME AND AWAY

swimming costumes and they are getting a tan, they are drinking and

partying and I think there are expectations that sex goes along with that. In

the same way that they are looking to do other activities, I think when the

sun goes down there are expectations of sex when people are travelling.

Even though the majority of people’s expectations might not get met, it is

one of those things that they are often travelling for a long period of time,

whether it is three, six, or twelve months, that is a long period of time, even

the most unlucky person should be able to pick up some time during that

travel period. [Doctor – #1/D1]

For backpackers, being privy to shared confidences about sex or witnessing others having sex in the communal backpacker context fostered a sense of sexual availability and opportunity that appeared to influence backpackers’ attitudes toward sexual intimacy. These young travellers often pursued new sexual prospects more assertively, and most sexual encounters occurred within a much shorter period of time after meeting potential partners than at home. The transient nature of the backpacking experience resulted in compressed time to pursue new sex partners and an acceleration of new sexual relationship development.

Sex expectations

It appeared that sex with new partners was part of the common expectation for a good holiday. In essence, it was a popular part to play in the holiday script. The responses from survey participants indicate that 61% expected to have sex with someone new on CHAPTER 6: SEX – HOME AND AWAY 135

their backpacking trip, this expectation being more common among men than women

(75% vs 44%; p < 0.001) (Table 6.4).

The majority of backpackers interviewed reported that “hooking up” with new sex partners was an expected part of their travel experience.

I think so, yeah, yeah, it’s like on a holiday. When you’re on holiday, everyone’s

looking for sex. Over here, it’s the same … backpackers, they’re all alike.

They’re all having a laugh … that’s what they’re here for, to have a good time. So

that’s normally what happens. [Nathan, 21 years, England]

I’m not sure of the reasons but it seems to me, for backpackers, it’s part of

the journey, whatever. You know, you go to places like Australia, […] it’s

part of … when you go on holidays, you expect it. It’s one of the reasons

you come away. [Scott, 25 years, England]

Well, everyone is sort of away doing the same sorts of things so you’re

looking for sex anyway and there is not too much attached to sex…

[Anita, 26 years, England]

While most women (71%) reported simply being open to the possibility of having sexual intercourse with someone new, there were still significantly more men who reported this than women (89%; p < 0.001). In contrast, men were less likely than women to report having no expectations of sexual activity (men 17%, 94/316; women

34%, 71/243; p < 0.001), or intentions not to have sex during their trip (men 17%, 136 CHAPTER 6: SEX – HOME AND AWAY

women 27%; p < 0.01). These findings would reflect the fact that openly expecting or seeking to have sex with new partners is more acceptable (even expected) for men than women. Women’s reports of new sex partners during their trip often far exceeded their expectations: this is discussed further in Chapter 7.

Table 6.4: Sexual expectations and intentions of backpackers visiting Australia, stratified by sex

Mena Womena Total Expectations of sex during trip n (%) n (%) n (%)

Open to possibility of sexual intercourse with 259 (88.7) 163 (70.6) 422 (80.7) someone new (n = 523) *** b Expected sex with someone new 222 (74.7) 101 (44.1) 323 (61.4) (n = 526)*** Expected to fool around, but not have sexual 88 (32.2) 63 (29.4) 151 (31.0) intercourse with someone new (n = 487) b No expectations of sexual activity 44 (16.5) 71 (33.6) 115 (24.1) (n = 477)*** Intended to have no trip sexual activity 45 (17.0) 58 (26.9) 103 (21.4) (n = 481)** a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in table. **/*** represent statistically significant differences between men and women at p < 0.01 and 0.001 levels respectively. b Sexual intercourse defined on questionnaire as anal or vaginal intercourse.

Gender

As these statistics reflect (Table 6.4), women were not opposed to new sexual partnerships while away from home. Many women viewed the trip as a protected space where they felt comfortable exercising their sexual assertiveness and engaging in behaviour they would not normally pursue at home. Perpetuating the “good holiday” script, Maya’s best friend encouraged her to seek out new sexual experiences.

CHAPTER 6: SEX – HOME AND AWAY 137

I mean, from where I come from, a lot of people go away to experience

the sexual aspects. When I went away, my best friend said “if I were you,

I’d go away and have sex with as many people as you want”.

[Maya, 22 years, Canada]

Maya originated from a small community and prestigious family where her actions would be viewed as an example for others in her community. After feeling constrained at home, she revelled in the anonymity she experienced while backpacking. Maya viewed her backpacking trip as an opportunity to achieve a “secret one-night stand”, something that was impeded in her home environment.

that’s my whole goal is to do it, to have a secret one-night stand and just do

it here. [Maya, 22 years, Canada]

The questionnaire and interview responses highlighted the increasing expectation of today’s young women across the developed world to be free to engage in the freedoms that men have traditionally enjoyed in their sexual lives, without the usual resultant negative reflection on their morality or character. These findings support those found in a study conducted from 1990 to 1999 with men and women attending Macquarie

University in Sydney (Grunseit, Richters, Crawford, Song, & Kippax, 2005). The researchers noted a tendency for women’s reports of sexual behaviour to increase over time, and become similar to men’s. The women in my study viewed backpacking as an opportunity to be more sexually assertive. In contrast to the dominant discourses of female (hetero)sexuality evident in much of Allen’s (2003) findings, the majority of women interviewees in my study distanced themselves from conventional discourses of 138 CHAPTER 6: SEX – HOME AND AWAY

heterosexuality. These women rejected the emotional hunger and vulnerability that women have stereotypically attached to sexual encounters. Many of the women interviewed were not seeking an emotional attachment, particularly to new sex partners. As Anita’s statement above indicates, in the backpacking environment she perceived that “there is not too much attached to sex”. Women in particular appeared to resist dominant constructions of heterosexuality and instead adopted a sexual script normative to the backpacking culture, a script legitimating a woman’s sexual desire without emotional attachment. Several of the men interviewed found this was a pleasant surprise and said it added to the sense of sexual adventure and play that permeated this context.

Sex as play

Backpackers’ travel experiences were primarily comprised of leisure activities, and for many, sex was one of those activities. In keeping with their predilection for

“recreational” travel activities (Chapter 5), all of the sexually active men and women backpackers interviewed were noticeably light-hearted about their sexual encounters and often described them as “good for a laugh” or “fun”.

It [backpacking] just seems like that kind of lifestyle. […] It’s quite fun to

just let go and have fun and having drinks and having sex and things.

[Bianca, 23 years, England]

Many of those interviewed reported having sex for the first time with another backpacker on the eve of their departure from a hostel. Some viewed it as their last CHAPTER 6: SEX – HOME AND AWAY 139

chance to connect with someone they found attractive and others were more opportunistic. Initiating sexual relationships on the eve of departure in that situation made it extremely unlikely that a continuing relationship would develop. Many reported not knowing their sex partner’s last name or having any means of further contact.

Sexually charged atmosphere

The social climate of sexual conduct in the backpacking context was perceived to be extremely relaxed and permissive. The acceptance and practice of casual sex within the backpacking community were in stark contrast to what most backpackers were familiar with in their home environment. Inexperienced backpackers suddenly found themselves immersed in a sexually charged atmosphere. Almost all backpackers interviewed considered sexual intimacy to be a private behaviour prior to their backpacking travels, yet in the context of backpacker hostels, with the scarcity of private spaces and alcohol-driven uninhibited behaviours, sexual encounters frequently occurred in public. Young, naïve backpackers (most often at the beginning of their journey) were shocked by the open hedonistic displays of sexual acts they witnessed in the common living areas, when returning to the hostel at night.

Almost everywhere you go you walk somewhere, like a back passage,

people will be having sex, and they get really embarrassed. But uhhh, I

think that, I think that is part and parcel of backpacking […] I’m just

amazed at how many people are actually doing it!

[Mark, 25 years, Scotland] 140 CHAPTER 6: SEX – HOME AND AWAY

Shared dorm rooms seemed to be one of the more popular locations for sexual intercourse with new partners. Almost all of the interviewees and nearly half (46%) of the survey responders witnessed other backpackers having sex while they were present in the dorm room. Not surprisingly, sex in public spaces was not without social consequences. The sexual antics of backpackers who “got lucky” during the night was fodder for gossip in the morning, perpetuating the generally accepted perception by backpackers that “everybody is doing it”. As Kevin’s comment suggests, sex stories abounded in this community.

The way we live in hostels, it’s hard to keep a secret. Most of it gets

around, people’s sex is up front … well, not all the time. It does tend to go

ahead and it comes up with everyone having a discussion probably the next

day. [Kevin, 27 years, Ireland]

Unlike their home environment, many backpackers were overwhelmed with the opportunities for new sex partners. Both men and women backpackers fondly viewed the backpacking context as fertile ground for opportunity to have as many sex partners as desired. Once novice backpackers heard the sex stories and/or witnessed uninhibited public displays of sexual behaviour, they were easily convinced that everyone was having sex except them. Further, the visibility and discussion of casual and indiscriminate sex acted as reinforcement for the pervasive acceptance of this behaviour. As several backpackers attested, casual sex was “part of the backpacker lifestyle” and “it just seems to be the in thing”. When asked their perception of what proportion of backpackers were having sex with someone new, the vast majority of CHAPTER 6: SEX – HOME AND AWAY 141

interviewees believed that almost every backpacker had sex with someone new during their trip.

Even those backpackers who did not seek out opportunities or intend to have sex would often end up meeting new sex partners anyway. Of those survey participants who reported sex with someone new, 25% reported having had no prior expectations to have sex during their trip. Clearly, the anonymous, sexually charged backpacking context influenced young people to alter their sexual behaviour and temporarily adopt a more impulsive, liberal moral code. Going beyond the moral boundaries of their everyday lives appeared to inspire a shared feeling of community and fellowship.

Communitas within the time-compressed context of backpacking

For most backpackers, the intended purpose of their travels was to see other parts of the world as cheaply as possible, so the transient nature of the endeavour limited the time most backpackers spent in any one place, unless they were “veteran” hostel guests

(Chapter 5). As a result, there was a shared sense of urgency in the pursuit of both platonic and sexual relationships. As Murphy (2001) notes, backpackers’ interpersonal relationships were often temporary yet intense. Consequently, backpackers spent more time with each other and formed what they perceived to be deeper bonds over a shorter period of time than they normally would with their friends at home. The accelerated social interaction and physical confines instilled a false sense of security.

The familiarity and trust they extended towards new acquaintances over a period of hours or days was often comparable to the intensity they felt in their close relationships that were developed over years at home. Taking comfort in the awareness that they 142 CHAPTER 6: SEX – HOME AND AWAY

would be unlikely to meet these people again following their departure, many backpackers disclosed highly personal information about themselves and engaged in sexual behaviours with relative strangers. The following statement from Anita is focused on the effects of time compression manifested in the bonds formed with other backpackers while travelling in this context.

…here you just sort of chat to everyone and you listen to them in a

different sort of way and you form bonds really, really fast with people, like

you’re telling them your deepest secrets within an hour or two, sort of

thing. [Anita, 26 years, England]

Tolerance and non-judgmental attitudes were cultivated in the backpacking community, where young travellers interacted with each other as social equals. The interactions with others were more intense than those at home. Backpackers took refuge in the awareness of their shared choice to temporarily leave their individual ordinary lives and independently pursue this extraordinary travel experience, while belonging together in a community. The backpacking community fostered communication with each other in a direct, personal, immediate, egalitarian, and unmediated manner, as do the bonds of communitas (Turner, 1969) (Chapter 3).

However, the togetherness inspired through new friendships and casual sexual encounters was impermanent. Frequent change of hostel guests and differing destinations was inevitable in this travel context, and backpackers would meet other strangers with whom they experienced obligatory togetherness.

CHAPTER 6: SEX – HOME AND AWAY 143

To use McCormick’s (1987) terminology, there was a script among backpackers that included “complex belief systems” that dictated why they had sex with new partners

(part of the cultural milieu), where one went to meet new sex partners (usually a bar popular among backpackers accompanied by a large group of backpackers), the sequence of behaviours that led to an invitation to have sex (i.e. flirting, non-verbal and verbal communication), how that invitation was communicated to a partner (“do you want to come back to my place?”), the nature of their sexual encounter (casual rather than committed), and where sex occurred (primarily dorm rooms). Chapter 7 will explore some of these cultural patterns in greater detail.

Conclusion

People often behave differently when they travel. While on holiday, travellers are unencumbered by the routines, rituals and social constraints of home and their norms of behaviour are temporarily altered or abandoned. It is clear from these respondents that “having a laugh”, drinking copious amounts of alcohol and having casual sex with new acquaintances was integral to a “good holiday”, regardless of whether it was two weeks or long-term as a backpacker. In the recreational travel atmosphere, these young people not only felt liberated from the surveillance of parents, obligations, and duties at home, but also felt pressure to seek excitement, adventure, and “play”.

Sex was seen as another form of play, free of the emotional sentiments or social obligations that some felt pressured to accommodate and indeed feel in their pursuit of sexual relationships at home. Characteristic of a liminoid space, backpackers assimilated to a group environment where work and play were voluntary. Individuals 144 CHAPTER 6: SEX – HOME AND AWAY

who embarked on a backpacking journey sought opportunities to engage in “ludic” or playful phenomena. This created an atmosphere of sexual availability and opportunity that, for most, was anomalous to their normal lives. The transience, anonymity and bonds of communitas in the backpacking environment promoted intense personal connections over a very short time, and this resulted in a false sense of security that they really knew each other.

“Good for a laugh”: Backpackers and sexual behaviour

Few studies have focused on situations in which liberal or “disinhibited” sex behaviour is the norm. My reference to sexual disinhibition is not to suggest that human sexual behaviour is based on an internal drive held in check by social forces (a view famously criticised by Foucault, 1978), but rather that one’s interest, repertoire and feelings associated with sexual behaviour can be enabled, encouraged and structured by the cultural milieu that one is immersed in.

First, the proportion of backpackers who engaged in sexual intercourse, number of new sex partners, frequency of sexual intercourse and descriptors of new partners will be presented, in addition to behaviour demonstrating sexual disinhibition. This quantitative section will be followed by an exploration of the characteristics that surround sexual encounters with new partners. These characteristics include where they meet, the process of negotiating sexual activity undertaken prior to sex, locations to engage in sex, sexual repertoire, and sexual pleasure.

The majority, 55% (n =300/548; 53% vaginal sex; 7% anal sex), of survey respondents did have sexual intercourse with someone new while backpacking (Table 7.1). Almost all of those who reported anal sex (n =41) also reported vaginal intercourse. Only two women reported exclusively anal sex. Slightly more men than women reported sexual intercourse with new partners during their trip (men 60%, women 48%; p < 0.01).

Among all the individuals who had sex with someone new while backpacking, sex with 146 CHAPTER 7: BACKPACKERS AND SEXUAL BEHAVIOUR

someone they met for the first time that day or evening (“just met”), or in the previous three days (“met recently”) was very common. During the analysis, “sex just met” and

“sex met recently” were not combined given that the responses suggested that the participants perceived a distinction between them. Seventy-one per cent (216/305) reported sexual intercourse with someone they had just met (Table 7.2). Note: the number of survey respondents who reported sex with someone they had just met

(n = 305) or met recently (n = 304) exceeds the number of respondents who reported a new sex partner during their trip (n = 300), see table 8.2. It is possible that a few respondents did not count the person with whom they had sex as a “partner” in Q38 on the survey.

Table 7.1: Proportion of backpackers who had sexual intercourse and number of new sex partners reported during their trip, stratified by sex

Mena b Womena b Total Trip sexual experience (n = 548) n (%) n (%) n (%)

Had vaginal or anal intercourse on 185 (59.9) 115 (48.1) 300 (54.7) trip** Number of new sex partners (n =548) 0 120 (38.8) 121 (50.6) 241 (44.0) 1 44 (14.2) 42 (17.6) 86 (15.7) 2 39 (12.6) 27 (11.3) 66 (12.0) 3 23 (7.4) 27 (11.3) 50 (9.1) 4 22 (7.1) 12 (5.0) 34 (6.2) 5 18 (5.8) 6 (2.5) 24 (4.4) 6-10 21 (6.8) 3 (1.3) 24 (4.4) 11-31+ 22 (7.1) 1 (0.4) 23 (4.2) a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in table. ** represents statistical differences between men and women at the p < 0.01 level. b Proportions were compared using the chi-squared distribution (unless otherwise state). Where cell sizes are small (<5) Fisher’s exact test was employed.

CHAPTER 7: BACKPACKERS AND SEXUAL BEHAVIOUR 147

Table 7.2: Number of backpackers (of those who had sexual intercourse on trip), who had sex with someone they just met or met recently, stratified by sex

Mena c Womena c Total Sex with new partner on trip (n = 300) n (%) n (%) n (%)

Sex just met on trip (n = 305)*** b 151 (79.9) 65 (56.0) 216 (70.8) Sex met recently on trip (n = 304)*** b 139 (73.5) 70 (60.9) 209 (68.8) a 185 men (59.9%) and 115 women (48.1%) had sex with someone new on their trip (N = 559). Response rates vary for individual questions and are referenced in table. *** represents statistical differences between men and women at the p < 0.001 level. b “Sex just met” defined on questionnaire as sexual intercourse with someone met that day or evening; “Sex met recently” defined on questionnaire as sexual intercourse with someone met within the previous 3 days. c Proportions were compared using the chi-squared distribution.

Table 7.3: Descriptors of last sexual partner and frequency of sexual intercourse with that partner, stratified by sex

Mena b Womena b Total

n (%) n (%) n (%)

Description of last partner ( n = 311)* Traveller from own country 56 (29.2) 40 (33.6) 96 (30.9) Traveller from different country 102 (53.1) 40 (33.6) 142 (45.7) Local resident of country visited 31 (16.1) 36 (30.3) 67 (21.5) Other 2 (1.0) 3 (2.5) 5 (1.6) Number of times had sex with last partner (n = 311) 1 71 (37.0) 47 (39.5) 118 (37.9) 2 46 (24.0) 18 (15.1) 64 (20.6) 3–5 40 (20.8) 25 (21.0) 65 (20.9) 6–10 14 (7.3) 10 (8.4) 24 (7.7) 11–20 10 (5.2) 7 (5.9) 17 (5.5) 21–50+ 11 (5.7) 12 (10.1) 23 (7.4) a 316 men (56.5%) and 243 women (43.5%) completed the survey (N = 559). Response rates vary for individual questions and are referenced in table. * represents statistical differences between men and women at the p < 0.05 level. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

A more in-depth exploration of young backpackers’ sexual encounters was useful in order to highlight contextual features that appeared to influence the sexual scenarios while backpacking. Information learned through this process included where they sought new sex interests, who they had sex with; how they knew they were going to have sex with this person(s), where they went to have sex, what sexual activities they

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engaged in on these occasions, how often they had sex with each partner, and whether they perceived their sexual experiences while backpacking to be pleasurable.

Given that almost all of the interviewees identified as heterosexual, the results of the qualitative analyses focus on the heterosexual experiences. The interviews with hostel staff focused on the social setting of backpacking, perceived sexual activity, and locations to have sex in the hostel setting. Also considered were factors that hostel staff believed influenced backpackers’ sexual behaviour. Interviews with clinic staff revealed further detail regarding how backpackers’ sexual behaviour was different from their home environment, and the factors that influenced their behaviour in the backpacking context. Gathering information from these three sources facilitated a much clearer understanding of backpackers’ sexual behaviour and the circumstances surrounding sex in this context. Considered in total, these interviews revealed interesting gender differences.

The sexual script

At the interpersonal level, the patterns of interaction described above represent the dominant sexual script that was frequently enacted prior to intercourse. Regardless of cultural background, this script already was, or quickly became, familiar to young backpackers. Clearly, a backpackers’ invitation to come back to their hostel or to go to another locale, and their subsequent success in having sex, would suggest that this element of the sexual script was not necessarily unique to the backpacking context.

Rather, it was a commonly practised way for potential sex partners to gauge how interested the other was to go to “the next level” of the sexual script. The specific bars

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that they went to, and locations to have sex (and culturally specific dynamics that these represent) might have changed, but overall the courtship ritual was roughly the same, just accelerated and less intimate.

Where do they meet?

Recognising the considerable profit potential of catering to this young travel population, many pubs and nightclubs in Sydney and Cairns customise their marketing to appeal to young travellers. Many of the popular bars advertised cheap drinks in free backpacker magazines. Consequently, heterosexual backpackers looking to meet and drink with other like-minded individuals frequently attended these bars. The solitary gay interviewee reported that he socialised in gay bars while travelling rather than in the bars that were preferred by heterosexual backpackers. The overt sexual images contained in these advertisements (Figures 8.1 and 8.2) reflect the sexualised ambience that bars and pubs represented to backpackers.

Backpackers knowingly sought out places where sexual scrutiny was pervasive. Similar to what Maticka-Tyndale and Herold ( 1997b) found in their study of young people on a spring break holiday, backpackers who visited Cairns often participated in the nightly

‘Mr Backpacker and Miss Backpacker’ contest by being judged on their dancing and exhibitionism on a public stage or counter of a bar. During my fieldwork in Cairns, I witnessed first hand the participants of this contest at a popular backpacker bar. Their dancing simulated sexual actions and interactions. The public display of writhing, scantily clad, intoxicated individuals in this contest, combined with the pervasive sense

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of sexual availability and opportunity with no commitments, contributed to the overall sexualised atmosphere.

During the interviewss, backpackers talked about backpacker drinking establishments as places “guaranteed” to find sex partners. As one hostel staff member said:

When you have places that serve five drinks for nine dollars, seven drinks

for ten dollars and add alcohol to that and a lot of things go out the

window. No matter how many towns you stop at there is always certain

nights that are known for cheaper drinks. There is a new place that started

Sunday night and they are called “a night at Ibiza” and everyone from the

UK knows what happens at Ibiza, so if you go to their nightclub, that is

pretty much saying to me that that is what they are trying to promote, good

music, get plastered, and hook up with some girl on the dance floor.

[Hostel staff, Cairns]

In the following statement, Martin refers to “another Australian girl” that he had sex with during his time in Sydney. He often frequented a particular bar, knowing that there would be a good possibility of meeting a new sex partner while he was there.

That was another Australian girl in the same bar. Scruffy Murphy’s in town

… you can’t fail (laughs). [Martin, 19 years, Scotland]

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Figure 7.1: Advertisement for inexpensive drink prices at “Sydney’s premier backpacker bar” in a free Australian backpacker magazine

(2004).

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Figure 7.2: Theme party advertisement for “Sydney’s premier backpacker bar” in a popular Australian backpacker magazine (2004)

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Backpacker interviewees reported having casual sex with Australians they met in backpacker bars. The popularity of these bars with locals suggests that they knew they would meet young travellers who would not be interested in a long-term relationship.

Backpacker bars were part of the sexual script for where backpackers could meet new sex partners. These establishments acted as an extension to the “holiday atmosphere” that backpackers experienced in the hostels they stayed in. Local patrons who attend these backpacker bars may be attracted to the disinhibited nature of backpackers.

Partner preferences

Analyses of the questionnaire responses revealed that of those who reported sex with someone new during their trip, 52% had sex with another traveller from their own country, 72% had sex with a traveller from a different country, and 48% had sex with a local of the country being visited (Table 7.4).

Table 7.4: Descriptors of sex partners during trip, stratified by sex

Mena d Womena d Total Descriptions of sex partnersb n (%) n (%) n (%)

Traveller from their own country 102 (54.3) 54 (47.0) 156 (51.5) Traveller of a different country*** 153 (81.4) 65 (56.5) 218 (71.9)

Local of the country being visited 93 (49.5) 51 (44.3) 144 (47.5)

Otherc 1 (0.5) 2 (1.8) 3 (0.9) a 185 men (59.9%) and 115 women (48.1%) had sex with someone new on their trip (n = 300). Response rates vary for individual questions and are referenced in table. b Respondents often reported more than one type of sex partner. *** represents statistical differences between men and women at the p < 0.001 level. c “Other” responses recorded by survey participants: 1) “mate of mine from home” (n = 1); 2) “British Navy crew member” (n = 1); 3) “Thai hooker” (n = 1). d Proportions were compared using the Chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

The frequency of kindling sexual relationships with other travellers was in part due to the amount of time that they spent with each other. As one clinic doctor said: “they stay in the hostels, they go out partying and drinking together, and they go home

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together”. The sexual “fun” that backpackers sought from each other generally did not come with any expectation of commitment due to the sexually recreational and transient nature of this travel community.

In contrast, the backpackers reported that local female sex partners were more likely to seek a commitment. Several of the men interviewed expressed disappointment with the expectations of local women they had sexual relationships with while travelling.

Yeah, well, I had an Australian girlfriend […] in Melbourne for five weeks

or so. [Laughs] She was actually getting really, she was wanting to move in

with me and things like that and I didn’t want that. She wanted me to move

in with her and wanted me to work for her as well, because she had her

own business, […] so one morning I just woke up and stopped answering

her calls, which was quite bad. Then, I met a new girl, Carla.

[Liam, 22 years, Scotland]

In this statement, Liam did acknowledge that the local woman had been his

“girlfriend”, but while backpacking he was not willing to meet the expectations of commitment this woman desired. A committed relationship was not what he wanted while abroad. Instead, Liam found it easier to move to the next city on his Australian tour and source new women with whom to have sex. At the time of the interview, his subsequent sex partners following this relationship were all fellow backpackers.

Whether their new sex partners were other travellers or locals, discussions with backpackers suggested that the majority of sexual encounters occurred after a night

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out. Men and women staying at the same hostel often paired off together following an infusion of alcohol and socialising in the local pub. The majority of these sexual encounters happened the same day they met. Overall, men reported more new sex partners than women, regardless of whether it was with a traveller or a local of the country they were visiting (Table 7.4).

During the interviews, men often reflected on why they were more likely to have sex with someone from a different culture than their own.

I think the Aussie girls are attracted to backpackers, probably mainly

because you’re not Australian.[…] I mean, you’re not an Australian and

you don’t have an Australian accent and so that’s slightly … seems to be the

attraction.[Martin, 19 years, Scotland]

Yes. It’s not that I prefer to try different cultures it’s just that, when you’re

out in the public, like I said there is that foreign accent or that foreign look

in a girl is more attractive than somebody you’re quite used to at home.

[Russell, 28 years, Ireland]

I think what it is, for both men and women, like a lot of girls you meet say

“Oh, geez, your accent’s lovely!” and it seems that the accent is more

attractive to girls … the grass is greener on the other side, as they say. So, in

that sense, you’re more attracted to foreigners, you know, because there’s

more appeal or you’re more attracted sexually. [Bobby, 23 years, Wales]

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These statements highlight the sexualisation of the “other”. These responses suggest that the power of attraction experienced by sexually exploring the Other in sexual courtship rituals should not be underestimated. Many backpackers romanticised the foreign accents of their sex partners while backpacking. Some men reported greater success in finding sex partners since travelling than in their home environment, and perceived that their foreign accent played a significant role in that success. By having sex with individuals originating from different cultures than their own, in a way they were able to gain an intimate insight into the Other. Appealing to their competitive nature, “scoring” with women foreign to their own cultural background was a source of

“sport” and entertainment among many male backpackers.

Competition

Between the men in particular, sexual conquests was a numbers game, the objective being to “rack up” as many casual sex partners as possible before going home. Fuelled by traditional discourses of masculine sexual insatiability, some young men took advantage of the availability of sexual encounters because to not do so would go against macho ideals of “take sex whenever you can get it”. This nurse talked about the sexual competition among backpackers and the health implications this behaviour has for the spread of STIs.

It’s the opportunities. They’d be treating it like a game, you know, scoring

or notches on the bedpost, kind of thing and, they’d even be meeting up

with people that they’d had sex with in various locations, up the coast and

things like that. And a lot of them, when we asked them if they were able

to contact somebody if they had an STD, they wouldn’t have any way of

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contacting them. They were very sort of quick, brief, anonymous things.

[Nurse: #9/N2]

As this statement suggests, competitiveness among male backpackers was prevalent.

One backpacker reported that some men collected flag badges to be sewn onto their backpacks proudly proclaiming the nationalities of the women they had sex with, rather than the countries they had visited during their travels. Through sex with the

“other” backpackers, they notched figurative countries on their belt. The sense of competition for sexual conquests among backpackers was heightened under the influence of alcohol.

Though it was not as common for women in this study to openly brag or compare numbers of sex partners with each other during their trip, many did actively seek out opportunities to have new sexual relationships while backpacking.

Oh, you get thrown into it pretty easily. I was complaining that I hadn’t

met anyone for quite a while, you know? But no, it’s pretty easy. All you’ve

got to do is go out with people from the hostel and get pissed and you’re

pretty much gonna be able to get off with someone. [Mona, 24 years,

England]

Negotiation of sex

Many people have difficulty negotiating sex (Holland, Ramazanoglu, Sharpe, &

Thomson, 1994), and the backpacking culture is no different. The process of agreeing

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to have sex with someone has a heavy non-verbal content and is most often not articulated clearly. When asked about how sex came about, interviewees hardly ever reported explicit verbal negotiation, rather they used phrases such as “one thing led to another”, or “do you want to come back to my place”, and they just knew what that meant. None of the backpackers interviewed indicated to their sex partners their explicit intention to have sex with them. Several of the interviewees said negotiation of sexual acts with new acquaintances was more likely once a rapport was established, rather than in casual sex encounters.

I think to talk about sex you need to be with someone for a bit before you

start talking about it. If it is just one-night stands, you don’t really talk about

it. [Joe, 23 years, England]

As Lear noted, “actually engaging in sex with a new partner can be less intimate than talking about it” (1996, p. 126). Overwhelmingly, the backpackers interviewed demonstrated a general passivity in their communication regarding their sexual intentions or desires, and a lack of introspection in their recounting of them. “I’ve never really discussed it; it just kind of happens”; “I just felt the tone”; and “one thing leads to another” were statements often voiced to describe how they knew that they were going to have sex with a new partner.

Similar to other populations studied, backpackers appeared to follow familiar sexual scripts that they brought with them from their home environment to negotiate sexual acts (e.g. Flowers, 2000). Yet in the transient backpacking context the courtship

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process was accelerated, which introduced unfamiliar challenges for backpackers to adapt old scripts to new sexual situations.

“Courtship may be defined as a process or set of behaviours that precedes and elicits sexual behaviour” (Seal & Ehrhardt, 2003, p. 295). In their courtship, heterosexual backpackers rapidly proceeded through a sequence of stages that started with initial attraction and culminated in sexual interaction. Almost all of the casual sex encounters discussed during the interviews started with getting to know each other briefly while drinking a lot of alcohol together in a bar/pub atmosphere. Yet, some backpackers skipped this “getting to know you” chat, and ultimately had sex with someone they had seen at the bar but not spoken to until the bar was closing. Regardless of how much time was spent getting to know someone, generally speaking, discussion about extending their time together beyond the confines of the bar was initiated after consuming significant amounts of alcohol.

Sexual attraction and intention were conveyed through a sequence of events, including mutual flirtation and non-verbal cues such as eye contact, physical touch, and kissing.

Many voiced that in the backpacking context, once they kissed someone the dialogue would eventually progress to one person asking the other “Do you want to go back to your place or mine?” Literature on traditional heterosexual scripts portrays men as initiators of courtship and women as boundary-setters (Byers, 1996; Peplau et al.,

1997; Reiss, 1967; Seal & Ehrhardt, 2003). However, gendered roles and expectations of sexual encounters have experienced a more egalitarian shift in recent decades

(Ortiz-Torres, Williams, & Ehrhardt, 2003; Allen, 2003). In keeping with this recent shift, women backpackers appeared to be more overt in their sexual courtship than traditional stereotypical scripts would suggest.

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Gender roles

The traditional motivations of love, commitment, and emotional intimacy were absent from the women’s narratives of their sexual behaviour. Instead, their responses were consistent with what has traditionally been viewed as men’s motivations for sex. Frank female sexual desire was once a taboo topic, but numerous women and men in this study talked about this openly.

I feel I’m a lot more personally wanting sex now, more turned on and

stuff. I don’t know why; but I just do. [Bianca, 23 years, England]

No, I would pretty much initiate. I hang around with a lot of guys at home

and I know how they work so I know you’re never going to be refused.

There’s more drink involved so maybe there’s more chance.[…] But no, I

think (me personally anyway) if I wanted it, I could go and get it, simple as

that. And if I don’t I don’t so … […]. The first guy I was just really

hammered so I knew what I wanted and I think I might have said

something to him. I definitely initiated that. I don’t … can’t remember

exactly what I said, probably I was very crude and whatever [laughs]. I just

wanted him; it was as simple as that. I don’t know, I’m a bit of a guy that

way. I’m not the settle-down kind of chick at the moment. I wanted it so I

just did it. No, alcohol might have been a bit [of an influence] but it was in

my head beforehand. [Siobhan, 25 years, Ireland]

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Men also talked about being in the unfamiliar position of being the object of someone else’s sexual interest. Warren, a night security guard at one of the hostels, reported that a woman staying at the hostel made a blatant pass at him one night on return after an evening of getting drunk. According to Warren, she was “simply begging for it!”

Warren did not feel compelled to take her up on her invitation and encouraged her to go to bed alone. Hearing her response surprised him: “What if I wake up and I’m all wet? Would you fuck me?”. Interestingly, this woman was also put in the unfamiliar position of being at a disadvantage, in that she extended an explicit invitation uncertain whether he would accept.

Several other men reported that women propositioned them to have sex, even if there had not been any prior interaction. Oscar spoke about having a sexual interlude with one backpacker in the hostel where he was staying. As soon as she left the hostel another backpacker propositioned him to have sex with her.

Yeah, well pretty much as soon as that other girl went, she made her move

… [laughs]

[Laughs] She was just waiting in the wings …

Yeah, she made her approach to me. I hadn’t even thought about that.

[Oscar, 25 years, England]

It may be that these primarily young women were simply becoming sexual confident over the course of their trip, and so became more assertive in their sexual desires.

Also, sex outside a committed relationship might have given them the freedom to ask for what they wanted with no sense of repercussions if they offended the man, which

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they may have felt reluctant to do with a steady boyfriend at home. Thus they may be getting more from sex and getting better at doing it. Bianca’s comment also suggests that the sexy environment may affect them. This may be related to the holiday atmosphere, no assignment deadlines, working hours, etc.

“The traditional double standard (Reiss, 1967) posits that casual sex, sex with multiple partners, group sex, and sexual experimentation are more acceptable for men than women” (Seal & Ehrhardt, 2003; p. 296). However, in this context, the sexual scripts were clearly more egalitarian that they had normally experienced and acted out at home. While female backpackers appeared to experience freedom from their traditional feminine role, men appeared to adhere to traditional scripts of masculinity in their aggressive search for sexual conquests. As Siobhan’s statement attests, it was widely recognised that, if propositioned by a woman, a man would rarely refuse the sexual opportunity, regardless of whether he felt any attraction to or connection with that woman. The following excerpt from my interview with a clinic counsellor reveals that he perceived male backpackers to be bound by traditional scripted masculine roles, wherein their failure to pursue sexual conquests brought their masculinity and/or sexual orientation into question (Seal & Ehrhardt, 2003). In his view, the pressure backpackers put on themselves to make the most of their perceived privileged sexual utopia compelled intoxicated young men to pursue sexual opportunities, even if their libido was not so inclined.

The barriers are probably what happens to their decision-making judgment

when they’re getting drunk all the time. I think it’s to do with … I think

guys (and this goes for both) is that they feel there’s something wrong with

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themselves, they feel that they can’t let sexual opportunity go by and that,

in some way, it’s unmanly to do that. So if they get latched on to by a bar

girl or if they know that sex can be very easily had, it seems like “Well, let’s

have it”, because it’s just sex. Whereas I think, for a young woman, there

would have to be a bit more of an emotional connection or … not all the

time, of course. But definitely for the guys there’s this sense of, you know,

“I can go to the same bar night after night and the woman kept on coming

back to me and back to me” and there’s the sense that “You know, I’m a

man; I should do this”. Even if they’re not particularly horny […] You

know, “There’s something wrong with me if I don’t take the opportunity”.

[Counsellor: #6/C1]

Testing the waters

Regardless of who extended the invitation, “your place or mine?” appeared to be an accepted part of the sexual script. This question was interpreted by most as a proposition to have casual sex, yet was ambiguous enough to veil their sexual intentions in the event that one party did not want to consummate the invitation. Clear negotiation of sexual intentions prior to sex could stem the “flow” of the courtship ritual, given that the acknowledgment of intentions would make transparent one’s sexual desire, thereby eliminating any expression of passivity in a future dismissal of their sexual behaviour as a “drunken mistake(s)”.

So I was talking to her and then we ended up kissing and stuff and I said

“Would you like to come back?” and I sort of knew it would happen […] I

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mean, I never ask the question you know, I never say it but … I don’t

know, it just sort of happens. [Nathan, 21 years, England]

Unfortunately, it sounds awful but I think, if you kiss somebody, and it’s

nice then you’re probably going to have sex. Have some fun, sort of thing;

that appears to be the case for me anyway. […] Umm, it just kind of

happens really. Obviously, there’s a point where you’re going to go like …

your place or mine? [laughs] I don’t know; I think that a lot of the time it is

just taken for granted I think, it is alcohol-driven, kind of thing. [Mona, 24

years, England]

Sex: the thing “to do”

The following excerpt describes Liam’s “one night” with another backpacker that he met at a pub.

I met this girl from Kilkenny, she came back to the house, ‘cause I had a

house in Melbourne, so she came back to the house, and then we did it

then, and that was that. […] it was actually quite funny [amusing], but it was

just one night and then I left the next morning. We didn’t exchange

numbers and that was that. [Liam, 22 years, Scotland]

Many of the male backpackers talked about their sexual experiences in a similar manner to Liam. Racking up casual sex partners was on the “to do” list for their trip.

Meeting sex partners during a night of cheap drinks meant that they were not

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particularly selective in their choice of sex partner. They reported feeling dismay and embarrassment the following morning when recalling their choice of sexual partner made with “beer goggles”.

Drink [laughs]. You have a few and you get your beer goggles on and you

wake up in the morning and you think “Oh God!” Some were quite nice,

some weren’t and I was pretty drunk and I regretted it, like. […] ‘cause I

was pretty drunk and I didn’t really worry about stuff like that

[attractiveness] [laughs]. [Joe, 23 years, England]

As noted in research with migrant tourism workers (Ford & Koetsawang, 1991), backpackers in my study appear to demonstrate a “recreational” sexual philosophy.

Any potential significance backpackers ascribed to their sexual experiences was often discounted and tenuous. Rather than demonstrating contemplative reflexivity, most of the backpackers discussed their sexual encounters in a style consistent with describing leisure activities that they “did” or “checked off the list”, rather than intimate moments.

While the men were more likely to report embarrassment over their poor choice of sex partner, women were more likely to report regret. Several women reported that they engaged in consensual sex, but later wished it hadn’t happened. These women’s narratives often detailed the accelerated courtship ritual characteristic of sexual partnerships while backpacking, and acknowledged uncertainty prior to the initiation of sex regarding whether this person(s) was a good choice of sexual partner. For these women, their personal awareness of partner assessment prior to sex often resulted in guilt following sex or upon sober recall.

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Umm, I’ve heard a lot of times that it’s [sex with someone new] been a

mistake … spur of the moment mistakes. People maybe lose grip when

they’re here. [Calliope, 19 years, England]

Some of them have been a mistake and some of them were like friends

that I kind of thought I fancied and then did it and it was too late.

Did you realise it was too late afterwards or at the time … ?

Umm, well, I kind of knew but I was really drunk. Obviously not straight

away but afterwards … after a while I was regretting it.[…] I think that was a

pretty bad idea because we kind of realised that we shouldn’t have had sex

… I mean, for me it’s easy enough to just go to one-night stands but I think,

you know, he might’ve thought something else might eventuate.

[Mona, 24 years, England]

Guilt following casual sex was also found among women who participated in Herold and Mewhinney’s (1993) study of gender differences in casual sex among dating bar attendants. While uncommon, several men did report feeling regrets about their sexual encounters. However, as evidenced by the following statement from Joe, his regrets stemmed from missed opportunities to have sex with women he was attracted to, rather than his impulsive, intoxicated decisions to engage in convenient sex with women who happened to be staying at the same hostel.

Oh, yeah, well to be honest with you, without me wanting to say, I regret it,

yeah I was pretty drunk and I wouldn’t normally have done that.

Why did you regret it with those two women?

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Cause she just really wasn’t my type plus at the time, she was living in the

hostel as well so it was a bit awkward … [Joe, 23 years, England]

By adopting a more liberal attitude while backpacking, most women transcended the more traditional sexual script prescribing that women act as gatekeepers in sexual courtship rituals. Some women rejected the conventional sexual script for women to assume a passive role, and instead took on the active role as sexual initiator

(McCormick, 1987). While in the backpacking context, women were more inclined to act on their desire for pleasure, fun, and sex (Leigh, 1989; Hynie, Lyndon, Côté, &

Wiener, 1998). For those women who expressed regrets in some of their sex partner choices, their recounting of the events suggested that they wished they had halted the progression of the sexual courtship ritual. In the socio-sexual context of backpacking, where casual sex was the “in thing” yet rarely explicitly negotiated, it is not surprising that these women felt ill-equipped to deviate from the most popular sexual script followed by backpackers. In the sexually charged atmosphere of the backpacking environment, these young travellers became caught up in the sexual liberation that was customary. However, clarity in negotiating sexual desires and limits may have been compromised in a sexual situation that was impromptu and where cultural scenarios were unfamiliar.

Many individuals temporarily adopted the liberal sexual script that was dominant in the backpacking culture. Yet it remains unclear whether, and to what extent, these young people understood and were able to interpret their partner’s sexual scripts. Seal and

Ehrhardt have suggested that a mutual understanding of sexual scripts is essential in order for effective dyadic communication, sexual decision making, and negotiation to

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occur (2003; McCormick, 1987). Indeed, the analyses of the interviews and questionnaires was based on one-sided reports of sexual behaviour without any understanding of what their partners’ perspectives were regarding the sexual event(s), and how convergent their sexual scripts were.

Location, location, location

The social space and physical locations available to have sex might have been an additional layer of influence on sexual activity and sexual decision-making. The spatial aspects of social contexts with regard to sexual behaviour have been a recent focus of some researchers. Hotels (Pritchard & Morgan, 2006), and popular venues for gay men to have sex have been locales and locations studied in the literature (Flowers et al.

2000; Richters, 2007). There is no published research that explores the favoured locations for backpackers to have sex, and how these social and spatial contexts affect their sexual behaviour. Guests of hostels, not unlike those of hotels, live in an environment that is “out-of-time and out-of-space” and this can contribute to the adoption of new behaviours that are “out-of-mind” (Pritchard & Morgan, 2006). I have argued in previous chapters for the broader landscape of backpacking to be considered a spatial and temporal liminal period when young individuals subvert social norms and temporarily challenge conventional mores. Given the popularity and importance of hostels in the backpacker lifestyle, hostels should be considered a micro-liminoid public space where the sense of transience and anonymity created conditions of freedom and opportunity to pursue illicit thrill seeking. Everyday activities in a hostel, including sleeping, cooking, eating, ablutions, and watching television were all conducted in a shared public space. Consequently, backpackers had

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very limited venues conducive to sexual activity, particularly if it was with another backpacker rather than a local resident. Therefore, the majority of sexually active backpackers felt obliged to act out in public places what most considered a private activity. By necessity, the paucity of private areas to engage in sexual activity transformed these common living areas into culturally constructed places of lasciviousness, and illicit sexual impulsivity. In an effort to find privacy, many backpackers found themselves having sex in less than ideal locations, which markedly affected their sexual practices.

Sexual disinhibition was one of the principal changes that these young individuals experienced while backpacking. Backpackers explained that it was the situational constraints of communal living that left them with little option but to have sex in public spaces. Engaging in sexual activity in locations where others were likely to witness this behaviour is reflective of the level of disinhibition that backpackers experienced.

Frequently backpackers expressed surprise at their own lack of inhibitions, often stating that “I never in a million years imagine doing this at home!”

Goffman (1959) conceptualised the “front-region” and “back-region” to explain the respective public and private spaces of everyday life. He suggests that in the “back- region” individuals are likely to go “off-stage” to engage in private activities including sex. Yet, in hostels, many back-stage activities, including sex, were performed by necessity in “front-region” public spaces. The most likely spaces in hostels for backpackers to have sex included dorm room, TV room, public shower, toilet stall, pool table, kitchen, stairwells, and garden bushes. For my study, interviews with backpackers and hostel staff revealed that dorm rooms were undoubtedly the most

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common place for sexual activity. Over half of the survey participants who had sex did so while others were in the room (53%). This was usually sex with people that they had met for the first time that day (68%).

Umm, well, sex in public is not something I would do anywhere else but,

in a hostel, you’re, you know in a dorm room and stuff. I would never

have done that back home but down here you don’t seem to mind that

there are other people in the room. [Anika, 20 years, Denmark]

It’s usually after people have been out drinking, but you’ll get it anytime,

say at three in the morning and you will walk into your room and they are

like banging away [laughs] [Mark, 25 years, Scotland]

Umm, [having sex in dorm rooms] it’s not ideal but we haven’t really got

any choice. Most of the time people are drunk as well; you don’t really

think about it too much … you just kind of get on with it. […] Sometimes

when I’ve been in dorm rooms I’ve been with a bloke and all his friends

are in the same room and you’re kind of very conscious that they’ll go …

you think “Oh, no, are they going to start saying something?” … or when

people walk in. So most of the times, I get on with it. [Bianca, 23 years,

England]

The hostel context, like sex-on-premises venues or gay saunas, was not a space where coital noise was socially constructed as a taboo, but rather was tolerated and expected as part of the hostel living experience. Admissions of embarrassment, repulsion, and

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guilt were noticeably lacking during the interviews. The most popular method used to gain some semblance of privacy in dorm rooms, visual but not auditory, was by draping a sheet from under the top bunk mattress so that it curtained the length of the bottom bunk. A similar arrangement for pseudo privacy was not possible on the top bunk, so bottom bunks were highly prized. Most backpackers familiar with hostel living were tolerant of sexual trysts behind draped sheets.

Despite the anonymity that pervaded the backpacking experience, hostels, like hotels, were compromised spaces (Pritchard & Morgan, 2006). Hostel guests were under the surveillance and scrutiny of other guests and staff. Dorm room occupants, regardless of the hostel, were familiar with the etiquette of dorm room sex. In the communal spirit of understanding and reciprocity, backpackers who lived in shared accommodation tolerated public displays of sexual activity but attempts were made to regulate the level of disruption from these events. Dorm room occupants expected that the sexual participants would keep their coital noise to a respectfully low level. If this transgressive sexual behaviour became too disruptive or went on for more time than was deemed acceptable, the roommates would become annoyed and request that the offenders “get on with it” outside the dorm room. If their pleas were ignored then dorm occupants often recruited hostel staff or night security guards to request the noisy sex partners to leave the room. Most backpackers interviewed were familiar with either delivering or personally experiencing the social consequences of having sex in the communal spaces of hostels. Similar descriptions of coital noise regulation and sexual etiquette among individuals in shared accommodation were drawn by Gurney (2000) during his interviews with 15 people who lived in a variety of housing settings and household types.

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Hostel staff reported that occasionally a backpacker would request a private double room to have sex with a new or existing partner; however, a strict budget prohibited most backpackers from considering this option. A couple of backpackers disclosed that they would use an unoccupied double room for sexual activity if the door was left unlocked. Some backpackers were imaginative in their search for a private space to copulate. In the following excerpt, Russell reflects on the locations he had sex in a hostel.

Basically every level of this hostel! The roof, the basement, behind the TV

screen, you know … the toilets, on the roof, once in the kitchen; just about

everywhere you can think of. […] Some of them are out-of-the-way areas,

you can lock the pantry door, in the toilet, in the basement, nobody goes

down there. In the fire exit it was a bit dangerous; I was a bit scared in the

fire exit. The two of us were … I met this Scottish girl, we were fairly

drunk. We actually started down at the bottom one of the fire exit but

apparently you could see down there from all the different levels [of the

hostel] and people were coming out and saying “What the hell?”, […] Yes,

in all our glory, you know! [Russell, 28 years, Ireland]

The communal nature of hostel living restricted the number of new sex partners a backpacker could meet within the hostel setting. Having sex with another backpacker staying in the same hostel meant that sexual activity with concurrent sexual partnerships had to take place outside the hostel in order to avoid repercussions.

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bear in mind that if you are seeing someone in the hostel you know, you

can’t exactly be bringing girls back [to have sex]. [Joe, 23 years, England]

Outside the hostel, backpackers had sex on the beach, in community parks, in back alleys, or if their partner was a local or a backpacker sharing an apartment, then they enjoyed the privilege of privacy at their partner’s accommodation. Some backpackers extended their stay in the homes of new sex partners by several days or weeks as a way to save money. Julia claimed that she stayed several days in the home of a local man that she met at a bar.

Normally if I just meet someone I wouldn’t but while I’m backpacking I

needed to save money [laughs] … you know how it is, so, it just seemed

silly that I was going to spend the whole weekend with him anyway, and to

check into a hostel when he had a spare room. [Julia, 23 years, England]

Interestingly, following the interview Julia admitted that she never used the spare room, but instead shared the home owner’s bed for the weekend.

Overall, the interviews revealed that through necessity, public displays of sexual activity were commonplace in the context of hostel living. Therefore, sex in dorm rooms was an integral part of the sexual script of backpackers. “Treasured elements of the traditional scripts of romance” (Flowers et al., 2000, p. 78) were abandoned during sexual encounters that were enacted in public spaces. Romantic props, such as music or candlelight, that are often used to set the mood prior to sex in a private setting were absent in descriptions of casual sex encounters.

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Similar to Flowers et al. study, the feasibility and verbal negotiation of sexual acts was limited by the communal nature of the spaces where sex occurred. “Sexual behaviour, or sexual repertoire, is shaped not so much by the individual’s sexual decision-making and choice of sexual acts but by the logistics and situational constraints of particular locations” (Flowers et al., 2000, p. 80). The risk of disturbing roommates together with the confined space, lack of comfort, and not knowing your sexual partner, often curtailed verbal communication of desires and sexual act preferences. However, the lack of verbal expression of desires during sex may have appealed to some of the female backpackers. Dworkin, Beckford, and Ehrhardt (2007) found that some women prefer non-verbal communication during sex, citing that they prefer to encourage or discourage their partners through their body language and with touch.

These findings had significant implications for sexual decision making, as is clear in

Mona’s expressed sexual regrets. The influence of location on her decision to proceed with sexual intercourse was not explored, but it would not be surprising if some individuals felt self-conscious or pressured not to deviate from a sexual script that their partner assumed would end in intercourse. In public spaces, there is an increased likelihood that other people could overhear the verbal exchange that might occur if one partner’s desires did not concur with the other’s.

In summary, the conspicuousness of sexual activity in hostels reinforced the demarcation of communal living areas as culturally produced liminoid spaces where the dominant discourses of private sexual behaviour were contested and resisted. The transgressive behaviour that occurred and was obtrusive in hostels was reflective of the change in norms and moral climate found in the seaside carnival (Shields, 1990).

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However, the situational constraints that accompanied having sex in these liminoid, often public spaces, limited the opportunity for verbal negotiation of sexual limits and sexual repertoire. The situational constraints also impacted sexual pleasure.

Sexual practice and pleasure

A shared understanding was fostered among backpackers that a limited range of sexual acts should be anticipated in the locations available to have sex, particularly in hostels.

However, it was challenging to investigate the range of sexual acts that backpackers frequently engaged in within these confined spatial contexts. Many backpackers were reluctant, or too embarrassed, to offer any more detail beyond a declaration of whether or not they had sex, how many partners and where. During the interviews it became apparent to me that there was often a break in the style of storytelling on the part of the interviewees when discussions turned to sexual practice during the course of the interview. At first, the interviewees appeared comfortable talking about their destinations, their social activities, and other descriptive elements of their trip. It seemed, however, that when we delved into topics that are not usually broached in their everyday conversations with people (such as sexual positions, if they had an orgasm during sex with their new partners, how they communicated their desires for pleasure to their partner), they did not know how to express themselves. It was as if they had no learned script for such discussions that fell outside what normally happens in a conversation, particularly between strangers. During these points in the interviews, the conversation was punctuated with “ummmm”, “errrr”, and “hmmmmm, I am not sure …”. It is unclear whether they did not know what terms to use, or if they were concerned about offending me or simply sounding mechanistic in their description of

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sexual encounters. When the interviews moved back into areas that they were more comfortable with discussing, such as their future travel plans, they would appear more at ease and expressive in their responses.

Alcohol and sexual practice

Alcohol

Ninety per cent of the survey sample reported getting drunk “often” during this trip, and of these participants, 63% reported having sex with someone new while travelling.

Although explicit accounts of sexual behaviour by interviewees were usually not divulged, it became clear with further probing that the lack of explicit detail may have also been due to the majority of sexual unions occurring in an alcohol-induced haze.

Thus, while some interviewees appeared genuinely uncomfortable disclosing details of their sexual experiences, the vast majority were simply incapable of remembering their sexual encounters. A number of backpackers interviewed, all male, admitted that the only reason they knew they had had sexual intercourse with a casual partner was from the reports of roommates present in the room when sex occurred. Bobby found humour in realising that he was so drunk during his sexual encounter that he had no recollection of the event.

Basically, this Australian girl took me home one day and I couldn’t

remember anything and I woke up in the morning and there were a couple

of stains all over the bed and I seen her the next night and she had bruises

all over her legs [laughs] and I couldn’t remember anything from being

with this girl. I have no idea.

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Do you remember much when you have sex with a girl?

No, I can but this night I was really, really, really drunk and she took me

home and my friends told me I had sex with her, not me. [laughs]

How do they know?

She told them, she put me to sleep [laughs]. It is a funny story that

one.[laughs] [Bobby, 23 years, Wales]

Of interest was the lack of similar stories from the women backpackers.

Siobhan had had casual sex twice in the two months since she had been backpacking at the time of the interview. On both occasions, she blamed alcohol for her willingness to have sex with these men.

I just met him when I was too drunk and whatever. It happened out of my

control, well not out of my control but I was drinking and whatever, but I

didn’t plan at all. […] I met him outside, we went on to the roof, had a few

drinks, he was actually in the same [hostel] room as me so he kind of

initiated it all.[…] Well, it was just like silly; he was flirtish, playful and crap,

kind of like saying things like “I need a massage”. So yes, it just happened.

That happened before I even knew it, if you know what I mean. […] he

initiated it. […] Alcohol had a big thing to do with that because I had no

plans at all. It just happened and it was because I was drunk. The next day

I went like “Shit!! I can’t believe that happened”. [Siobhan, 25 years,

Ireland]

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Similarly, this woman made qualitative comments on her questionnaire that suggested that alcohol and the disinhibited party atmosphere influenced her to have casual sex, despite having no previous history of such behaviour.

As a committed Christian I do not believe in casual sex, but have had a

one night stand which was out of character – I blame Koh Phi Phi islands

party attitude and alcohol. [#150, Female]

Sexual practice

The findings indicate that backpackers engaged in foreplay, some participated in either receiving or providing oral genital stimulation, yet in keeping with the traditional script for a heterosexual encounter, almost always their sexual sessions ended with intercourse. As observed in Holland et al.’s (1994) study, for heterosexuals the definition of sex included intercourse, “which starts with penetration and ends when the male achieves his orgasm” (p. 30).

Because of the often public and confined places where backpackers had sex, they were frequently compelled to be quick, furtive, and less exploratory in their sexual encounters than was their normal practice. One backpacker said his sexual repertoire while travelling “was probably less than I normally do”. Another backpacker reported that the sex he had while backpacking was more “straightforward” than his usual repertoire.

Oral sex. From the survey, 48% of men and 47% of women reported giving oral sex to a partner. Almost all the in-depth interviewees reported either giving or receiving oral

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sex or both during their backpacking journey. For all of the sexually active interviewees, oral sex was viewed as foreplay to the “natural” culmination of the sexual script. However, in highly public or spatially challenged situations, oral sex was less likely. A few backpackers disclosed that they never gave or received oral sex in this transient, anonymous environment out of fear that the STI risks may be greater in the backpacker setting where casual sex was quite common.

No, no, no, no. I wouldn’t let him do that [give oral sex to her] because …

like, you have to be careful when you’re travelling obviously and no, I

didn’t want to do any of that. […] No, I didn’t want to risk passing on if I’ve

got anything. I don’t think I do but just in case, I decided I wouldn’t do

anything like that. So it was really just sex [intercourse].

So you don’t perform oral sex on men?

No way! Not here, not here, no way. [Siobhan, 25 years, Ireland]

Siobhan’s increased awareness and anxiety surrounding the risks of unprotected sex

(oral or otherwise) might have been influenced by her own sexual health history. Later in the interview, she reported that a boyfriend prior to her backpacking trip had infected her with genital chlamydia and that she did not discover the infection until she underwent a routine examination several months after their break-up.

Although many backpackers may have wanted to receive cunnilingus or fellatio from their sex partner, the spatial circumstances precluded them from doing so. As Roberts and colleagues note in their qualitative study of the sexual practice and sexual lives of young people in Sydney, Australia, oral sex is viewed by many to be an intimate

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practice and the feelings of intimacy may be intensified by the fact that the practice involves the exposure of the genitals (Roberts, Kippax, Spongberg, & Crawford, 1996).

Thus, not only did some backpackers feel uncomfortable voicing their desire for oral sex when others in the room could overhear, but it would also not be surprising if some simply avoided the practice out of fear of others being able to view not only this intimate act but their genitals as well.

Sexual experimentation. While some interviewees were surprised by how unimaginative their sexual encounters were, others viewed their backpacking trip as an opportunity to expand their sexual repertoire and sought outlets for sexual experimentation. In addition to public sex, the remaining examples of sexual experimentation included: anal sex, “arse licking”, sex with the same gender, and group sex. A few individuals expressed that they were open to a variety of new sex experiences, one woman reported experience with all of the examples listed above.

Her statements suggest that the anonymity, non-judgmental atmosphere, and amount of alcohol she regularly consumed definitely influenced her willingness to engage in new sexual activities.

One girl, I had a threesome with a guy and a girl whom I happened to

meet. […] Yeah, well, I’ve never like been with a girl before and it was

pretty easy, you know you get curious about these sorts of things, no one

cares and everyone is just staying out here because you know it’s only

casual and everyone’s looking for a good time and it’s not like you’re going

to get any weird reputation, whatever, and it’s also with people you know

you won’t see again; that makes it a lot easier. […] Yeah, it was a lot of fun.

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It was … I mean, I was just thinking “I don’t believe I’m doing this” but it

was really fun. It wasn’t like the first full-on sexual experience I’ve ever had

but it was really fun. I’d do it again if the situation came up, just for the

laugh. Yes [I had] oral sex with the girl and sex with the guy, both of us.

[Mona, 24 years, England]

Similar to Mona’s experience, survey results revealed that a small group of heterosexual men and women engaged in sexual experiences with their own gender while backpacking. A few women (1.7%, n=4) and men (1%, n=3) engaged in oral sex and hand-genital stimulation (women 2%, n = 5; men 1%, n = 3) with a person of the same gender. One man, who identified as heterosexual, reported receptive anal penetration with a man during his trip. Later in the interview, Mona talked about her other new experience, “arse licking”.

The Canadian guy, he basically was like licking my arse, that was new …

and that’s not for anyone, I don’t think, unless it was like a boyfriend of

mine. […] Yes. I wouldn’t do that with a complete stranger, no way. It was

a new situation, but there was not a lot that I wouldn’t do.

[Mona, 24 years, England]

Since many backpackers could not recall the details of their sexual encounters, it was not surprising that they were also vague in the recollection of how pleasurable their sexual encounters were. Some backpackers, most frequently men, gave a standard response that “all sex is good”; yet further probing revealed that they often could not remember what happened or even their partner’s name. Others concurred, stating that

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they were quite intoxicated during many of their sexual encounters and consequently they “weren’t that great”. After the initial “hook up”, some backpackers would meet up with these partners again under more sober circumstances, and reported that the sex was better on these occasions.

The situational constraints discussed earlier also negatively influenced some women’s ability to have an orgasm during sex. The pressure not to disturb sleeping roommates, awkward positions necessary in confined spaces, the physiological effects of alcohol

(Rosen & Keefe, 1978), and unfamiliarity with their casual partners likely contributed to their inability to orgasm in this context. During both of her casual sex encounters,

Siobhan did not experience an orgasm even though she reported regularly having orgasms prior to backpacking.

Yes, it depends on the circumstances. Like I didn’t with either guy but I

still had a pretty good time. I tend to take a little while and it wasn’t the

right situation.

Right. Is that just because of the location?

Yeah. […] Yes, and probably because I didn’t feel too much for either of

them. [Siobhan, 25 years, Ireland]

Thus, while the women in this study demonstrated an “active” role in meeting new sex partners and initiating sexual courtship rituals, the situational constraints hampered their ability to adhere to these liberal sexual scripts during sex. Because they were unable to influence their heterosexual encounters, these anorgasmic women were obliged to experience “normal sex”, which “entails active men satisfying passive

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women in the satisfaction of their own ‘natural’ desires. Women’s sexuality is defined as finding fulfilment in meeting men’s needs” (Holland et al., 1994, p. 29). In effect, the women interviewees’ newfound sexual liberation only served to increase men’s opportunity to receive sexual pleasure yet their own sexual pleasures were often diminished in contrast to their home environment. These findings correspond with the

Sex in Australia study’s finding of a low rate of female orgasm with casual partners

(Richters, de Visser, Rissel, & Smith, 2006).

Despite the general lacklustre description of sexual pleasure while backpacking, most backpackers viewed their sexual experiences as “fun”. This suggests that backpackers were not motivated to meet new sex partners solely by the prospect of sexual pleasure.

The unpredictable nature of casual sex punctuated the backpackers’ lives with excitement. As in Stanley’s (2005) study of the sexual behaviour of English youth in seaside locales, my findings suggest that the titillation backpackers experienced during their intense but transient connections, combined with the situational constraints, afforded “more opportunities for illicit thrills than for pleasurable sex” (p. 345). The anonymity and lack of social stigmatisation of promiscuity fuelled the pursuit of transgressive thrills and novel experiences.

Sex in Thailand. Thailand is popular as an extended stopover for backpackers en route to Australia. Interviews with both backpackers and health care providers revealed high-risk sexual behaviour in countries of high HIV prevalence, particularly

Thailand. Unprotected sex with Thai locals has obvious implications for the sexual health of backpackers and their subsequent sex partners.

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Interviewees Joe, Geoff, and Nathan viewed their time in Thailand as an opportunity to have novel sexual experiences with women who were “more up for it than English girls”. The interviews with these men offer a glimpse into the motivations, activities, and ambiguous context in which their sexual encounters in Thailand were initiated, negotiated, and conducted. The backpackers’ experiences, all with bar girls, were typically set within a context of partying as a group while consuming excessive amounts of alcohol.

Me and Nathan shared a girl and the four of us shared a girl as well, which

is a bit crazy because I have never done anything like that before in my life.

I don’t know, I was away on holidays pretty drunk, so.

[Joe, 23 years, England]

Adopting a consumer’s approach, they “shopped around” for a bar girl that appealed to them and whom they would readily discard if someone more attractive came along.

While Joe, Geoff and Nathan all reported sexual encounters with numerous bar girls during their 18-day stay in Bangkok and Phuket (between seven and 15 bar girls), each of these men engaged in one extended “relationship” lasting between five and 10 days.

In developing countries, the customer–prostitute relationship is often protracted

(Cohen, 1982; Kleiber & Wilke, 1995; Hanson, 1998).

Confused by the ambiguous nature of their protracted “relationships” with local Thai women, these backpackers were lulled into a naïve sense of false security. As noted by

Kleiber and Wilke’s (1995) study of German sex tourists, backpackers in this study who had sex with local women did not perceive all of the women to be sex workers,

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even though they often paid for their sexual services. Joe was convinced that his temporary “girlfriend” had never worked in sex work, because he did not pay specifically for her sexual services, only for her subsistence while they were together.

Their definition of a sex worker was based on notions they brought from their home environment, but in developing countries such as Thailand the boundaries between emotional and mercenary relations between men and women are blurred (Cohen,

1982). According to health care providers in Sydney, this is a common misconception for many young male backpackers who attend their clinics, particularly those from the

UK. The backpackers often denied that the bar girls they had sex with were sex workers, but rather suggested they were local Thai women with whom they just developed a sexual relationship. As this nurse stated:

They are a bit naïve about the whole bar girl thing as well. You know

sometimes they come in and say, “yeah, I had unprotected sex with this

person,” and we always say, “so who was this person, was it a sex worker?”,

and they go “well, I am not sure”, and you say “well did you pay them for

sex?”, and they go, “well kind of”, and they say “well, I took her out for

dinner and I bought her digs [accommodation]”. And you are thinking

“well, they have their own place!”, you can just see by the look on their

face that the penny is dropping and they just have no idea, they just think

that this person wanted to hang around with them for a week, and have sex

with them because they were nice … a bit naïve about that kind of stuff.

[Nurse]

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A counsellor also made the following observation:

A story I frequently hear is that in Asia it’s not clear who are workers and

who aren’t because you don’t necessarily go to a brothel, you just sit in a

bar and someone starts talking to you and buying you drinks and you go

back and have sex with them and then they want money. So a lot of

people, especially younger guys, fall into this trap of thinking that this is a

nice girl, and then they find out that actually she’s a worker and “Oh, my

God!”. And sometimes it’s not even the story that they’ve had unsafe sex

but the fact that they’ve been with a bar girl and then people sometimes go

into quite high anxiety problems. So yeah, probably that’s the group that I

end up seeing, they […] I’ve seen a fair few like that, people from the UK

or Sweden … [Counsellor]

While three of the four men became consistent condom users with sex workers in

Thailand, most were uninformed of the risks associated with paying for sex in countries where HIV prevalence is high. Such men could act as vectors for transmission of STIs in Australia, “bridging” the gap between higher and lower risk populations (Ragsdale et al., 2006).

While these four interviewees are by no means representative of all men who backpack to Thailand, the consistency of their responses, combined with the opinions offered by professional staff at sexual health centres, suggests that the backpackers’ experiences are not idiosyncratic. These findings suggest that male backpackers should be the target of health promotion campaigns and screening initiatives before they travel

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(Chapter 11). Although pre-travel information disseminated through the campaigns may not reach all backpackers, the advice learned could potentially be shared with their peers, and encourage them to practise safe sex.

Change in behaviour?

Many of the backpackers surveyed and interviewed reported other noteworthy changes in their sexual behaviour. Most often they engaged in more frequent casual encounters or different sexual behaviours than they had experienced prior to backpacking. The total sum of new sex partners often exceeded their reported sum of sex partners acquired over their lifetime prior to travelling. The ability for backpackers to meet new sex partners may have been because casual sex was anticipated. Eighty-four per cent of backpackers with intentions to have sex did have casual sex during their trip. The

“holiday atmosphere” clearly had an influence on even those who had no expectations to have sex during their trip, since a quarter of those with no expectations did have casual sex.

Some research suggests that travellers’ casual sex behaviour while abroad largely reflects their casual sex experience at home (Bloor et al., 1998; Egan, 2001b). My current research concurs with this. Overall, 39% of the survey respondents had casual sex while travelling and over half of these individuals reported experience with it in their home environment. Yet, a quarter of those with no history of casual sex did have it for the first time while backpacking. According to the following statement by Martin, backpackers often experienced a relaxation of their sexual norms that created an atmosphere of sexual availability never experienced before.

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Well, more opportunities but there’s more emphasis, there’s more … it’s

just easier (laughs). It’s easier because, especially living in Coogee

[beachside suburb], it’s like … the majority of the population of Coogee

are backpackers so you go down the pub and most of the people in the

pub are going to be backpackers so, when everyone has had a few, nobody

really gives a damn, you know? “Wouldn’t mind some sex”… lots of

people are thinking, I know they are, and then you’d go and have sex with

them and then it’s like … the funny thing, you’re saying opportunities. I

think there’s opportunity everywhere if you look for it whereas in

somewhere like when you’re backpacking, in somewhere that’s quite a

backpacker area, you don’t need opportunity because most people are

pretty laid back about the fact that … they’re not so picky (that’s what I’m

trying to say). [Martin, 19 years, Scotland]

In contrast, some backpackers reported less sexual activity than in their home environment. Prior to travel, several backpackers had been in a monogamous sexual relationship and had frequent sex with their partner, so in comparison their sexual activity was not as frequent, but the number of casual sex partners while travelling was more than they had at home.

A few of the men interviewed perceived that their behaviour had not changed at all, and if anything, they were less sexually active that they usually were at home.

According to Joe, his occupation caused him to live a transient lifestyle in England similar to what has come to be associated with a holiday context. This, coupled with the normative indiscriminate intermixing of sexual partners within his social group of

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friends, generated a perception of sexual availability, and he felt this contributed to his avid sexual pursuits at home.

[In my home country] I was working away a lot and was sleeping around

quite a bit, cause you know, I wasn’t at home and was working away and

we were out drinking every night. Yeah, I used to be a contractor and

worked all over the UK, and in different cities so, there would be a group

of what, fifteen, twenty of us who would be working out of town, and you’d

be drinking every night so that sort of stuff goes on. Pretty much like, when

I was working it was pretty much like being on holiday sort of thing, like

going out here. No, back home I hang out with a big group of lads and

girls and a lot … everybody seems to have slept with every one like.[...] all

the single people seem to have slept with each other. That is just the way it

is. [We] have slept with the same girls back home.

And do you guys talk about that and compare notes about how –

[talks over] Yeah we do sometimes, unless obviously one guy likes a girl

he might not want to hear you talking about it like. Uhhh, yeah we do,

we’ll say like did you do that, and did you do this, and yeah yeah yeah. […]

We have always been outrageous back home and some people come out

of the shell more [while backpacking], but we have always been like that

back home. It is no different for us, especially going to Thailand and then

coming here, if anything it is a lot quieter than all that, you know.

[Joe, 23 years, England]

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Interestingly, interviews with several of the clinic staff mentioned their familiarity with stories of indiscriminate sexual behaviour, particularly among the clinic attendees who were blue-collar males from Britain, like Joe. Whether this reflects a change in behaviour at home or in Britain I cannot ascertain and it is beyond the scope of this study to explore class differences in Britain. Further, the generalisability of these findings to other backpackers with blue-collar occupations in their home country is beyond the scope of this study and thus cannot be verified. This topic is worthy of further exploration in future studies of young travellers.

Why the change in behaviour?

Considered together, the backpacker interviews highlighted numerous factors that influenced them to engage in more frequent, and different, sexual encounters than they would in their home environment. The liminoid “holiday atmosphere” pervasive to the Australian backpacking context, inspired many young people to temporarily indulge in activities that deviated from their normative mores, social rituals, and conventional sexual behaviour. Temporary transformations to liberated sexual norms have also been documented in other locations, including during carnival week in Brazil

(Parker, 1991).

Many backpackers travelled alone or frequently changed travel companions during their journey, the result being omnipresent anonymity. The independent and often solitary nature of backpacking travel ensured that there would be no “unwanted means of transmitting accounts of this holiday environment to the home environment where it might be negatively sanctioned” (Thomas, 2005, p. 576). Excessive alcohol

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consumption and the apparent sexual availability that permeated the backpackers’ daily lives persuaded many to adopt more permissive sexual norms. Consequently, many backpackers were “less picky” in their choice of casual sex partners, and women in particular sought little emotional attachment with new partners.

My interviews with clinic staff, particularly the sexual health counsellors, introduced further insight into the factors that influenced the backpackers’ changes in sexual behaviour. Distanced from any ties that bound them to their life and usual behaviour at home, backpackers experienced a newfound sense of freedom. Young backpackers travelling on their own often sought out new role models, many of whom lived by a new set of rules that were inverse to their home environment. Living by a new set of rules can often disorientate a person’s perception of risk in an unfamiliar context that is ripe with new sexual opportunities. One nurse recalled her personal experience of staying in a hostel during her travels abroad and her perceptions of backpackers’ sexual behaviour.

I would say that they are more risk-taking, just because I think that whole

excitement of backpacking … you know that whole thing of role models,

good role models, if you sit in a backpackers’ [hostel] and listen you can

hear the boys talk about their conquests and you can hear the girls

swooning over some guy and it is like everything revolves around that. […]

You know, their whole purpose for being there was to shag someone […]

it’s exciting and the young, for some of them it is the first time to have the

open opportunity to have sex like that and they are out for it. [Nurse:

#8/N1]

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Sexual health care providers consistently spoke about the absence of role models who could influence backpackers’ decision-making regarding casual sex. People usually have “checks” in place, such as friends and parents, who would generally discourage them from engaging in behaviour that would be negatively sanctioned. As Hennink,

Cooper and Diamond note in their research on seasonal workers, while away from home the distance and anonymity eliminated any fears they had of being reprimanded or suffering the social consequences of judgmental friends or family (2000).

Solitary travel can be a lonely experience. The sense of isolation and loneliness that some backpackers occasionally experienced during their trip may have also contributed to the development of rapid and intense sexual connections. Years of counselling backpackers at a busy sexual health clinic in Sydney provided this counsellor with a unique insight into the backpackers’ psyche. She suggested the loneliness that backpackers sometimes experience, coupled with the anonymity of the environment, can have a significant impact on the rate at which sexual situations develop.

You’re a bit alone, you know … yeah. You’re alone and you’re looking for

a connection and a sense of belonging. […] And it’s an intense time of life.

You’re living life at a fairly intense level and you’re being exposed to lots of

new things and all that sort of stuff and there are lots of things to intensely

talk about and connect with people. And people doing it are right at that

age where they’re unattached, they’re young and gorgeous and so, it’s a bit

hard for them to keep their hands off each other. So yeah … there’s all of

that and the usual constraints, you know, your girlfriend saying “don’t go

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out with him he is a real jerk!”. And knowing people, you know? And

people knowing what you’re doing and parents and all that. […] So you’re

more likely to do things a bit more on the spot because you’re not worried

that everyone’s going to talk about you tomorrow. [Counsellor: #7/C2]

Sexual health care providers report that this is particularly true for those who were in a long-term relationship prior to leaving their home country. Backpackers who miss their partner and the sexual intimacy they shared with that person may question their decision to embark on a backpacking trip. The opportunity to emotionally connect and be intimate with a fellow traveller could be enticing. Racking up as many casual sex conquests as possible may not have been their intention, but casual sex may have served to satisfy a person’s craving for intense intimacy.

You know, missing your partner at home, being in a relationship that, I

guess, had sex regularly and sort of being lonely. This can be a big factor,

people feeling loneliness and wanting to connect, to make some intimate

connections and, with sex, intimate connections can be made very quickly.

[Counsellor: #6/C1]

Conclusion

It appears that the liminoid period of backpacking encouraged sexual disinhibition.

Whether this change in behaviour is temporary would be a topic of further research with backpackers after returning to their home environment. The recreational sexual philosophy that dominated in the backpacking culture was evidenced by: 1) their

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proclivity to engage in sexual intercourse within a short period of knowing someone, 2) their favourable attitude toward casual sex, 3) the absence of concern regarding their sexual reputation, and 4) their competitive nature toward acquisition of new sex partners.

Script theory offers one view into the new sexual encounters and into the social and cultural context that structure heterosexual interactions while backpacking. Scripting theory can highlight the social process in context-specific sexual behaviour. The consistency of findings across surveys, interviews with backpackers, hostels and clinic staff and field observations suggests that what has been generated in the analyses of this study are valid accounts of the backpacker sexual script. The sexual script that most backpackers appeared to follow was simply an adaptation of the sexual script that they are familiar with at home. The vast majority of occasions of first sexual intercourse with each new partner followed the dominant sexual script. Following a sequence of

(scripted) events (i.e., where to go to meet sex partners, courtship rituals, how to assess receptiveness to intercourse), sexual intercourse was an assumed culmination to the sexual script for most backpackers.

Broader cultural norms encourage passivity in women during sexual decision-making.

Yet women backpackers’ unabashed participation in all of these activities clearly refutes recent research suggesting that it is still more acceptable for men than women to engage in these behaviours. Women did not appear to be hindered by traditional sexual scripts of sexual passivity, but rather their behaviour was reflective of the egalitarian scripts that were more normative in the backpacking context. Women appeared to have a greater licence to be sexually active and to engage in more frequent

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and different sexual behaviour than they would contemplate at home. The disinhibited sexual atmosphere inspired some women to assert verbal initiation of sexual encounters, yet situational constraints often precluded the assertion of their sexual desires in order to attain similar pleasurable ends as their male partners. Women continued to be left with the burden of limit setting at the dyadic level.

“I’ve done things here that I wouldn’t do normally”

Condom use abroad

The most serious limitation of condoms is their inability to spontaneously

migrate from pocket to penis (Ward & Plourde, 2006, p. 307).

When used consistently and correctly, condoms are effective as a contraceptive method and in preventing a variety of STIs (Trussell, Warner, & Hatcher, 1992).

Many researchers agree that the vast majority of young people have adequate knowledge about how to prevent STIs, but there is ample evidence to suggest that knowledge does not necessarily translate into condom use (Azjen & Fishbein, 1980;

East, Jackson, O’Brien, & Peters, 2007). Moreover, knowledge does not appear to influence young people’s perception of the risk of catching an STI (Andersson-

Ellstrom & Milsom, 2002). The literature also shows that despite adequate knowledge on how to prevent pregnancy and STIs, some individuals continue to not use condoms. Ingham et al. (1991) note, “one way in which this area can be considered is in the light of the distinction between competence and performance. It could be the case, for example, that young people know what they ought to do but are unable in the circumstance due to external or internal pressures to put this ideal knowledge into place” (p. 129). Counter to their good intentions for sexual safety, many of the backpackers in this study engaged in high-risk sexual behaviour. For the purposes of this study I have adopted Cooper’s (2002) definition of high-risk sexual behaviour:

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… any behaviour that increases the probability of negative consequences

associated with sexual contact, including AIDS or other sexually

transmitted diseases (STDs) and unplanned pregnancy. These behaviours

are considered in two broad categories: (1) indiscriminate behaviours,

including having multiple partners; having risky, casual or unknown

partners; and failure to discuss risk topics prior to intercourse and (2)

failure to take protective actions, such as use of condoms and birth

control. (p. 101–102).

The risk of STI transmission and unplanned pregnancy can be minimised through safe sexual practices that do not include penile–vaginal or anal intercourse. However, the men and women interviewed in this study all appeared to share the assumption that a sexual encounter would include male penetration of the vagina. Therefore this study defined risky, unprotected or unsafe sex as not using a condom on one or more occasions of sexual intercourse (less than always), and “safe sex” as intercourse with condoms.

Chapters 8-10 elucidate data gathered in the self-administered questionnaires and in the semi-structured interviews with backpackers and health providers concerning condom use. The aim is to gain a deeper understanding of the barriers and facilitators of consistent condom use among young adult backpacking populations. Four areas of discovery are central to these chapters: (1) results related to whether or not, and how, condoms are used with new sexual partners in the travel context; (2) results related to how the backpackers’ condom use behaviours compared with condom use in their home environment; (3) results related to the different strategies implemented by

198 CHAPTER 8: CONDOM USE ABROAD

backpackers to encourage or discourage condom use in their sexual encounters; and

(4) results related to how traditional gender constructions of femininity and masculinity and their unequal relational power differentials affect safe sex practices.

This chapter focuses on the demographic characteristics, sexual history, safe sex intentions, and situational and sex partner characteristics of those who practised unsafe sex during their trip, in order to shed light on the characteristics of sexual situations or personal sex history shared by the less-than-consistent condom users.

Intentions

The vast majority of backpackers surveyed (86%; 429/499) expected to use a condom if they had sexual intercourse with a new partner during their trip. Sixty survey respondents did not answer the question about what they expected to do, despite having sex during their trip. But did those who intended to use condoms actually use them? Just over half of those who expected to practise safe sex while abroad did consistently use a condom with their most recent sex partner during their trip (57%;

147/256). Clearly the link between intentions and actual condom use is tenuous

(Boldero, Moore, & Rosenthal, 1992; Fisher, Fisher, & Rye, 1995; Gallois et al.,

1992). “One reason for this is that characteristics of a sexual encounter can influence whether or not an intention to use a condom is enacted during a specific sexual encounter.” (de Visser & Smith, 1999, p. 266). Other research with homosexual and bisexual men has also found that characteristics of the situation are central to safe sex decisions (Smith, Grierson, Pitts, & Pattison, 2006). An in-depth exploration of some of these characteristics will be presented in Chapters 9 and 10.

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Survey respondents who reported a new sexual partner were asked about their consistency of condom use. Approximately half of those who had sex with someone new during their trip always used condoms. Thus, despite good intentions, the remainder had unprotected sex while travelling (46%; 143/310). One quarter of the survey sample who reported penetrative sex never used condoms and an additional

25% reported that either they “rarely”, “sometimes”, or “frequently” used condoms with their last new partner during the trip (Table 8.1). There was almost no statistical difference in condom use or non-use between genders. Men and women were equally likely to report consistent condom use with their most recent partner (53% of men, n =

101; 56% of women, n = 66) as they were to report never using a condom with this person (26% of men, n = 49; 24% of women, n = 28). Similarly, there was little difference between men and women with regard to condom non-use during their last occasion of intercourse on the trip: 36% of men (69/190) and 40% of women (47/119) reported that they did not use a condom on the last occasion of intercourse.

Table 8.1: Consistency of condom use with last partner during trip, stratified by sex (n = 310)

Men Women Total Condom use with last partner n (%) n (%) n (%) Always 101 (52.9) 66 (55.5) 167 (53.9) Frequently 24 (12.6) 12 (10.1) 36 (11.6) Sometimes 12 (6.3) 7 (5.9) 19 (6.1) Rarely 5 (2.6) 6 (5.0) 11 (3.5) Never 49 (25.7) 28 (23.5) 77 (24.8)

Consistent condom use was equally represented by men and women survey respondents (men: 53%, n = 101/191; women: 56%, n = 66/119). The interviewees appeared to be no more consistent than the survey participants in their condom use while travelling.

200 CHAPTER 8: CONDOM USE ABROAD

Age

Does age influence condom use behaviour? Twenty-nine backpackers stated that they were virgins when they started their trip. It is not surprising that half of them (19/39) were under 20 years old and among the youngest in the survey sample. A relationship was evident between age and condom use on the trip. Backpackers under 20 years of age were the most likely to report unsafe sex during their travels (55%, 31/56).

Backpackers 25 to 29 years old were the most consistent condom users (63%, 43/68)

(Table 8.2).

Table 8.2: Backpackers’ condom use with new sex partners during trip, stratified by age (n = 308)

<20 20–24 25–29 30–35 36–37 Total Condom Use n (%) n (%) n (%) n (%) n (%) n (%) on Trip Safe Sex 25(44.6) 88 (53.3) 43 (63.2) 8 (47.1) 2(1.2) 166 (53.9) Unsafe Sex 31 (55.4) 77 (46.7) 25 (36.8) 9 (52.9) 0 142 (46.1)

Casual sex

Are backpackers more or less likely to have safe sex if they have recently met their partner? Unfortunately, backpackers’ sexual health protective behaviour was not necessarily more careful even when they knew their partner for a very short time.

Seventy-one per cent of those backpackers who practised unsafe sex reported that they took these risks with partners they had “just met” or “met recently” (101/143) (Table

8.3); almost half of them reported that they never used a condom with that partner

(43%; 60/143).

Partner type

Does partner type (traveller vs local) influence condom use? Survey participants were asked to describe their last sex partner according to the following categories: traveller from your own country, traveller from a different country, local resident of the country

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you visited, or other. Partner type appeared to influence men more than women in their propensity to use a condom consistently (Table 8.3). Approximately one third of women had unprotected sex with their last partner, regardless of whether this person was the same nationality, from a different country, or a local. However, men were less likely to use condoms if their partner was also a traveller, from their own country or of a different nationality from themselves, than if this partner was a local of the country they were visiting. Due to limitations of the survey instrument used, I was unable to determine backpackers’ sexual risk-taking in relation to the countries visited and whether they also engaged in unsafe sex in areas of high HIV prevalence.

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Table 8.3: Descriptors of last partner and incidence of inconsistent condom use with last sex partner on trip, stratified by sex

Unsafe sex (n=143) Mena d Womena d Total

n (%) n (%) n (%) Last partner characteristics: partner type (n=142) Traveller from your own country 24 (27.0) 19 (35.8) 43 (30.3) Traveller from a different country*** 46 (51.7) 15 (28.3) 61 (43.0) Local resident of country visited*** 16 (18.0) 16 (30.2) 32 (22.5) Other (please specify)b 2 (2.2) 3 (5.7) 5 (3.5)

Sex just met /met recently (n = 142) c 65 (73.0) 36 (67.9) 101 (71.1) Number of sexual episodes with last partner on trip (n = 143) 1 28 (31.1) 14 (26.4) 42 (29.4) 2 21 (23.3) 8 (15.1) 29 (20.3) 3–5 18 (20.0) 12 (22.6) 30 (21.0) 6–10 9 (10.0) 4 (7.5) 13 (9.1) 11–20*** 5 (5.6) 6 (11.3) 11 (7.7) 21–50+*** 9 (10.0) 9 (17.0) 18 (12.6) a Of the 310 backpackers who reported a new sex partner during their trip, 90 (47.2%) men and 53 (44.5%) women inconsistently (less than always) used condoms with their last sex partner during their trip. Analysis was limited to include only inconsistent condom users’ responses to this question. *** represents statistical differences between men and women at the p < 0.001 level. b “Other” responses recorded by survey participants: 1) “mate of mine from home” (n = 1); 2) “British Navy crew member” (n = 1); 3) “Thai hooker” (n = 1). c “Sex just met” defined on questionnaire as sexual intercourse with someone met that day or evening; “Sex met recently” defined on questionnaire as sexual intercourse with someone met within the previous three days. d Proportions were compared using the Chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Sexual experience

Does sex experience prior to the trip influence condom use during the trip? Sexual experience prior to travel and condom use during travel shared a relationship (p <

0.05) (Table 8.4). Those who lost their virginity during their trip (n = 10/39) were the least likely to report always using condoms (30%, 3/10), and were the most likely to report never using a condom (50%, 5/10) with a new partner, but the sample size was too small to establish statistical significance. In contrast, 60% (32/165) of the backpackers who reported more than 20 sexual partners before their trip consistently

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used condoms with their last partner. Backpackers with more sexual experience were more likely to use condoms. This finding suggests that they had more experience with safe sex negotiation and therefore had self-assurance in asserting safe sex. Despite the travel context being different from their home environment, their previous experience with safe sex negotiation and condom use potentially provided the framework for implementing safe sex practices while abroad. In contrast, inexperienced backpackers may not have had the sexual experience necessary to develop sexual health protective behaviours, such as negotiating condom use. Given that the dynamics with each sexual partner were new and unpredictable, the potential for risk-taking increased since they would have had to renegotiate with each new partner. More in-depth discussions surrounding the complexities of safe sex negotiation are presented in Chapter 9.

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Table 8.4: Descriptors of sexual risk taken at home by those who were inconsistent condom users while backpacking, stratified by sex

Unsafe sex (n = 143) Mena c Womena c Total n (%) n (%) n (%) Number of sex partners before trip (n = 142)* 0–5 31 (34.4) 25 (48.1) 56 (39.4) 6–20 39 (43.3) 24 (46.2) 63 (44.4) >20 20 (22.2) 3 (5.8) 23 (16.2) Consistency of condom use at home (n = 136) Safe sex at home 10 (11.5) 4 (8.2) 14 (10.3) Unsafe sex at home 77 (88.5) 45 (91.8) 122 (89.7) Safe sex on last occasion at home 28 (31.5) 16 (32.0) 44 (31.7) (n = 139) Safe sex during sex just met/met 38 (43.2) 14 (28.0) 52 (37.7) recently at home (n = 138) b a 90 (47.2%) men and 53 (44.5%) women had unsafe sex with their last sex partner during their trip. Analysis was limited to include only inconsistent condom users’ responses to this question. */*** represent statistical differences between men and women at the p < 0.05 and 0.001 level. b “Sex just met” defined on questionnaire as sexual intercourse with someone met that day or evening; “Sex met recently” defined on questionnaire as sexual intercourse with someone met within the previous 3 days. c Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Condom use: home & abroad

Does the backpacking environment influence condom use behaviour? Condom use at last intercourse with someone that they “just met” or “met recently” at home was the best measure of backpackers’ propensity to use a condom the last time they had sex with someone that they “just met” while abroad. Male and female survey respondents were less likely to use a condom the last time they had sex with a partner they had just met or met recently while travelling than they were at home, but these differences were not significant according to gender or context (Figure 8.1). Consistent with Bloor et al.’s (2000) telephone survey of a representative sample of international travellers in

Britain, and my previous research with backpackers visiting Canada (Egan, 2001b), backpackers’ condom use behaviour while travelling reflected broader patterns of risk

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exposure in their home environment. In short, condom use with partners they had

“just met” or “met recently” while travelling was very strongly associated with condom

use with partners they had “just met” prior to their trip (2 (2) = 38.70, p < 0.001).

Seventy-nine per cent (111/140) of those who used a condom on the last occasion of

sex with someone they just met prior to the trip also used a condom on the last

occasion of intercourse with someone that they had just met, or met recently, while

travelling. These findings did not differ significantly across gender.

Figure 8.1: Condom use with last partner “just met” or “met recently”, stratified by sex

Conversely, the overall proportion of backpackers who consistently used condoms

while abroad was significantly higher than the reported rates of consistent condom use

prior to travelling (2 (1) = 29.04, p < 0.001) (Figure 8.2). However, consistency of

condom use prior to travelling was indicative of consistency of condom use abroad.

Eighty-one per cent (61/75) of those who reported always using condoms at home

continued to use condoms consistently while abroad, while 55% (122/224) of those

206 CHAPTER 8: CONDOM USE ABROAD

who reported unprotected sex at home continued taking sexual risks while travelling.

Forty-five per cent (17/38) of those who never used condoms at home continued not to do so while travelling.

Figure 8.2: Consistent condom use prior to and during backpacking trip, stratified by sex

The significant rise in overall consistency of condom use among backpackers may be attributable to their relationship status prior to travelling. Of those who never used condoms in the 12 months prior to travelling, 64% (57/89) described their relationship status just prior to travelling as a committed relationship. Therefore, some survey respondents may have been using another form of contraception (i.e. hormonal contraceptives) with their sexual partner at home due to the complexities inherent in insisting on condom use in committed relationships (Chapter 10). That finding aside,

62% (43/69) of those who were in a committed relationship prior to their trip continued not to use condoms consistently on the trip, despite having new sex partner(s). These findings suggest that young backpackers who were in a committed long-term relationship prior to travelling and who did not habitually use condoms with that partner may have continued to have unprotected sex while backpacking. These

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are interesting findings and of great concern. Perhaps being out of practice with condom use may affect backpackers’ feelings of self-efficacy and confidence in initiating discussions and ensuring that condoms are used with new and unfamiliar partners. Numerous studies have supported the hypothesis that self-efficacy surrounding condom use positively influences condom use (e.g. Baele, Dusseldorp, &

Maes, 2001; Wulfert & Wan, 1993).

Reassuringly, of those backpackers who had a history of unprotected sex prior to travelling, 31% (51/163) reported always using condoms while abroad. This suggests that the new context of travel does spur some individuals to adopt more frequent use of protective measures in their sexual health behaviours. The following quote reflects that Joe perceived himself to be at risk while travelling, but many others did not.

I don’t like wearing condoms normally though, but I thought I had better

start doing it sort of thing. I mean, back home in the UK I never bother, I

should do, but … a lot of them are quite keen on safe sex, a lot of them

have sex with me and I will wear a condom, […] Whereas back at home in

the UK you might not get it as much.

So you don’t normally wear condoms at home?

But you have while you have been travelling?

Yeah […] ‘cause well, ‘cause I went to Thailand and it sort of opened my

eyes a little bit, you know what you can get if you are not careful, so.

[Joe, 23 years, England]

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Less encouraging were the findings that 19% (14/75) of backpackers who prior to their trip were consistent condom users became less consistent while travelling.

Approximately a quarter of both men (24%; 26/108) and women (26%; 14/55) who did use a condom the last time they had sex with someone they just met prior to backpacking, did not use a condom with their most recent sex partner during their trip.

Interviews with sexual health providers at Sydney clinics revealed that some of the backpackers they saw reported taking more sexual health risks while travelling than they normally would at home.

Yeah, anecdotally they used to say to me that, you know “I’ve done things

here that I wouldn’t do normally”; they would have a lot of guilt generally

about having lots of unprotected sex, especially when they’re males. They

would have been more careful at home. They’d sort of say that they’d

taken more risks generally. [Nurse: #9/N2]

Other backpackers assessed at Sydney clinics were inexperienced with using condoms and did not perceive themselves to be more at risk while travelling, even in HIV- prevalent countries.

Certainly there are sorts of experiences that I have … that people describe

to me … that English backpackers (particularly the boys) do lots of

drinking and then risk behaviour. I think that the lots of drinking isn’t that

different to what they did at home, but the risks are different because their

sexual behaviour and where they are has changed. […] I think that they

haven’t used condoms so much at home and haven’t recognised the risk,

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and haven’t translated any changes or adapted to a change in environment.

Hopefully, after they see us, they [do]. [Nurse: #10/N3]

Skidmore & Hayter’s (2000) research found that the 16 to 25-year-olds in his study perceived not using condoms to be more acceptable if one was on holiday, particularly if abroad (p. 28). Validating these findings is beyond the purview of this study, but

Skidmore and Hayter’s research offers valuable insight into the travel perspectives of some young individuals and should be explored in future research involving young backpackers.

Oral sex

Oral sex is another sexual health risk behaviour that can facilitate transmission of viral and non-viral STIs (Edwards & Carne, 1998; Cherpes et al., 2005). However, there is a paucity of literature devoted to this topic, particularly relating to oral sex risks among heterosexuals. The propensity for backpackers to use barrier methods during oral sex was not explored in the survey questionnaire, but giving and receiving oral sex was common (Chapter 7). National studies conducted in Australia (de Visser, Smith,

Rissel, Richters, & Grulich, 2003) and the UK (Wellings et al., 2001) have also shown that oral sex is common in heterosexual partnerships, especially among younger people. However, none of the backpackers interviewed used a condom during fellatio or a dental dam during cunnilingus. Evidence of young people’s aversion to using barrier protection during oral sex is presented in Stone et al.’s study of 1368 students aged 16–18 years in the UK (Stone, Hatherall, Ingham, & McEachran, 2006). Despite the majority of the participants having knowledge of the STI risks associated with

210 CHAPTER 8: CONDOM USE ABROAD

unprotected oral sex, only 20% of their sample had ever used a condom during fellatio. This is not because they thought there was no risk; rather the interviewees perceived oral sex as an acceptable risk that did not warrant use of condoms or dental dams. These preliminary findings merit further exploration of the complexities and challenges to using barrier methods with oral sex.

Conclusion

Sexual encounters in the context of backpacking are most often casual. Research has found that young people are more likely to use condoms in casual encounters, and the prevalence of condom use in this study is concurrent with that research. This study supports the assertion that “the use of condoms for STI prevention is associated with loveless relations, relations with a casual partner, and having many partners – so called

“hedonistic relationships” (Wulff & Lalos, 2004, p. 75). The interviews revealed that men and women were unlikely to interpret sexual liaisons as a promise of love, a stable relationship, or long-term commitment. They generally did not expect anything beyond a casual encounter while backpacking.

While the young and less sexually experienced backpackers are at most risk of practising unsafe sex, it appears that condom use behaviours tend to be fairly consistent prior to the trip and during the trip. The findings indicate that inconsistent condom users (rarely, sometimes, frequently) are a mixture of would-be non-users who occasionally have sex with a partner who insists on condom use, and people who have good intentions to use condoms but characteristics of the situation act as barriers to use. Chapters 9 and 10 will explore the sexual communication that normally occurs

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prior to and during a sexual encounter, and barriers to practising safe sex while backpacking.

Safe sex communication

The quantitative findings on safe sex communication were drawn from an item on the survey that asked the participants who suggested or initiated condom use at last intercourse with a new partner. Overall, condom use was suggested by 31% of the survey respondents themselves, 11% by their most recent sex partner, and 40% by both parties; 18% reported that nobody suggested condom use at all during their last encounter. Table 9.1 reports who suggested condom use with their last new partner and succeeded on the last occasion of sex with this person.

Table 9.1: Condom communication (condom users only), stratified by sex

Condom use last occasion of sex

(n = 193) Suggested/initiated condom use with Mena Womena Total last partner (n = 193) b n (%) n (%) n (%) You 45 (37.2) 20 (27.8) 65 (33.7) Your partner 12 (9.9) 6 (8.3) 18 (9.3) Both 62 (51.2) 43 (59.7) 105 (54.4) Nobody 2 (1.7) 3 (4.2) 5 (2.6) a121 (63.7%) men and 72 (60.5%) women used condoms on the last occasion of sexual intercourse with their last sex partner during their trip. Analysis was limited to include only condom users’ responses to this question. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Only 4% (22/539) of the survey respondents agreed with the statement “It is my partner’s responsibility to initiate condom use”. This suggests that almost all of the participants believed they should take either partial, or full responsibility for initiating safe sex. There were no significant differences across gender or age. A clear relationship existed between the suggestion of condom use by one or both partners and their actual use with a new sex partner on the trip (Table 9.1). Backpackers were CHAPTER 9: SAFE SEX COMMUNICATION 213

most likely to report condom use with their last new partner while travelling if both partners suggested condom use (40%, n = 120/193), (2 (1) = 113.94, p < 0.001). On the occasions where no one suggested condom use, only 3% (5/193) used them in those instances (2 (1) = 36.82, p. < 0.001). Condom use on the most recent occasion was found to be more likely among those respondents who suggested condom use (34%,

65/193) or when their partner suggested condom use (9%, 18/193). Those participants who suggested condom use themselves were found to be significantly more likely to use condoms than those who did not suggest condom use (2 (1) = 75.72, p < 0.001).

Survey results show that dyadic communication about condom use was the most common practice among backpackers and their new partners. However, there were occasions when both parties were agreement to use condoms yet did not: 12%.

Analysing this data without a qualitative exploration of each sexual situation offers little insight into possible explanations. The barriers to condom use that became evident during the interviews will address some of the reasons why some couples’ safe sex expectations were not actualised (Chapter 10). The proportion of women versus men reporting communication about condom use was examined. Unilateral initiators of discussions regarding condom use prior to intercourse were more likely to have safe sex than when their partners suggested condom use, regardless of gender (men: 37%,

45/121; 10%, 12/121; women: 28%, 20/72; 8%, 6/72) (Table 9.1).

These survey findings are useful in illuminating the importance of asserting safe sex expectations and intentions, particularly as a dyadic interaction rather than unilaterally.

However, the limitation of quantitative methodology made it impossible to determine specifically how condoms were discussed. Was the “suggestion/initiation” of condom

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use expressed non-verbally and implicitly, i.e. showing a condom or putting one on without discussion, or verbalised explicitly i.e. asking, suggesting, telling or threatening to withhold sex if a condom was not used? During the analysis, it became clear that the wording of this survey question assumed that all of the participants who declared that they “suggested/initiated” condom use did it verbally and explicitly. Yet some of the participants may have interpreted this question differently and, therefore, this assumption may not accurately reflect the communication that took place. Therefore, while these survey findings are valuable in offering insight into what proportion of backpackers attempted to express their safe sex desires to new partners, the interviews offered more descriptive detail on the various safe sex communication strategies that were favoured among backpackers.

In contrast to the survey findings, the majority of interviewees who endeavoured to practise safe sex did not report experiences of explicit verbal negotiation with their new partner that ended in a mutual agreement to use condoms. Instead, their communication surrounding safe sex intentions mainly fell into two categories: non- verbal communication and unilateral verbal communication. Like Bird et al.’s findings

(2001), the men in my study primarily practised non-verbal communication and the women primarily practised unilateral verbal communication.

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Verbal and non-verbal safe sex strategies among consistent condom users

The safe sex strategies discussed in this section reflect those interviewees who were successful in their safe sex pursuits. Every young man who used condoms reported that they preserved their own sexual safety by “just putting it on”.

I just put one on. Better safe than sorry, you know.

[Russell, 28 years, Ireland]

It was never mentioned, I just put it on. They never mentioned it.

[Kevin, 27 years, Ireland]

There’s never a discussion. You just put one on.

[Martin, 19 years, Scotland]

to the girls we don’t really talk about it, just put it on.

[Nathan, 21 years, England]

As noted in Edgar et al.’s study of negotiation styles in sexual encounters, each of these men, regardless of who their new partner was, automatically wore a condom during intercourse while travelling (Edgar, Freimuth, Hammond, McDonald, & Fink, 1992).

They considered it unnecessary to talk about condom use with their new partners, given that they were the ones who wanted to use them. For a few of these men consistent condom use was not their usual practice in the home environment, yet while

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abroad they deemed it appropriate to wear condoms with all new partners (Chapter

10).

The interviews revealed that although some men did not explicitly suggest the use of condoms to their female partners, they did wish to protect their sexual health and so applied condoms without consulting them. For women, the experience of ensuring safe sex was more onerous. Given their dependence on a male partner to comply with their request for safe sex, women felt compelled to make an extra effort to attain their safe sex wishes by introducing the topic of condom use prior to the moment of intercourse. The following statement from Martin shows that through his sexual experience with new partners he came to recognise that women who wanted to protect their own sexual health deemed it necessary to assert their expectations for condom use. Further, his impression was that a woman’s willingness to become immersed in sexual pleasure was dependent upon first informing their partners of safe sex expectations.

Sometimes, like during foreplay, a girl might say “You’ve got to put on a

condom”. Obviously that’s probably like a small security thing, like a safety

feature in their head. They’re just thinking a bit and they have to get that

out of the way before they can actually enjoy themselves. I think that’s the

same with quite a lot of girls because I’ve had that quite a few times. I

never think of it until, like … I don’t know; I don’t really think of it and

then it’s like an automatic thing. I usually have them [condoms] in my

wallet so I just like, you know, say “Hang on”, put it on, and there you go!

I think, when I was with my ex-girlfriend, when I first started there was a

CHAPTER 9: SAFE SEX COMMUNICATION 217

bit of conversation but there’s never been conversation about it out here.

[Martin, 19 years, Scotland]

The fact that men, like Martin, often do not feel obliged to discuss condom use prior to sex may reflect the dominant position that men have in sexual decision-making.

Some would argue that women do not have the benefit of “not thinking about it” or to automatically “just put it on” because men are in control of condom use given that they are required to wear them. Others could argue that it is not an anatomical inevitability that men control condom use. Indeed, condoms can be applied by women and are not necessarily the sole responsibility of men. For example, in the sex work industry it is very common for women sex workers to apply condoms. That being said, none of the women interviewed reported that they applied the condoms during sex as a way to gain control over their use. Women possibly viewed the act of condom application as

“unfeminine” and therefore worried that it might turn off their sex partners if they did so.

The alternative option of the female condom is available to women but they are not as popular or as widely used as the male condom. Its high cost relative to the male condom can represent a significant deterrent (Marrazzo, 2005). Martin “just puts it on” because his anatomy and social custom placed him in a position of control. He perceived no need to ensure that his partners cooperate in his aim for safe sex. The willingness of a man to take the initiative in condom use appealed to several of the women for obvious reasons; it alleviated women of the necessary burden of navigating through gendered power relations to safeguard their own sexual health.

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As evidenced by Martin’s experience and by women interviewed, the most influential strategy to achieve safe sex was to explicitly assert a desire for condom use. As observed by Martin and other backpackers interviewed, women backpackers who consistently practised safe sex were direct and unilateral in their expressed desire for condom use with new partners. Rather than trying to persuade or convince their new partners to use condoms, the female interviewees were inclined to stipulate that a condom would be used: “you’ve got to put on a condom”. Falbo and Peplau (1980) classified a person who exhibited unilateral attributes in their strategising as someone who takes independent action rather than being highly interactive. In other words, the women who insisted on condom use did not engage in a dyadic interaction by

“negotiating”.

A counsellor at a sexual health clinic in Sydney suggested that young people’s preference for unilateral safe sex strategising may reflect the individuals’ feelings of vulnerability and need for control in a sexual situation. In addition, it may also reflect the self-esteem and confidence required in order for women, in particular, to assert their safe sex needs when engaging in sexual encounters with new partners:

Oh, yes, they talk about that [women talking about condoms with new

partners] and invariably that’s a really tricky one. It gets down to being able

to talk in a sexual situation, which you know, so many people think that

when you open your mouth in that situation, you are going to break

something. Often it’s also about how you feel about yourself, how

confident you feel about yourself to do that … to ask if they have a condom

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and guys often reassure, “I am clean”, or “I will pull out” [Counsellor:

#7/C2]

The confidence that this health provider refers to is apparent in Siobhan’s agency in protecting herself by setting her sexual health as a priority. Siobhan’s condom use strategies with new partners (while travelling and at home) went beyond telling her partners of her safe sex expectations. Acting as a gatekeeper and guardian of her own sexual health, she stated that she would not hesitate to withhold sexual intercourse if her partners refused to use condoms.

And do you usually carry them [condoms] on you or do they initiate it?

I always ask. I don’t always carry them, no. But if I don’t and they don’t,

it’s like, forget it. […] Yeah, they’re just kind of waiting for you to say

something. If you don’t, they’re like … “Yes!!”. […] I don’t know. They

usually have them [condoms], like you know, they’re obviously expecting

you to [ask them to use condoms] but they will never say … very rarely.

[Siobhan, 25 years, Ireland]

It is interesting to note that Siobhan did insist on condom use yet did not routinely carry condoms with her, which would have further reduced her dependence on men for her sexual safety. Another woman who demonstrated confidence in her safe sex negotiation abilities discussed her experience with another backpacker who was resistant to condom use.

220 CHAPTER 9: SAFE SEX COMMUNICATION

Yeah the Swedish guy, he kind of gave me this story, yeah, yeah, “but I

have only slept with my girlfriend and I don’t like the condoms”, and I was

like, “okay, I will give you one lesson, always use it [Alexandra laughs] …

so when it broke, I said here is another one” [condom] [Alexandra laughs].

[Alexandra, 22 years, Netherlands]

Previous research has emphasised the important connection between having the confidence to assert a desire to use a condom and success in condom use (Snell &

Wooldridge, 1998; Yesmont, 1992; Zamboni, Crawford, & Williams, 2000). As noted in de Visser and Smith’s (1999) study of Australian heterosexual young adults, “the strongest multivariate correlate of condom use for both sexes was having an agreement to use a condom” (p. 275).

The women interviewees who were consistent condom users often insisted on condom use and demonstrated a strong sense of self, like women discussed in other research in the UK (Holland, Ramazanoglu, Scott, Sharpe & Thomson, 1990). These women also frequently acted as sexual initiators:

I’m not the settle-down kind of chick at the moment. I wanted it so I just

did”. [Siobhan, 25 years, Ireland]

While both the safe sex communication strategies discussed here are unilateral, men and women’s preference for non-verbal and verbal tactics, respectively, may reflect gender differences according to perceptions of power in safe sex negotiation. The

CHAPTER 9: SAFE SEX COMMUNICATION 221

burden of safe sex communication that women endure drives some women to act autonomously in their pursuit of safe sex by threatening to withhold sex.

[M]en may not need to resort to the threat of withholding sexual

intercourse because condom use is in their domain. If a man really wants

to wear a condom, he can put one on. A woman must rely on her partner’s

cooperation. Women’s potential use of withholding sex may, thus, reflect

the fact that condoms are not female controlled (Bird, Harvey, Beckman,

& Johnson, 2001, p. 239).

While the women who threatened to withhold sex if condoms were not used were more likely to be successful in achieving their safe sex intentions, other less assertive, or perhaps more sexually impulsive, women might have been at risk of failing, depending on the safe sex intentions of their male partners. Furthermore, the fact that a woman can negotiate condom use the first time does not ensure condom use on subsequent occasions of intercourse. Women may encounter challenges to condom use if a “relationship” is perceived by either partner. In the context of a “relationship”, abandoning condom use can be symbolic of trust between partners, regardless of whether this is hours or days since first intercourse.

Sex: a process of attrition

As the following conversation with John will show, asserting one’s desires for condom use prior to intercourse does not necessarily mean that a safe sex agreement has been negotiated. A woman’s unilateral approach to verbalising her safe sex wishes allows opportunity for men to abuse their power and be non-compliant with condom use.

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John discussed his extensive sexual experience with women acquiescing to his preference not to use condoms. He admitted that he did not like using condoms and up to that point in his life had successfully avoided using them. The vast majority of his female sex partners, if aroused enough, would not show resistance to unprotected sex at the moment of penile penetration. John appeared to view sex as a “process of attrition” (Holland, Ramazanoglu, Scott, Sharpe, & Thomson, 1991, p. 142); he continuing to stimulate and excite a woman until she acquiesced, even though some of these women had verbalised their intentions to use condoms at the beginning of the sexual encounter. Further, by not buying condoms he gave the appearance that he would have used condoms if they had been available. Yet as his statement shows, even when women provided a condom prior to intercourse he intentionally avoided using one.

So have you used condoms when you’ve had sex with these women [on

trip]?

[pause]. Not often enough.

So how many women would you say you haven’t used a condom with?

Oh, this is disgusting … ok, I’ve always said I’ve slept with between 80 and

120 girls. I’ve got no idea of the figures.

In total?

In total. I’d say, out of them, probably four or five that I’ve used a condom

with and never slept with them again.

Four or five you’ve used a condom with but never slept with again? And all

the other people, you’ve not used a condom?

Yeah. Maybe the first night I have done and then other times I wouldn’t.

CHAPTER 9: SAFE SEX COMMUNICATION 223

So, when you have a one night stand, is it common for you to use a

condom or not?

No.

[…] And so when you get into these situations, does it come up in the

conversation or do the girls bring it up?

Yes, most of the time, it’s “Not without a condom” and I always say “Fine.

I haven’t got any.” And it’s usually “No” and I then say “Well, OK, well

there’s nothing we can do and we can just do it another time” and usually

sex ensues and it’s definitely, definitely not me. It’s not that I just slip it in

… it’s a fairly mutual thing and it leads to sex.

Right. So basically you fool around. Do you usually give oral sex to these

women?

Yes, all the time.

All the time … and how about them to you?

I try to get them to a lot of the time, yeah, but not a lot of them do.

So do you carry any condoms with you or …

No. I just got some the other day but, someone gave me them so I have

some at least; I’ve got some.

But you normally have never bought any while you’ve been travelling?

No. Some girls have pulled condoms out, to use it, and we haven’t.

And you haven’t? And why is that, do you think?

Just messing around and just sort of just carried on without actually

stopping. They’ve [condoms] been lying on the bed next to you.

Right, so you just get caught in the heat of the moment, kind of thing.

Yeah. I don’t like using them see. It makes you look like a bank robber.

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So you, obviously, if they don’t bring it up, you just forget about it.

Yes. [John, 26 years, England]

John did not directly refuse to wear condoms but rather engineered his own passive aggressive non-verbal strategy that successfully delivered a high rate of condom non- use. His partners were willing to sacrifice the security of deliberately protecting their own sexual health so as to avoid confronting his unwillingness to wear condoms, or avoid jeopardising a potentially satisfying sexual encounter. He assumed that if his partners did not insist on condom use or bring the sexual encounter to a halt prior to penetration, then their silence signified a willingness to engage in unprotected sex, therefore absolving him of any responsibility for protecting his partner’s sexual health.

John’s statement about looking “like a bank robber” alluded to the visual image of a stockinged head when he wears a condom. This may suggest that he believes it makes him appear untrustworthy, infected, or has something to hide when encumbered by a synthetic sheath shrouding his “manhood”. Not wearing a condom could imply that the opposite message was assumed by his partners: that the women he has sex with could trust him not to commit any crime or infect them, that he is an honest man.

Sadly, John’s high rate of success with this strategy and disregard for his own and his partners’ sexual health, eventuated in these women being complicit in high-risk sexual behaviour. It is of great concern that very few of his sex partners asserted their desire for safe sex at the moment when it counted. Men’s resistance to safe sex poses significant implications for women’s sexual and reproductive health, particularly given that STIs in women are often asymptomatic and consequently often undetected, risking permanent damage to the reproductive system (Weström & Eschenbach,

1999). Unfortunately, the burden rests with women for self-protection in heterosexual

CHAPTER 9: SAFE SEX COMMUNICATION 225

sex, given that their partners are frequently not willing to act in their mutual best interests by automatically using condoms with new or casual partners. Interviews with other backpackers also revealed that this scenario is not uncommon.

Safe sex negotiation: a difficult challenge

Safe sex is hard to negotiate at the best of times and in that context of

being fairly impulsive, it often does not come up. [Doctor: #1/D1]

Researchers have argued that women’s ineffectiveness and discomfort in negotiating condom use is a significant impediment to exercising sexual health protective behaviours, including condom use (Amaro, 1995; Pulerwitz, Gortmaker, & DeJong,

2000). As underlined by Bajos, “how sex and protection are negotiated implicitly or explicitly is different according to gender, age, culture, and the degree of intimacy in the relationship” (1997, p. 231). Early in a “relationship” or at the beginning of a casual sex encounter, some individuals avoid initiating the discussion of condom use, either in case they decide not to have sex, to avoid appearing presumptuous, or to “retain ambiguity about whether sexual intercourse will take place” (Marston & King, 2006, p.

1584). Buysse and Van Oost’s (1997) study findings suggest that although condom use is desired, failure to initiate a conversation about condom use is because many women are afraid of the “condom-related interaction” (p. 558).

Women’s ineffectiveness and discomfort in negotiating condom use was a key issue raised during the interviews. Before the sexual encounter it was often perceived as too early to negotiate condom use. Conversely, just prior to penetration it was perceived as

226 CHAPTER 9: SAFE SEX COMMUNICATION

too late, a catch-22 situation. It makes sense that it would be extremely difficult for any woman to refuse intercourse to a man she was sexually engaged with, if he was drunk and didn’t know her. Under these circumstances, the chance, or at least the perceived chance, of being sexually assaulted could be high.

Research has also suggested that women willingly place themselves at risk rather than face being abandoned by a potential romantic partner (Rosenthal, Gifford, & Moore,

1998). Alternatively, the findings of my study would suggest that some women may not initiate discussions of condom use when they are sexually aroused and want to have sex. Further discussion of this can be found in Chapter 10.

Although pursuit of committed relationships was less likely in the backpacking context, the romantic notion of crossing travel paths with someone “just like me” pervaded this transient culture. The protracted nature of backpacking heightened young travellers’ feelings of isolation and loneliness. The importance of making romantic or sexual connections was similar, or even more urgent, than at home. However, the turnover potential for sexual interests was greatly accelerated as a backpacker. Having sex with someone unknown may have introduced a fragility and vulnerability to the safe sex negotiation process. Unlike their home environment, most sexual connections were established in an accelerated manner and short-lived, leaving little time to feel comfortable and confident in expression of safe sex desires. Further, many of the backpackers who “hook[ed] up” together cohabited in the same hostel, and some women may have feared that their refusal to have unprotected sex would affect their interactions with this partner or his friends for the duration of their time together.

“The influence of both fear of the safer-sex-related interaction and fear of relational

CHAPTER 9: SAFE SEX COMMUNICATION 227

strain on unsuccessful implementation of safer sex in an encounter gives evidence of the importance of dyadic safer-sex-related communication as a determinant of safer or more risky sexual behaviour” (Buysse & Van Oost, 1997, p. 558). Davies and

Weatherburn (1991) prefer that negotiation of safe sex is not a definitive contract but rather is “continuous throughout the encounter, verbal and non-verbal and situated in a real physical and social context” (p. 114). These perspectives suggest that people are always able to engage rational self-protection strategies during sex, yet the study findings emphasise that backpackers were frequently ill-prepared for the intensity of

“flow”-like experience during their sexual encounters.

Conclusion

The challenge of safe sex negotiation is that it is a complex, dynamic, gendered process and its effectiveness can shift based on the receptiveness of the sexual partner, the level of sexual desire and/or intoxication, different stages in a relationship, or even from one sexual encounter to another. The inconsistency of condom use among backpackers made women vulnerable to the consequences of high-risk sexual behaviour, i.e., unwanted pregnancy, determining if they want an abortion, infertility, or any stigmas associated with these conditions. In their home environment, the men in this high-risk group may have been concerned with getting their partner pregnant. However, much of that fear was alleviated in the transient environment of backpacking, where last names were often not exchanged and “relationships” were fleeting. By the time a woman would have realised she was pregnant there is a high probability that the impregnator would have moved on in his travels without facing any of the emotional anguish or consequences. “In conclusion, females seem to be placed in an unequal

228 CHAPTER 9: SAFE SEX COMMUNICATION

power situation in which they care more about safer sex, although they themselves are not allowed to control condom use” (Buysse & Van Oost, 1997, p. 550).

Overall, the backpackers in this study utilised a variety of verbal and non-verbal strategies to communicate about condom use. A unilateral approach to communicating one’s wishes for condom use was common, but the survey participants who reported a dyadic negotiation of condom use were more successful in achieving their desires for safe sex.

Social and cultural conditions can work to disable some women’s ability to overcome the disparity in power that is often experienced when safe sex is desired. However, the freedom and anonymity experienced in the backpacking environment, or any travel context similar to this, fuels opportunity for intense erotic sexual play. Numerous women interviewed talked of the enjoyment they felt in embracing the sexual opportunities at hand and abandoning themselves to the pleasures of sex (Chapter 7).

Barriers to safe sex

The results regarding the survey participants’ attitudes to condoms (compiled from 14 measures, see Chapter 4) were analysed for consistency of condom use and gender. It is encouraging to discover that the majority of the survey sample recognised the value of condoms to “prevent infection” (88%) and as “a reliable contraceptive” (68%). Very few of the survey respondents reported being “embarrassed to suggest condoms” (5%), feared that their partners would assume they were “promiscuous” (2%), or that they were “infected” (3%) if they suggested condom use. Only 3% (5/176) of those who did not use condoms consistently with their last partner reported that this was because their “partner did not like them”. These findings suggest that young people’s attitudes have become more progressive since the 1980s when studies suggested that condom non-use was partly because people feared being perceived negatively by their partner

(Edgar et al., 1988). More recent work showed that college students were more likely to report respect and a perception that their partner was less likely to have an STI if they insisted on condom use (Hocking, Turk, & Ellinger, 1999). These findings, together with those of this study, suggest that concern over a partner’s perceptions may no longer play a significant role in an individual’s decision to initiate a discussion regarding safe sex.

Few backpackers regarded condom use as “fun and erotic” (6%). Many more agreed that condoms “disrupt[ed] the flow of sex” (55%), “reduce[d] sensitivity” (49%), were 230 CHAPTER 10: BARRIERS TO SAFE SEX

“not romantic” (48%), and that they “[did] not like the feel of condoms” (40%) (Table

12.1). Yet these negative attitudes were no more common amongst inconsistent condom users than among consistent condom users. Consistent condom users were more likely to feel that “condoms give me a sense of security” (77%, 127/164; 2 (1) =

25.761, p < 0.001) than inconsistent condom users (50%; 71/143). Otherwise, there were no significant associations between the backpackers’ attitudes toward condoms and whether they were consistent or inconsistent in their safe sex practices while travelling. These findings are in contrast to literature which suggests that individuals who expect to experience negative outcomes, such as reduced physical pleasure, are less likely to use condoms than individuals who have positive outcome expectations

(Wulfert & Wan, 1993; Abbey, Parkhill, Buck, & Saenz, 2007).

Men were significantly more likely than women to report negative attitudes toward condoms, including such statements as: “I do not like the feel of condoms” (48% of men, 30% of women; 2 (1) = 18.20, p < 0.001), “I think condoms reduce sensitivity”

(57% of men, 39% of women; 2 (1) = 16.12, p < 0.001), and “I think condoms might lead to loss of erection” (17% of men, 11% of women; 2 (1) = 3.51, p < 0.05). Among the small group of backpackers who thought that condoms were “fun and erotic”, there were more men than women (8% of men, 23/307; 3% of women 8/232, 2 (1) =

3.99, p < 0.05). In contrast, although slightly more women than men reported that they

“feel embarrassed to suggest condoms” (7% of women, 4% of men; 2 (1) = 3.76, p <

0.05), women were in general more likely to report positive attitudes toward condoms, including: “sex is less messy with condoms” (42% of women, 26% of men; 2 (1) =

15.65, p < 0.001); and “condoms give me a sense of security” (73% of women, 58% of men; 2 (1) = 12.53, p < 0.001).

CHAPTER 10: BARRIERS TO SAFE SEX 231

These findings taken together are interesting; suggesting that the backpackers’ frequency of condom use was not strongly associated with their attitudes toward condoms, but rather external factors. These factors included the characteristics of the backpacking environment, the sexual situation, and their subjective assessments of prospective partners. These factors may have played a more pivotal role in a young individual’s propensity to use condoms while backpacking.

Table 10.1: The attitudes toward condoms of backpackers visiting Australia, stratified by sex

Mena Womena Total Attitudes to condoms b n (%) n (%) n (%)

I think condoms are fun and erotic (n=539)*** 23 (7.5) 8 (3.4) 31 (5.8) I think condoms are not romantic (n=539) 144 (46.9) 117 (50.4) 261 (48.4) I think condoms disrupt the flow of sex (n=539) 175 (57.0) 122 (52.6) 297 (55.1) I think condoms prevent infection (n=540) 274 (89.3) 202 (86.7) 476 (88.1) I do not like the feel of condoms (n=539)*** 147 (47.9) 69 (29.7) 216 (40.1) I feel embarrassed to suggest condoms 11 (3.6) 17 (7.3) 28 (5.2) (n=539)*** My partner might think that I am infected 295 (3.9) 4 (1.7) 16 (3.0) (n=539) I think they are a reliable contraceptive 209 (68.1) 155 (66.8) 364 (67.5) (n=539) My partner might think I am promiscuous 8 (2.6) 3 (1.3) 11 (2.0) (n=539) I think condoms might lead to loss of erection 52 (16.9) 26 (11.2) 78 (14.5) (n=539)*** I think sex is less messy with condoms 80 (26.1) 98 (42.2) 178 (33.0) (n=539)*** I think condoms reduce sensitivity (n=539)*** 174 (56.7) 91 (39.2) 265 (49.2) It is my partner’s responsibility to initiate 11 (4.7) 11 (3.6) 22 (4.1) condom use (n=539) Condoms give me a sense of security 178 (57.8) 169 (72.5) 347 (64.1) (n=541)*** a 316 (56.5%) men and 243 (43.5%) women completed the survey. Response rates vary for individual questions and are referenced in this table. *** represents statistical differences between men and women at the p < 0.001 level. b Proportions were compared using the Chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

In an effort to further explore possible external factors that influenced backpackers’ inconsistency to practise safe sex, the survey asked respondents who reported sexual

232 CHAPTER 10: BARRIERS TO SAFE SEX

intercourse with a new partner for the reasons why they did not use condoms with their most recent sexual partner (Table 10.2).

Table 10.2: Reasons for not using condoms consistently with last partner on trip, stratified by sex

Men b Women b Total Reasons given for inconsistent condom n (%) n (%) n (%) use on trip (n = 176)

Heat of the moment 71 (62.3) 42 (67.7) 113 (64.2) Alcohol 62 (54.4) 30 (48.4) 92 (52.3) My partner was on the pill* 33 (28.9) 29 (46.8) 62 (35.2) I thought that my partner was safe 35 (30.7) 17 (27.4) 52 (29.5) None were available during sex 21 (18.4) 12 (19.4) 33 (18.8) My partner did not like them 4 (3.5) 1 (1.6) 5 (2.8) I could not find any to buy when travelling 4 (3.5) 1 (1.6) 5 (2.8) Other reasonsa 15 (13.5) 8 (12.8) 23 (13.2)

* represents statistical differences between men and women at the p < 0.05 level. a “Other” reasons recorded by survey participants included: 1) “couldn’t be bothered” 5 (2.8%); 2) “I can’t wear condoms” 1 (0.6%); 3) “penetration but not orgasm, pullout” 1 (0.6%); 4) “didn’t think of it/forgot” 2 (1.1%); 5) “too small” 1 (0.6%); 6) “trusted/knew partner” 2 (1.1%); 6) “long-term relationship” 4 (2.3%); 7) “she had a cup fitted” 1 (0.6%); 8) “Don’t like condoms” 2 (1.1%); 9) “after first time not safe (no condoms), there is no point in using one after” 1 (0.6%); 10) “condom ripped, after that he was my boyfriend” 1 (0.6%); 11) “stupid” 1 (0.6%); 12) “condom rarely used in country” 1 (0.6%). b Proportions were compared using the Chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Oral contraceptive use rated as the third most likely reason for not using condoms consistently with their last new partner. It was evident that, despite recognition by the vast majority of backpackers of the importance of condoms in infection and pregnancy prevention, the circumstances surrounding the sexual encounter were the reasons cited most frequently by survey respondents for unsafe sex while backpacking (Table 10.2).

Barriers to condom use

The survey and interview results considered together revealed that there are four main categories of reasons for not using condoms: 1) characteristics of the sexual situation;

2) perception of risk for STIs/HIV and unplanned pregnancy; 3) use of oral

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contraceptive pill; and 4) logistical problems with buying and carrying condoms while travelling.

Characteristics of the situation

For both men and women survey respondents, the most frequently cited reasons for not using a condom consistently with their last partner related to characteristics of the sexual situation, including getting caught up in the “heat of the moment” (62% of men,

68% of women) and/or drinking too much alcohol prior to the sexual encounter (54% of men, 48% of women) (Table 10.2). In fact, a significant cross-over effect occurred between these two variables in that 80% of those who reported not consistently using condoms due to alcohol consumption also reported that getting caught up in the “heat of the moment” negatively affected the consistency of condom use with their last partner (2 (1) = 34.09, p < 0.001).

Heat of the moment: desire

Not surprisingly, 62% (70/113) of the backpackers who did not use condoms because they got caught up in the heat of the moment reported thinking that condoms disrupted the flow of sex (2 (1) = 6.45, p < 0.01). Notions of getting caught up in the heat of the moment are underpinned by the construction of heterosexual sexual encounters as impulsive, lust-driven, and irresistible (Flood, 2003). Moments of sexual intensity, particularly during casual sexual encounters, can be a major impediment to practising safe sex (Bajos et al., 1997). Flood (2003) argues that the apparently irresistible sexual abandon experienced during moments of unbridled desire and passion subverts recognition of risk and responsibility during a sexual encounter. The

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intense spontaneity suggestive in being carried away by the “magic” and present in the

“moment” denies any preconceived awareness or decision that sex was anticipated and thwarts calm reflective consideration of prophylaxis use against infections or unwanted pregnancy. “Communicating about condoms may force the partners to explicitly acknowledge the fact that they are about to engage in sexual intercourse. Talk about condoms may make the act more “real” for participants.” (Hocking et al., 1999, p.

366).

Passivity, ambivalence, or resistance?

Being caught up in the “heat of the moment” suggests that sex was something that “just happened” to these individuals, and reflects a position of passivity in their decision making with regard to their sexual safety. The individuals acted as passengers in their sexual encounters, each dependent on the other to initiate communication about condom use. For some women, their passivity reflected their ambivalence regarding condom use. During my interview with Bianca, she revealed that her safe sex practices were entirely dependent on her partner’s willing use of condoms. She also reported that on almost every occasion of intercourse with a new partner, both she and her partner were drunk and that most of those new partners did not discuss or initiate condom use.

OK, so did you use condoms when you had sex with this bloke?

No.

So do you never use condoms, or sometimes or … ?

Sometimes, but more often not.

And so how does that play out? Does anyone ever bring it up or … ?

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No. Sometimes they’ll say “Are you on the pill?” and I’ll say “Yeah” but

most of the time they just do it anyway. They don’t ask. […] I think that’s

really bad but … [Bianca, 23 years, England]

Bianca’s perception that most men will not insist on condom use was echoed by several other backpackers, including Mark, who offered this perception of condom use among backpackers: According to Mark, it is a woman’s responsibility to ensure condom use in the “heat of the moment”, given that “a guy will have sex without a condom, no problem”.

Sometimes it is spur of the moment, people get so drunk, it’s eh, it really

depends, I have got to say it really has to depend on the girl. ‘Cause she

always … a guy will have sex without a condom no problem I would think

[…] if it is heat of the moment, she is going to be the one [to negotiate

condom use], ‘cause the guy is not going to say anything, she has got to be

the one to say something. [Mark, 25 years, Scotland]

Mark’s statement suggests that men’s sex drive goes into overdrive in the “heat of the moment” and that in this state, men are either no longer in control of their safe sex needs or unable to assert them. Mark ignored the power inequalities in heterosexual sex that render many women “ill-equipped to advocate for their own sexual health”

(East et al., 2007, p. 106). It is unclear whether some women’s ambivalence to condom use is due to their own dislike of condoms, or if it instead reflects the powerlessness they feel when faced with men’s resistance to condom use. Male dominance and female passivity in sexual encounters are reinforced by deeply embedded social and

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cultural norms. These systematic power imbalances are likely to hinder women’s comfort and ability in negotiating safe sex (Rademakers, Mouthaan, & de Neef, 2005).

Women’s ambivalence towards condom use can work to men’s advantage, regardless of the men’s condom use preferences. Some men who prefer not to use condoms, like

John (Chapter 8), resort to tactics to improve their chances of not being expected to wear a condom. John purposefully did not have condoms available during sex. He strategically orchestrated the timing and sequence of sexual events to increase the probability that his sexual partners would not insist on condom use while in the throes of passion. Given that the “heat of the moment” locates the barrier to condom use “in the sexual episode itself” (Flood, 2003, p. 361), John induced his sexual partners’ complicity in not using condoms, and orchestrated the circumstances of the encounter to satisfy his goals.

The hegemonic discourse of heterosexual relationships also privileges men who prefer to preserve their sexual health through the use of condoms, even if their partners are ambivalent. These men can simply “put it on” without determining their partner’s condom use preferences. That many women were ambivalent, or even “flippant”, about prophylaxis and contraception was disturbing to Russell.

Some of them [backpackers] are actually quite flippant, you know. Some

of them wouldn’t even think about it. I actually just put one on … to be

honest with you, some of the women I’ve seen are so flippant it is scary

like, you know? I mean, there was one girl I was with at one stage and a

couple of weeks later, if I hadn’t been wearing one at all, she was saying

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“Do you use a condom?” and she goes “No, no” and I say “You’re

kidding me, are you on the pill?” and she goes “No”. It doesn’t appeal to

me, you know what I am saying. You know, they don’t appear to care if

they have a baby or not. She was just totally oblivious to it, you know; I

couldn’t believe it. […] Just naïveté, really, you know?[…] it was just

miseducation. It was just not being taught. […] maybe it’s because you’re

travelling and, eventually when you’re travelling you live in hostels and

eventually people just go “Oh, I don’t care” they just go for it … you know?

[Russell, 28 years, Ireland]

As Russell’s statement reflects, being unpredictable, spontaneous, and impulsive epitomised the commonly held construction of the “authentic” backpacker. This may play a part in why so many backpackers engaged in activities or behaviours that they had no experience with prior to their extended journey. The majority of backpackers’ sexual unions were with individuals they had recently met (Chapter 7). Therefore, part of the allure of a casual sexual encounter, such as one-night stands, may be tied in with their desire to experience themselves as impulsive, spontaneous, and lust-driven

(Flood, 2003). So, regardless of how much previous sexual experience they had, having casual sex while travelling promised to be unpredictable, given that they would be having sex, and frequently, with relative strangers (Holland, Ramazanoglu, Scott,

Sharpe, & Thomson, 1991).

Backpackers who were not ambivalent about or resistant to condom use, and who discussed or even negotiated condom use prior to sex, did not necessarily meet their safe sex goals (Chapter 9). Even these backpackers were not immune to being caught

238 CHAPTER 10: BARRIERS TO SAFE SEX

up in the heat of the moment. Among the survey respondents who reported one or both partners suggested/initiated the discussion of condom use prior to sexual intercourse, and subsequently failed in their safe sex pursuits, 60% reported the heat of the moment as a reason for their unsafe sex. Stories of being “caught up in the heat of the moment” despite good safe sex intentions were also not uncommon among interviewees. In the following excerpts, Anika and Mona talk about the situations in which they did not use condoms.

And did you use condoms, or how often would you use condoms?

With a few of them. […] Yeah, most guys have them but sometimes it just

doesn’t work out that way. […] I am pretty comfortable about bringing it

up. My situation is more just “Have you got condoms?” The times that I

didn’t use a condom I just got caught up in the heat of the moment.

[Anika, 20 years, Denmark]

Mostly [I used condoms while backpacking]. There was a couple times

when I didn’t, and I know that was stupid and I knew at the time it was

stupid.

What were those situations like? Maybe you could go through with me …

Well, it was one of them … we had used a condom but it split and we sort

of thought “Oh, well” and just kept on going … went with the flow. And

after that we just didn’t bother. […] Yeah, so we just kept on going. And

another guy, with another guy we had sex once and we only had one

condom and then … we just kept on going [without a condom] - which was

really stupid. We knew at the time it was stupid, but like … [pause]

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Have you ever not used condoms before you came out here?

Umm, I can’t remember. I think … I’m pretty sure I used them sometimes

at home in my relationships. [Mona, 24 years, England]

In the throes of passion, some individuals may abandon any intention to use condoms and therefore not insist on their use. Bianca’s statement below reveals that she believed she would be able to assert her desire for safe sex by supplying the condoms during the encounter, but that safe sex may not be something she “wants”.

Would you feel comfortable enough bringing one out if you were in a

sexual situation with somebody? Would you feel comfortable?

Yes, I think I would be able, if they said they didn’t have one, to say

“Well, I have”. And I would if I felt I wanted to.

[Bianca, 23 years, England]

Rather than being ambivalent about condom use, Bianca revealed that sometimes she preferred not to use condoms. In Holland et al.’s (1991) study, 26% of the 78 women interviewed reported a dislike of condoms. In some sexual situations, condoms can represent an unwanted intrusion that promises to prematurely deflate the sexual tension, interrupt the natural flow of events during sex, or permanently spoil an ethereal moment. It was eloquently stated by a participant in Hoffman and Cohen’s

(1999) study: “ ‘By the time you locate a condom, open it up, get it on, convince him it was something to do, then it loses the spirit, the magic’ “ (p. 563).

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The interviews revealed that the individuals who demonstrated passivity, ambivalence, or resistance to condom use while abroad were often also inconsistent condom users at home. Of concern is the finding that some of the participants who practised safe sex consistently at home were influenced by external factors to break from their safe sex behaviours while travelling. Almost half of those who were consistent condom users at home reported that being caught up in the heat of the moment with their most recent partner was the reason for their change in safe sex behaviour. This highlights that the rules young individuals apply at home may change while backpacking and consequently may affect their safe sex decision-making.

The psychic and temporal boundaries of being “caught up in the moment” share some parallels with liminality: while in this mind-set, the usual rules of safe sex do not apply.

Existing in this liminal moment of passion obviated the discussion of condom use.

Initiation of communication or application of condoms risked disrupting the “flow” of events making the participants present in the moment, thereby breaking their sensatory trance. Csikszentmihalyi’s theory of flow is useful to better understand the sexual experiences of young people travelling as backpackers (Chapter 3). “Being” in the

“moment” is quintessential to the “flow” experience (1975). In this state, backpackers abandon any feelings of self-consciousness, anxiety, or constraint and embrace feelings of enjoyment and pleasure. The effects of alcohol may also heighten sensations and disinhibition. Most of the survey respondents who reported being caught up in the heat of the moment also reported that alcohol was the reason for the detrimental change in their safe sex behaviour.

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Alcohol

Partying and drinking excessive amounts of alcohol are an integral part of the backpacking experience and have significant implications for sexual risk taking. Half

(52%, 92/176) of the survey respondents who were inconsistent condom users reported that the disinhibiting properties of alcohol influenced them not to practise safe sex with their most recent partner (Table 10.2). Similarly, a British STI clinic found that 76% of their female study participants reported drinking as the reason for their unprotected sex (Standerwick, Davies, Tucker, & Sheron, 2007). The relationship between sexual risk taking and alcohol has been repeatedly supported in the literature (e.g. Cooper, 2002; Hennink et al., 2000; Perkins, 2002), yet, “the co- occurrence of drinking and unprotected sex does not demonstrate a causal relationship or elucidate what types of individual and situational factors contribute to intoxicated sexual-risk taking behaviour” (Abbey et al., 2007, p. 76).

There was a strong relationship between frequency of intoxication and unsafe sex: 94% of those who reported that alcohol was a reason for having unsafe sex with their last partner also reported that they got drunk “often” during their trip (2 (1) = 68.15, p <

0.001); there was no significant difference by gender. Comparative analysis of drinking behaviours at home and while travelling revealed that the vast majority of survey respondents got drunk “often” in both environments (92%), so the indications were that this was not a new behaviour. A recent study comparing backpackers with local young people who attended Sydney Sexual Health Centre showed that backpackers (n

= 4,382) were twice as likely to report drinking alcohol at hazardous levels as non- travellers (Appendix M). Of the female backpackers, 25% reported drinking more than 140 g per week (2 standard drinks per day) versus 14% of non-traveller women (p

242 CHAPTER 10: BARRIERS TO SAFE SEX

< 0.0001). For men, 15% of backpackers drank more than 280 g per week compared with 5% of non-traveller men (p < 0.0001) (Egan, McNulty, & Donovan, 2005).

The interviews with backpackers were helpful in offering further insight into backpackers’ drinking behaviours. Most of the interviewees reported that they got drunk much more frequently and started drinking earlier in the evening than they would at home. So while the survey results suggest that alcohol intoxication was familiar to most of the respondents, the increased rate and frequency that they got drunk while backpacking was not. These factors were significantly associated with their propensity to have sex with new partners they had just met or met recently (Chapter 7).

Sexual risk-taking. Backpackers acknowledged that alcohol played a significant role in their high-risk sexual behaviour, and the staff who provided sexual health services to backpackers in Sydney clinics concurred with this assessment. As has been documented in other studies, alcohol offers a convenient excuse for unsafe sex (Crowe

& George, 1989; Gold, Karmiloff-Smith, Skinner & Morton, 1992; Waldby, Kippax, &

Crawford, 1993). During my interview with Scott, he talked about how he met another backpacker at a bar, got drunk, and returned that night to his hostel to have sex with her, but failed to use a condom on this occasion because he was “so drunk”.

Just because I basically was so drunk and I forgot the first time. I didn’t

even thing about it, I don’t think. [Scott, 25 years, England]

The survey respondents who engaged in high-risk sexual behaviour with partners they had just met echoed Scott’s experience. Inconsistent condom use due to excessive

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alcohol consumption was significantly more likely in the instances that their partner was someone they just met or met recently (86%; 2 (1) = 10.82, p = 0.001). These findings expand on those of Graves and Hines (1997) who found that alcohol consumption was more common in sexual encounters between partners who knew each other for a short period of time prior to intercourse, but in their study there was an inconsistent relationship between alcohol consumption and safe sex.

One of the main impediments to using condoms is the absence of a safe sex agreement prior to intercourse (Chapter 9). Negotiating safe sex was particularly difficult when excessive quantities of alcohol had been consumed. Many individuals’ concerns and anxiety surrounding unsafe sex was diminished while in an intoxicated state, and they were more likely to acquiesce.

If someone said can we use one I would be like “yeah”, but I’m always

quite pissed and just caught up in the moment and just kind of just let it go.

I probably would prefer to use them but it’s quite difficult …

Do you find it difficult to talk to them? Like, would you ever initiate that

discussion?

I might do if I was kind of not that drunk. I’m always quite drunk and it’s

kind of like, when you get to a certain stage, it’s hard to say stop and let’s

do this. You sort of carry on because you just want to do it.

[Bianca, 23 years, England]

Literature has suggested that intoxication may cause individuals, particularly women,

“to be less focused on these concerns and feel more comfortable about unprotected

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sex with a casual partner” (Abbey et al., 2007, p. 78). One doctor talked about drunkenness among backpackers being a health education challenge given that the safe sex messages they are exposed to most often occur when they are sober. According to this doctor, those messages are not at the forefront of the backpackers’ minds when they are drunk. He suggested that the most effective way to optimise condom use would be to educate backpackers not to get drunk. However, he believed that the central limitation to this approach is that backpackers want to get drunk. Therefore, although backpackers generally have a high level of awareness on how to prevent STIs and unplanned pregnancy, this doctor did not anticipate any significant change in backpackers’ proclivity to have unprotected sex in the future, given that drinking is so central to their culture.

Well they [backpackers] are young, healthy, fit, people who want to be

sexually active,. But […], the only way to get a quick relationship going is to

be drunk, get them into bed. […] Majority of [backpackers I see] only have

sexual relationships when they are drunk, and when they are drunk they

don’t have safe sex because they don’t know what they are doing basically.

That’s what’s happening. That’s how it happens because to have a

relationship with someone, you can’t do it unless they’re drunk, so that

makes them less inhibited and that’s what happens to talking about safe

sex, it really is not happening […]. Well, really people need to be informed

not to get drunk ‘cause that is how people have a good time, get drunk and

sleep with a person of the opposite sex and have sex and that is fun, that is

what they want, their cup of fun. You can’t change people’s lifestyles, […]

the whole culture is to have “a good time”, thousands of the backpackers

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all come to Bondi beaches and party and they come here to have a good

time and a good time is to be with someone and drink. And if you get

dehydrated with alcohol, you don’t know what you are doing basically. It is

behaviour; you can’t change a behaviour when you are drunk. It is not a

medical problem that much, you are treating, I treat their problems as

medical because I am a medical practitioner and I treat their problem but

uh, to solve their problem you can’t tell people not to get drunk, they

actually come here to have a good time. [Doctor: #2/D2]

The backpackers whose sexual experiences informed the perspective of this doctor and every other health care provider in this study, were representative only of backpackers who engaged in high-risk sexual behaviour and subsequently attended clinics to seek testing and/or treatment, and therefore were not representative of all backpackers. It is clear from the survey results that a significant number of backpackers were consistent condom users at home and while travelling (Chapter 8).

However, even some of those individuals were not immune to the disinhibiting effects of alcohol.

For instance, Martin, who reported that he always used condoms at home unless he was in a long-term monogamous relationship, explained that he did take sexual risks while backpacking that he would not normally take at home. He reported being scared and surprised by his impulsive sexual behaviour. This young man exhibited a deeper degree of personal reflection than the majority of other young backpackers interviewed. Martin realised that being intoxicated did negatively influence his safe sex decision-making and consequently made a personal commitment to avoid future

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sexual situations where he would be too intoxicated to trust that he would use a condom.

I’ve not really gone out on pills and picked up girls when I’ve been on

drugs. It’s more when I’ve had a few [drinks]. But the thing is I don’t

generally, if I’m really drunk, I generally won’t go with a girl. I won’t try

and score basically because it’s dangerous. That’s more why I’m worried.

Because if I’m not in full control, I don’t really want to … like … if I’m not

making some kind of control of what I’m doing, I don’t want to go away

with somebody because God know what we’re going to do. You know? It’s

a fear factor but it’s also sort of just common sense, really. […] I’d just say

… well, most people are [looking for sex] and then some people who aren’t

will find it anyway. It’s just the way it is. I mean, if you’re backpacking, you

generally get drunk so, when you’re drunk, you generally lose caring …

[Martin, 19 years, Scotland]

Risk taking was highly dependent on the sexual situation. Even risk-averse individuals such as Martin were susceptible to taking risks, depending on whom their potential sex partner was, what relationship they had with that person, and the social context that sex occurred. When extremely intoxicated, particularly in the “anything goes” culture of backpacking, Martin recognised that he was susceptible to engaging in high-risk sexual behaviour. Unbeknownst to Martin, his attitudes and behaviours reflected a belief in the constructivist approach whereby his own construction of risk was inextricably woven with his social experience (Douglas & Calvez, 1990). Upon realising that excessive alcohol consumption triggered a propensity within him to engage in sexual

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risk-taking behaviour, Martin vowed that his future sexual decision-making, depending on the structure of the situation, would be acted out based on the framework of constraints that he had made for himself.

The strategy that Martin formulated to protect his sexual health could inform future health promotion campaigns targeting this population. Encouraging backpackers and other individuals to monitor their level of intoxication and to distance themselves from situations where they might be tempted to disregard pre-existing safe sex intentions made when sober may be an effective tool to instil a sense of autonomy, self-efficacy and assertiveness in individuals who may otherwise “just let it go” or “lose caring”.

Sexual assault. The interviews also unexpectedly revealed that the communal arrangements characteristic of hostel living could pose a threat to backpackers’ sexual safety, particularly in situations where the offenders and/or victims are intoxicated.

Several sexual health staff reported that they had provided sexual assault services to female backpackers who attended the clinic because they woke up in their hostel bed to realise that another backpacker was having sex with them. According to the clinic staff, these women had consumed considerable quantities of alcohol prior to the event, had no recollection of consenting to sex, and consequently felt traumatised by these experiences. These young women feared being infected or impregnated during their sexual assault. In contrast, John described a similar experience while backpacking, but viewed it as just another humorous sex escapade from his backpacking trip. This anecdote offers an account of a young woman who acted as a sexual aggressor toward

John while backpacking.

248 CHAPTER 10: BARRIERS TO SAFE SEX

Another good story is this Canadian girl … where was she from? I think it

might have been Vancouver. She used to set [look] on me every night. I

never really clocked on to it. I just thought she was friendly. There were

two of them but she’d always stay up all night until I went to bed at five or

six in the morning. ([…] Yeah, and one night we was out and I picked up

this Australian girl. Nothing happened, just a kiss. I took her phone

number and everything. I come back and was asleep and I was dreaming

that I was having sex with her. I sort of woke up with a girl screaming her

head off me, telling me to shut up, and the Canadian was sleeping with me.

She was fucking me basically and I don’t know if I was … I don’t know.

So were you sleeping or were you drunk or … ?

I was asleep and I thought I was having sex with this Australian and I’d

kind of woken up and I was like “Ahh” and then the Canadian’s there.

Because this bed used to be facing this way and that girl was screaming

“shut up” and I didn’t have a clue where I was, kind of thing. I just came

back to the surroundings; I don’t know if I picked her up outside and told

her to come in or she just let herself in. But night security told me that

he’d let her in because she said her washing was in there. And she’s

basically just jumped on top. I don’t know if I was fast asleep or if I was

sort of semi-comatose or what.

Wow! So you’re just a heavy sleeper, obviously.

If I’m drunk. […] I was yeah! I was really, really on my way, you know?

Very, very drunk.

[…] Right. So how did that work out? Did you just go along with it?

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I’m trying to get out of the bed to look at this girl and she’s still trying to

carry on and the door’s come open and there’s some lads standing at the

door saying “What’s going on?” There was screaming going on which was

this other girl. I slept with her again after. [Laughs] It [availability of casual

sex] was there. [John, 26 years, England]

The disparity between women viewing their experience as an assault and John viewing his similar experience as good fortune may reflect the socially accepted constructions of masculinity and femininity in Western society. Men may find it difficult to refuse an opportunity for sex, regardless of how they ended up acquiring these opportunities

(Chapter 8). John acknowledged that he may have agreed to have sex with this woman but could not remember, yet young women in a similar circumstance might assume that they did not give consent for sex, since they could not recollect the sequence of events prior to intercourse. Clearly, extreme states of intoxication precluded effective negotiation of condom use and this raises questions regarding whether consent can easily be assumed, or intentionally offered, when in this altered state.

Poor recall of events. Alcohol consumption affects memory. “Alcohol primarily disrupts the ability to form memories that are explicit in nature, including memories for facts (e.g., names, phone numbers, etc.) and events (e.g., what you did last night)”

(White & Swartzwelder, 2005, p. 164). Therefore, backpackers’ recollections of condom use may actually have been assumptions, given that they frequently reported being drunk when they had sexual intercourse with a new partner. The interviews highlighted that alcohol significantly diminished the backpackers’ memory of the sexual event, specifically condom use. This poor recall was attributed to the period of

250 CHAPTER 10: BARRIERS TO SAFE SEX

time that had lapsed, the numbers of partners accrued since the event, or to the amount of alcohol consumed prior to their sexual encounters. Almost all of the backpackers who consistently used condoms when sober reported consistent condom use when intoxicated. However, further probing into details of safe sex communication or condom application during these encounters illuminated the participants’ poor recall of events. The level of intoxication reported by most of the backpackers, particularly with those that they had “just met” or “met recently”, brings into question the accuracy of their recall regarding safe sex practices while backpacking. In the following statement, Bobby argues that he used a condom on every occasion of sexual intercourse, yet acknowledged that sometimes his recall was poor. He therefore assumed that condom use while intoxicated was a reflection of his usual safe sex practices.

How often would you say that you use condoms?

Every time … that I remember [laughs]

Do you think there is a possibility that you may not have on some

occasions? If you were drunk or something?

If I am capable of using one then I do. [Bobby, 23 years, Wales]

Bobby most likely would agree with Abbey et al. (2007), who argue that the “strongest predictor of condom use when intoxicated is condom use when sober” (p. 82). In most situations this may be true, but, if the respondents who were unable to recall their condom use behaviour while drunk generalised their reports of condom use behaviour based on their safe sex practices while sober, then their statements may be misleading and inaccurate. As with any sexuality research studies, the popularity within the

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backpacking community of getting drunk “often” and having sex with a new partner does raise important concerns regarding the accuracy of the results of the surveys and the interviews. Reports of condom use may have been artificially inflated not only by response bias, but also by poor recall. As Cooper states, “the relationship between alcohol and risky sexual behaviour appears to be both complex and highly circumscribed” (2002, p. 115). Abbey and colleagues recognise that “there is a need for more sophisticated theories that include potential moderators to identify which individual drinkers are most likely to engage in risky sexual behaviour when intoxicated” (2007, p. 82). The challenge for those generating such preventive measures and strategies for sexual health is that while under the influence of alcohol, a person’s sexual decision making can be highly unpredictable and circumstantial.

Personal perception of risk

A quarter of women, (27%), and a third of men (31%) did not use a condom on one or more occasions because “I thought that my partner was safe”; these findings did not differ significantly according to gender nor age (Table 10.2). Further, 84% (210/251) of those who had sex with someone that they had “just met” on their trip and 77%

(67/87) of those who did not use a condom the last time they had sex on their trip with someone they “just met” or “met recently” perceived the risk of getting HIV to be low to nil. The interviews offered further insight into how these backpackers assessed the

“safety” of their new sex partners.

252 CHAPTER 10: BARRIERS TO SAFE SEX

Table 10.3: Perception of risk of HIV while abroad (inconsistent condom users only), stratified by sex

Inconsistent condom users on trip

Perception of risk of HIV while backpacking Mena c Womena c Total on this trip (n = 141) n (%) n (%) n (%) No chance 12 (13.6) 9 (17.0) 21 (14.9) Very low 36 (40.9) 19 (35.8) 55 (39.0) Low 25 (28.4) 13 (24.5) 38 (27.0) Moderate 12 (13.6) 9 (17.0) 21 (14.9) High/very highb 3 (3.4) 3 (5.7) 6 (4.2) a 90 (47.2%) men and 53 (44.5%) women inconsistently (less than always) used condoms with their last sex partner during their trip. Analysis was limited to include only inconsistent condom users’ responses to this question. b Response categories “high” and “very high” combined due to small numbers. c Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Global assessment of risk

Analyses of the interviews brought to light one of the intrinsic differences between the backpackers who always used condoms and those who did not. Consistent condom users appeared to hold a generalised index of risk with new partners, rather than assessing each individual’s risk potential. According to Green, Fulop, and Kocsis

(2000), regardless of who the sex partner is, these men and women are more likely to ask themselves “what is the risk of me getting infected with HIV or other STIs if I don’t use a condom?” Each of the consistent condom users among the interviewees stated that they always used condoms because they “never really knew” the sexual health of their partners. Therefore these individuals perceived every sexual partner as a potential risk to their sexual health and as a result exhibited an internal locus of control over their own sexual health by insisting on condom use and/or refusing sex if a condom was not available.

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I don’t know her, she could have slept with anybody so, anybody in the

world so, safer to use a condom, feels a lot better.

[Liam, 22 years, Scotland]

One backpacker viewed all backpackers as potentially “risky” partners. He believed that most backpackers were sexually irresponsible and that he was more likely to contract an infection from a fellow backpacker than from a sex worker.

I do, or she does, it depends really, before everything gets going. That is

the only way it is going to be because you have got more chance of

catching things amongst backpackers, than you would amongst prostitutes.

Why do you think that?

Because they get checked out more regular and they are more, they always

use condoms and the backpackers don’t.

Do you think some might be exposing themselves to STDs?

More amongst the backpackers [than prostitutes].

[Bobby, 23 years, Wales]

Individual assessment of risk

In contrast, inconsistent condom users were more likely to utilise an individual assessment of risk with potential partners during their trip. These individuals were more likely to ask themselves: “what is the likelihood that this person will infect me with HIV?” (Green et al., 2000). Earlier prevention campaigns recommended

“knowing” one’s sexual partner through “health-protective sexual communication”

(Catania, Binson, Dolcini, Moskowitz, & van der Straten, 2001), including a discussion

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of their sexual risk history (Hoffman & Cohen, 1999). This communication included discussion about contraception, sexually transmitted infections, and sexual histories.

However, sexual self-disclosure through explicit communication was not popular as a method of determining sexual risk among backpackers. None of the interviewees inquired or were asked about their STI status or serostatus by potential partners; one backpacker reported feeling that it “dampened the mood”.

I never asked anyone anything like that. And I’ve never been asked either.

But it’s probably something that’s not a bad idea. It kind of just like … it’s

sensible and it’s a good idea. It is … it’s just one of those things that you

know you should really ask but you kind of … it sort of dampens the

mood. [Oscar, 25 years, England]

Backpackers’ aversion to explicit risk communication is not surprising given that few backpackers had enough time together to develop the level of comfort in self- disclosure more commonly found in committed long-term sexual relationships.

Furthermore, initiating a discussion about a potential partner’s sexual risk history may have prompted a sense of mistrust and conflict between the partners (Kirkman,

Rosenthal, & Smith, 1998). Given that the majority of sexual liaisons among backpackers were casual and the “relationships” were fleeting, I believe it was more a case of potential partners being uncomfortable and awkward broaching such a personal subject with a relative stranger, and fearful of bursting the bubble of anonymity that pervaded their culture. While living in this context, backpackers experienced a temporary reprieve from the scrutiny, disapproval, and judgment of friends and loved ones at home (Chapters 3 & 5). By asking potential partners to recall

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their own sexual risk history, a backpacker would be compelled to transcend the protected liminal boundaries of their existence. Furthermore, asking about a partner’s sexual history would invite a reciprocal line of questioning. Consequently, the shroud of anonymity from their travel experience would be lifted through disclosure of their sexual history, meanwhile, they would also potentially subject themselves to judgment from their sexual partners. Women may worry that their partners would perceive them negatively if their sexual permissiveness (which appeared to be more acceptable in the backpacking context), was also apparent in their home environment. It is difficult not only to ask about a person’s sexual history, but also to believe that you are receiving truthful answers (Holland et al., 1991).

Backpackers who were predisposed to practise unsafe sex applied more oblique approaches to assess the risk of having sex with a new partner, if they did so at all.

These backpackers often depended on subjective assessment tools to provide an assurance of lack of risk. Lear argues “potential partners are sometimes assessed in terms of risk by their appearance of lifestyle characteristics” (Lear, 1996, p. 122). In the backpacking culture such lifestyle characteristics included: attractiveness, place of origin, and sharing a lifestyle choice to travel as a backpacker instead of being a short- term “typical tourist”.

Too “fit” to be infected. During the interviews, numerous backpackers proudly remarked on the “fit(ness)” or attractiveness of their chosen sex partners. To these young travellers, their partners’ attractiveness seemed synonymous with their state of health, and therefore symbolised an absence of risk. Several backpackers talked about the shock they received in learning disturbing details about partners that alerted them

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to their new partner’s potential sexual “riskiness”. Divulging this information in the interview would often prompt them to make statements like: “I was so stupid”, “what else didn’t I know about him/her?” However, it appeared that backpackers were not as shocked by the information they learned about partners, as they were that they could have chosen their partners so poorly. Siobhan had sex with a Canadian bartender she met in Thailand, whom she described as “beautiful”. Shortly after meeting, she had sex with him and several days later he told her that he was in a relationship with a Thai

“lady-boy”.

I seen him in the bar, you know, and that’s just (I don’t know) kind of how

I operate, just see him and go “Ooh, yeah, tasty!” […] he had a fit body,

nice eyes and a really lovely smile. […] Oh, yes and get this! He told me he

had a Thai girlfriend who was a lady-boy so, needless to say, I backed right

out of that situation and didn’t pursue it any further.

So he told you afterwards [after sex]?

Mmm [affirmative] … […] It stopped me in my tracks a bit because

obviously the guy had another side to him sexually … it kind of turned me

off him a bit. It made me look at him and think “What??” because he was

a really, really attractive guy and whatever. [Siobhan, 25 years, Ireland]

On that occasion, Siobhan did use a condom with this partner, but the experience reinforced to her that appearances can reveal little regarding a person’s sexual preferences or risk history.

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Similarly, Mona talked about the regret she felt when a man with whom she had just had unprotected sex disclosed how many sexual partners he had prior to her. During the interview she appeared surprised and concerned by how many partners he had had before her.

The first guy told me that he had slept with over forty women, so I felt

“Urgh, that’s a bit stupid of me” but at the time, you know, you sort of … it

is just so stupid because I should just go and buy some [condoms].

[Mona, 24 years, England]

Mona could not recall if she had ever used condoms in any of her previous sexual encounters. She realised that her apathy regarding condom use and her propensity to have sex with men who preferred not to practise safe sex would eventually be detrimental to her sexual health.

Cultural familiarity

The interviews also revealed that a false sense of security regarding sexual health often surfaced when backpackers had sex with young individuals similar to them, either in cultural background or simply by belonging to the same travel community. The interviews with health care providers echoed Black’s (2000) findings of young travellers who attended clinics in the UK. Backpackers attending Sydney clinics seeking sexual health services reported they often based their assessment of sexual risks on the area of the world their sex partners originated from, where sexual contact took place, and the characteristics of the person, i.e. if they were a backpacker or a local. There appeared to be a perceived boundary of imagined safety within the backpacking community. My

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interactions with backpackers during the fieldwork and interviews informed my perception that backpackers, as a social group, found comfort in recognising similarity among themselves, in their travel motivations, and objectives. This sense of community generated a feeling, albeit mistakenly, of “knowing” that “they are like me and therefore are probably safe, like me”.

Health care providers reported a distorted perception of risk in the “at risk” backpackers who attended their clinics. Frequently these backpackers would be shocked that a backpacker, someone just like themselves, could infect them with an

STI.

I think some sort of recognition of the risk changes once you’re actually

into a particular sort of environment. I don’t think there’s any recognition

of risk of other travellers because this person is also from the UK, so

they’re safe. But the fact that they’ve been travelling for a while and, you

know, have had unprotected encounters with a whole range of people,

doesn’t necessarily register as being something that happens to “a nice girl

like me”. [Nurse: #11/FG]

According to the clinic staff, many of the young backpackers who did not have much sexual experience prior to travelling and who became more experimental sexually while travelling, did not recognise that the probability of contracting an infection was significantly higher than it was in their home environment. Their personal perception of risk did not adapt to their increased sexual permissiveness.

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They [backpackers] see other travellers as being less at risk and so if you

talk to them about safe sex in Africa they will say “well oh, you would be,

anybody would have a death wish to have sex with somebody in Africa”,

because everybody knows what a high incidence of HIV there is in Africa.

But they won’t see other people on their tour as necessarily being as “at

risk” [compared to Africans]. Like when they are doing a truck safari tour

around Africa, they won’t know if that person hasn’t slept with a local

person or indeed just being “at risk” from anything. [Doctor: #17/FG]

Some of them say, of, you know, when you ask then about their nationality

[of sex partner], they will say, “but oh, she was Australian”, or Dutch, or

something, like she wasn’t Asian. They are the ones that understand that it

is riskier in Asian countries with an Asian person or an African person, but

[think] it is okay to have sex with an English person without a condom!

[Nurse: #8/N1]

Survey respondents were asked to cite up to three destinations they perceived to be the most risky with regard to contracting HIV while travelling (Table 12.4). Interviews with backpackers corroborated these survey results in that the majority of backpackers were aware of the high prevalence of HIV/AIDS in South-east Asia and Sub-Saharan Africa, yet often did not perceive Western sex partners, particularly other travellers, as “risky”.

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Table 10.4: Destinations perceived by backpackers to represent most risk of contracting HIV while travelling, stratified by sex

“Risky” destinations (n = 528) Mena b Womena b Total n (%) n (%) n (%)

New Zealand/South Pacific* 12 (3.9) 18 (8.1) 30 (5.7) North America 25 (8.2) 25 (11.2) 50 (9.5) Western Europe (including UK)* 30 (9.8) 35 (15.7) 65 (12.3) Australia 34 (11.1) 35 (15.7) 69 (13.1) Eastern Europe & Russian Federation* 48 (15.7) 19 (8.5) 67 (12.7) Central America 54 (17.7) 34 (15.2) 88 (16.7) East Asia (including China, Japan) 87 (28.5) 49 (22.0) 136 (25.8) South America 107 (35.1) 72 (32.3) 179 (33.9) South Asia (including India) 121 (39.7) 88 (39.5) 209 (39.6) Middle East/North Africa 160 (52.5) 124 (55.6) 284 (53.8) South East Asia*** 180 (59.0) 97 (43.5) 277 (52.5) Sub-Saharan Africa 189 (62.0) 135 (60.5) 324 (61.4) None of these answers* 7 (2.3) 15 (6.7) 22 (4.2) a 316 (56.5%) men and 243 (43.5%) women completed the survey. Response rates vary for individual questions and are referenced in this table. */**/*** represent statistically significant differences between men and women at p < 0.05, 0.01 and 0.001 levels respectively. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Knowing and therefore trusting

In general, backpackers perceived that “everybody is getting some [sex]” (Chapter 6), and therefore there was a widespread understanding that sexual exclusivity should not be assumed when having sex with other backpackers. The backpacking environment was a liminal context in which sexual permissiveness was condoned and protected from risk of social marginalisation. However, some women’s sexual permissiveness was not accompanied with contraceptive preparedness.

Backpackers did describe being involved in short-term “relationships” that they defined as monogamous, but the transience of the backpacking culture usually severely curbed any personal fantasies of these relationships being “the one”. Backpackers’ concurrent string of “relationships” that lasted a few days to a few weeks could be

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described as serial monogamy, given that while in those “relationships”, they most often did not have sex with anyone else. Nevertheless, some backpackers did not internalise the risk their potential partner’s previous sexual behaviour may pose to their own sexual health.

Condom use is often associated with casual sexual encounters (Baylies, 2001), and interviewees most often reported condom use on the first occasion of intercourse with new partners that they had “just met” or “met recently”. However, many interviewees reported that they stopped using condoms after knowing this new partner for as little as a day. Flood (2003) similarly found that some of his heterosexual male participants felt they could trust their new sex partners after just one night together. While condom use implies mistrust (Kirkman et al., 1998), “having sex creates trust, and trust means sex without condoms” (Flood, 2003, p. 363). That being said, only 3% reported that “my partner might think that I am infected”, and only 2% of backpackers reported that “my partner might think that I am promiscuous” if condoms were used (Table 10.1). These findings give support to the notion that young individuals may not be as fearful of being perceived negatively by new partners for wanting to use condoms as was the case a decade ago.

Friendships and sexual “relationships” were accelerated and intensified in this transient context, and generated a false perception of trust and “knowing” among backpackers.

“As a relationship develops and the sense of “knowing” grows, the continued use of safer sexual practices raises new and complex issues” (Ingham et al., 1991, p. 129).

Consistent with Ingham et al.’s findings (1991), backpackers’ knowledge of their new

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partners based on casual acquaintance prior to sexual intercourse was sufficient to assure them of lack of risk associated with these encounters.

The familiarity that was assumed by the second sexual encounter often precluded the use of condoms on that occasion and every following occasion. Despite an awareness at some conscious level that their trip “romances” were likely to be very short lived, many interviewees adopted monogamy as a substitute for safe sex practice for the remainder of their time together. Other research has also found that individuals often have unprotected sex soon after a relationship is initiated as a symbol of the level of intimacy and trust that they feel with their new partner (Maxwell & Boyle, 1995;

Mewhinney et al., 1995; Seal & Ehrhardt, 2003).

After reviewing related literature on young people’s condom use behaviours with partners, it is not surprising that there was a strong inverse relationship between condom use and number of times intercourse occurred with a new partner (2 (1) =

132.12, p < 0.001). Condom use was more common when the backpackers only had sex once with their most recent partner (Table 10.5). Backpackers were almost ten times as likely to practise safe sex with a new partner with whom they had sex only once, compared with those who had sex with their new partner five or more times.

Unfortunately, inconsistent condom use on multiple occasions of intercourse potentially represents multiple exposures to infectious pathogens. Of concern was that over half of the survey sample who had sex with someone new on the trip (53%;

101/192), reported multiple exposures to possible STIs/HIV while travelling (two or more episodes of unprotected sex); there were no significant differences by age or gender. Slightly more women than men reported having sex more than 20 times with

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their new partner (men 6%, 11/192; women 10%; 12/119), but this gender difference was not statistically significant. Only 2% of those who had multiple exposures (more than 20 times) reported “always” using condoms; the remaining individuals reported inconsistent condom use. Previous travel and sex research has found women to be more likely than men to report repeated exposures to the risks of unplanned pregnancy and STIs (Bloor et al., 2000), but this study shows that male backpackers were almost as likely as women to have unprotected sex when they engaged in multiple occasions of intercourse with the same partner.

Table 10.5: Frequency of sexual intercourse with last partner on trip (consistent condom users only), stratified by sex

Consistent condom users (n = 167)

Number of episodes of sexual Mena b Womena b Total intercourse with last partner on trip n (%) n (%) n (%) (n = 166) 1 42 (41.6) 33 (50.8) 75 (45.2) 2 25 (24.8) 10 (15.4) 35 (21.1) 3-5 22 (21.8) 13 (20.0) 35 (21.1) 6-10 5 (5.0) 6 (9.2) 11 (6.6) 11-20 5 (5.0) 1 (1.5) 6 (3.6) 21-50+ 2 (2.0) 2 (3.1) 4 (2.4) a 101 (52.9%) men and 66 (55.5%) women consistently (always) used condoms with their last sex partner during their trip. Analysis was limited to include only consistent condom users’ responses to this question. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Bloor et al. argue “having sexual intercourse with a new partner more than once is bound to increase the probability of inconsistent condom use” (2000, p. 161). Multiple episodes of unprotected sex in concurrent “relationships” have significant epidemiological implications for the rapid dissemination of HIV and other STIs

(Morris & Kretzschmar, 1997). In many cases, the turnover frequency in which these consecutive relationships occurred precluded any possibility for the partners to experience symptoms of an STI or HIV before having unprotected sex with their next

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sex partner. For many STIs, individuals are most infectious immediately after they themselves have been infected (Bloor et al., 2000). Therefore the rapid succession of backpacker “relationships” should be seen as a significant public health concern.

Oral contraceptive

A backpacker’s propensity to report condom use was negatively correlated with oral contraceptive use (Table 10.2). Thirty-five per cent (62/176) of the survey participants reported the use of oral contraceptives as a significant reason for not using condoms the last time they had sex with a new partner. Over half (55%; 34/76) of those backpackers who never used condoms on their trip cited this as a reason. Several participants also made qualifying comments on their questionnaire to emphasise this point.

I grew up in South Africa before immigrating and I have been exposed to

a country with an HIV crisis that should have instilled more sense into me

but I tend to think that if I am on the pill I won’t have a problem with

pregnancy which is my main concern and I don’t tend to think about

STDs. I am very cautious about who I sleep with and tend to know them

through friends or over a couple of days. [#191, Female]

Other research has also shown that condom use is less likely if another form of contraception is used (de Visser & Smith, 1999; Rosenthal, Smith, & de Visser, 1997); particularly the pill (Shew, 1997, Weisman, Plichta, Nathanson, Ensminger, &

Robinson, 1991).

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Condoms are a reliable contraceptive (Trussell & Kost, 1987) and 68% of the survey sample agreed (Table 10.1); there were no significant differences between men and women. Numerous researchers submit that condoms are more often used as prophylactics against pregnancy than to prevent transmission of STIs/HIV (Flood,

2003; Garside et al., 2001; Ott, Adler, Millstein, Tschann, & Ellen, 2002). Interviews with sexual health providers in Sydney endorsed these findings. Many of the clinic staff reported that most backpackers, particularly women, viewed the risk of pregnancy as more immediate and urgent than their risk of contracting a STI. The clinic staff concurred that these perceptions of risk were not inaccurate; they reported that, generally speaking, the probability of conception was greater than the probability of contracting an STI when not using a condom with locals or other backpackers while travelling in Australia, or other Western countries. An unwanted pregnancy while abroad usually incurred significant repercussions to backpackers’ trip plans, and frequently resulted in the necessity (financial and psychological) for women to abruptly end their trip and return to their home country.

We certainly see a lot of pregnancies amongst, particularly, UK

backpackers that are often messy to sort out when they are half-way

around the world. [Doctor]

According to the clinic staff, fear of this consequence prompts many young women to initiate using hormonal contraceptives while backpacking; Anika was one of those women. Following unprotected sex with her first sex partner, she sought out a medical doctor who could supply her with the “morning-after pill”, and subsequently started taking oral contraceptives at his suggestion.

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Are you on the pill?

Yeah. Well, I am now anyway.

Were you before or is this just a recent thing?

It’s been, well, after that first guy I met. I had to go to the doctor and get

the morning-after pill and he said “Maybe you should just go on them [oral

contraceptives]” because it’s probably not going to be the last time. And he

was right … [Anika, 20 years, Denmark]

Interestingly, interviews with the health care providers revealed that it was not uncommon for female backpackers to attend Sydney clinics seeking post-coital contraception. Unplanned pregnancy carried more immediate negative implications for women than men, and consequently women most often carried the burden for preventing unplanned pregnancy. Thus, even though it would be effective for Anika to insist on condom use during her sexual encounters, her reluctance to dampen the

“heat of the moment” and/or compromise her male partner’s sexual pleasure resulted in her expending much greater efforts (alone) to obtain medication after sex that would prevent her from experiencing an unplanned pregnancy and possibly put her trip in jeopardy.

Ironically, the advancement of women’s rights in having control over their own reproduction has resulted in the pill being one of the most widely used hormonal contraceptive on the market internationally (Wilkins, Johansen, Beaudet, & Neutel,

2000), yet has served to bolster men’s desire for “natural” sexual pleasure, and thereby has reinforced men’s resistance to condom use (Skidmore & Hayter, 2000; Flood,

2003). Wulff and Lalos (2004) have suggested that if men are more concerned about

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preventing pregnancy than they are about safe sex, then they may be less likely to use condoms when hormonal contraceptives are used. Men often assume that birth control is women’s responsibility (Buysse & Van Oost, 1997), which helps explain men’s silence in the safe sex negotiation process.

So who initiates the discussion of condoms when you use them?

Umm, there’s mostly just a general pause when one of you has nothing to

say and I think it mostly means yeah, go ahead [use condoms].

And do you think they would be used if you hadn’t spoken up?

I think with some people it probably would have been, but I know there

are plenty of others who would have just not even thought about it, you

know? They’d have just thought “Well, if she’s not saying anything, then

she must be on the pill” and there’s that assumption that you’re going to

take care of the contraceptives. [Anita, 26 years, England]

Men’s proclivity to be more concerned with pregnancy than safe sex, and their inclination to assume that contraception is “being taken care of” by their partners, was reflected in Bianca’s sexual experiences with her sex partners during her trip. Bianca’s statements, and those of several other backpackers, suggested that some men were more preoccupied with determining if their partners were on the pill (or other contraceptive) than they were with discussing condom use. Even “consistent” condom users, like Oscar, reported that they would opt not to use condoms if their partner was on the pill.

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I always wear a condom anyway but this other girl that I’ve been seeing,

she’s on the pill. […] So I have had sex with her without having a condom.

[Oscar, 25 years, England]

Perception of a “relationship” also negatively influenced condom use among backpackers, particularly if hormonal contraception was used. Holland et al. (1991) have highlighted the complexities involved in insisting on continued condom use after women start using hormonal contraception.

The girl I was seeing for two months, like, I started wearing but she was on

the pill. Now I know that doesn’t stop you getting infections or …

[Russell, 28 years, Ireland]

As found in Flood’s research (2003), several of the men and women interviewees in this study quickly moved from condom use to sole reliance on hormonal contraception before it was possible to confirm being free of STIs, including HIV. The significant proportion of backpackers who relied solely on non-barrier contraceptive methods were vulnerable to STIs, yet may still have been vulnerable to pregnancy if they had unprotected sex within a month of starting the pill or if their partner did not take the pill appropriately. Several male backpackers talked of previous experience or

“close calls” with fatherhood prior to their trip, which incited fear and caution in their future sexual encounters. Similar accounts shared by men in Flood’s research reinforce that “heterosexual men’s desire to avoid pregnancy and fatherhood is a potential resource of safe(r) sex, and does inform some men’s use of condoms”

(Flood, 2003, p. 357).

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Logistical problems: availability, accessibility and affordability

Availability

Almost a fifth of men (18%, 21/114) and women (19%, 12/62) survey respondents who did not use condoms consistently with their last partner reported “no condoms were available during sex” (Table 10.2). Yet almost 80% (444/559) of the survey respondents reported carrying condoms at the time of completing the questionnaire.

Carrying condoms was slightly more popular among men (86%) than women (72%; 2

(1) = 17.29, p < 0.001).

Where the backpackers chose to carry their condoms may offer insight into why the condoms were not available when they needed them (Table 10.6). The most popular places for backpackers to store their condoms was either in their luggage (39%; men:

47%; women: 29%; 2 (1) = 18.81, p < 0.001) or in their hostel room (38%; men: 44% ; women: 30%; 2 (1) = 11.62; p < 0.001). Only a fifth (22%) of the survey sample carried condoms on their person. Men were significantly more likely to carry condoms on them than were women (33% vs. 8%; 2 (1) = 51.20, p < 0.001). Consistent with these survey findings, the men interviewed preferred to carry condoms in their wallet or a back pocket of their pants, which improved the accessibility of condoms, regardless of the location where sex occurred. The women interviewees often reported that they preferred to store them in their backpacks. These women acknowledged that, despite their good intentions, they often could not produce a condom if sex occurred outside the immediate vicinity of their hostel room. There were more than twice as many women as men who reported not carrying condoms at all (men: 14% vs. women: 31%;

2 (1) = 25.98, p < 0.001). By not carrying condoms on their person, or at all, these

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women acted as passive agents in their sexual decision-making and thereby put their personal sexual safety and that of their partners at risk.

Table 10.6: Location preferred by backpackers visiting Australia to store/carry condoms, stratified by sex

Carrying/Storing condoms: Mena b Womena b Total locations on Trip n (%) n (%) n (%)

Any location (n = 553)*** 269 (86.5) 175 (72.3) 444 (80.3) In your luggage (n = 553)*** 145 (46.6) 69 (28.5) 214 (38.7) In your room (n = 553)*** 138 (44.4) 73 (30.2) 211 (38.2) On your person (n = 552)*** 102 (32.8) 18 (7.5) 120 (21.7) Not carrying any condoms (n = 553) 42 (13.5) 76 (31.4) 118 (21.3) a 316 (56.5%) men and 243 (43.5%) women completed the survey. Response rates vary for individual questions and are referenced in this table. *** represents statistical differences between men and women at the p < 0.001 level b Proportions were compared using the chi-squared distribution.

Anika, who frequently had unprotected sex with her new partners, recognised the foolhardiness of not carrying condoms with her. Like many other backpackers in this study, Anika often had sex at the end of an evening spent socialising in a bar, and while intoxicated. Unless she had sex in her hostel room, she was unable or chose not to supply a condom.

No, I have some in my backpack but it’s just a joke. Me and some of my

friends, we did have some so I had them in my bag over the weekend but I

didn’t use them. [Anika, 20 years, Denmark]

Health care providers stated that some backpackers were not equipped with condoms and consequently did not use any during these new sexual encounters simply because they did not expect to have sex on their trip.

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I guess that sense that people aren’t expecting to have sex; if you’re

expecting to have sex, you’re often prepared. If you’re not expecting,

you’re not prepared and frequently backpackers’ sex is something that just

happens, late at night. They could be drunk and get into conversation with

someone you met but haven’t prepared and, at three o’clock in the

morning, where can they get a condom? So I guess it’s those sorts of things

that get in the way. [Counsellor: #7/C2]

Ideals of femininity constrained some women’s willingness to be prepared with condoms prior to an evening at the bar for fear of appearing that they were “looking for it”. Heterosexual men, in contrast, felt their virility was reflected in their willingness to carry condoms as a testament that they were always ready to have sex. Furthermore, men may have felt they could not refuse sex even if they did not have a condom.

I think boys generally tend to take risks in terms of not using condoms. It

was often that they didn’t have them at the time, they thought about it at

the time but just didn’t have it, so they still went ahead [with sex] … that

sort of thing. [Nurse: #9/N2]

The survey results revealed a clear association between carrying condoms on your person and their use with a new partner (2 (1) = 15.51, p < 0.001). Nearly three quarters (72%, 57/79) of those who were carrying condoms on their person used a condom on the last occasion of intercourse during their trip. However, as the rest of this chapter shows, there were clearly other factors that negatively influenced condom use given that 28% of this group did not use condoms despite their availability.

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Access

The logistics of buying condoms in an unfamiliar country posed a problem for a very small proportion of backpackers in this study. Only 3% (5/176) of the survey sample marked “I couldn’t find any [condoms] to buy when travelling” as a reason for their unsafe sex (Table 10.2). Given that the majority of these respondents had not travelled to third world countries, they may not have encountered these challenges with condom acquisition. However, discussions with health care providers regarding barriers to condom use suggested that this had been an issue for a number of their backpacker clients. This highlights the importance of education for backpackers prior to travelling on possible problems regarding access to condoms in countries where the language is foreign and the cultural attitudes to condoms may be negative.

Well, I think there are problems about access and certainly, you know, say

I had somebody that I knew was going on a backpacking holiday, on one

hand there would be a bit of a dilemma about, do you take your condoms

with you and whether they’re going to actually still be safe after going

through changes in climate or that sort of stuff, or how reliable condoms

are that are tested in other countries, and stuff like that. About access, I

mean, in countries like Australia it’s very easy to go into a supermarket or

chemist or whatever. You know, in pubs there’s vending machines. But in

other places around the world, that isn’t the case. [Nurse: #9/N3]

You know, even just knowing where to get the condoms and how to get a

hold of them, what different cultures need to buy them in different

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countries, what they’re called. It’s the logistics that can become a problem.

[Counsellor: #7/C2]

I spoke to a traveller who went to Austria and he said he went to Vienna

and couldn’t find them [condoms to buy] anywhere. It does sound really

bizarre. But still the point remains that it may be two o’clock in the

morning and maybe you don’t actually know your way around Vienna very

well, and maybe you can’t speak German and you just don’t know where

to go. [Doctor: #3/D3]

Affordability

Concerns over dwindling funds for the remainder of their journey were a consistent theme during my interviews. Excessive spending on entertainment and alcohol at the beginning of the trip made it necessary for many backpackers to find employment in order to replenish their travel finances. However, their wages were often lower than they could earn in their usual jobs at home and consequently most backpackers became concerned about over-spending. During my fieldwork, several backpackers indicated that they would use condoms more often if they were available to them at no cost. The cost of condoms was perceived by some of the clinic staff as a barrier to their use for this extremely budget conscious travel population.

I think access to free condoms [would encourage backpackers to practise

safe sex]. They are very stingy; it could be the difference between a meal

and purchasing a condom [Nurse: #8/N1]

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Well I think financially they just won’t go out there and buy them. They

cost … most of them mentioned huge financial problems. You know, they

didn’t have work and they were living hand-to-mouth. Some of them didn’t

have enough money to eat, sort of thing. They’d be using all their money

to go drinking and … you know. So I don’t think they’d buy condoms. If

they were given them, they’d use them. [Nurse: #9/N2]

Entertaining the possibility of providing free condoms to the backpacking populations raised significant issues for clinic staff. New South Wales public health clinics did not have the budget to provide hostels with unlimited free condoms. There was also a concern it would encourage backpackers to be dependent on receiving free condoms and might discourage a sense of self-efficacy and personal responsibility for themselves and their sex partners, particularly when many of the backpackers who visited the clinics would rather spend their money on alcohol than protecting their sexual health.

Conclusion

Backpackers’ condom use behaviour abroad was broadly a reflection of their condom use behaviours at home. Consistent condom users appeared to adopt a general assessment of risk toward contraceptive use; whereas inconsistent condom users were more likely to be influenced by their own personal perception of risk and other external factors. Condoms carry symbolic meanings in a sexual encounter. Their use or non-use is grounded in the construction of heterosexuality and related gender power struggles and is highly dependent on who the partner is and the characteristics of the situation, and may vary over time. Young and inexperienced backpackers were

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often ill prepared to navigate their way through the complexities that accompany subjective assessments of risk in an unfamiliar context.

A significant number of backpackers were at risk of acquiring STIs, including HIV infection. Sexual risk, together with backpackers’ propensity for rapid partner change, placed them and their partners in optimal circumstances to act as vectors for the rapid dissemination of infectious pathogens. Despite these findings, many of the backpackers in this study failed to perceive themselves as at risk for contracting STIs.

Health implications and recommendations

Global estimates of the burden of ill health due to STIs are on the rise, particularly in young people (Dehne & Reidner, 2005), but the precise magnitude is unknown

(Memish & Osaba, 2006). Significant proportions of individuals infected with STIs are asymptomatic, yet international rates of STI incidence are derived from STI surveillance systems that are based primarily on reports of symptomatic STI cases.

Consequently, the current estimates of global and regional STI incidence are probably substantial underestimates (WHO, 2002).

Young people are particularly vulnerable to STIs including HIV as they generally have higher numbers of sex partners and a faster rate of partner change than older age groups (Brown et al., 2004). “Almost two-thirds of sexually transmitted infections are contracted by people under 25 years of age” (East et al., 2007, p. 108). The sexual health of young people has deteriorated in some developed nations in recent years

(e.g. UK, USA, Switzerland, Sweden) (Hughes & Bellis, 2006). Numerous countries, including the UK and Australia, are currently experiencing an alarming increase in the incidence of Chlamydia trachomatis infection. Currently, chlamydia is the most commonly reported notifiable infection across NSW and the incidence of genital chlamydia infection in NSW more than tripled between 2000 and 2007 (NSW Health,

2008). According to the Health Protection Agency, the 2006 rate of diagnoses in

GUM clinics in the UK was two and a half times higher than in 1997. Two-thirds of CHAPTER 11: HEALTH IMPLICATIONS AND RECOMMENDATIONS 277

genital chlamydia infections diagnosed at GUM clinics during 2006 were in young adults. Further, approximately one in 10 of the 14,939 young adults (aged 16 to 24) who were screened outside GUM clinics were infected with chlamydia. This has clear implications for infection dissemination. STI diagnoses are increasingly being made in general practice settings, which suggests that they are not restricted to small subgroups of young people but broadly spread across the general under-25 population (Health

Protection Agency, 2007). Given that the majority of young backpackers travelling to

Australia originate from the UK, these findings are of great public health concern.

“The prevalence of STIs in the community and core group that the new partner is from is a major determinant of risk” (Rogstad, 2004, p. 215).

Because of the way in which STI data is collected it is difficult to quantify the association between travel and risk of infection. However, reviews of the literature have made clear the connections between travel, sexual behaviour, and an increased propensity for acquiring STIs (Memish & Osaba, 2006; Ward & Plourde, 2006b).

Several studies reveal that the transmission rates of STIs among travellers are of concern (Arvidson et al., 1996; Catchpole et al., 1997; Etkind, Ratelle, & George,

2003; Hawkes et al. 1995; Steffen, deBernardis, & Baños, 2003; Thompson & Najera,

2001), and recent data from the Sydney Sexual Health Centre shows that chlamydia diagnoses were more common among backpackers than in the local population of young people attending the clinic (Egan et al., 2005). It is undeniable that backpackers play a significant role in the transmission of STIs from one population to another.

Backpackers cross international borders within the incubation period of many STIs

(de Schryver & Meheus, 1989). Their risk behaviours serve to sustain transmission of

278 CHAPTER 11: HEALTH IMPLICATIONS AND RECOMMENDATIONS

STIs in the backpacking community and beyond to future partnerships with local inhabitants and compatriots upon returning home.

This chapter explores backpackers’ concern over their sexual health, the occurrence of

STIs among backpackers visiting Australia, and the observations of health care providers regarding the challenges to improve backpackers’ health protective and health monitoring behaviours.

Was sexual health a concern for backpackers during their trip?

Survey respondents were asked to indicate what concerned them during the trip, choosing from a list that included drinking water, sickness/diarrhoea, sexually transmitted infections, HIV/AIDS, etc. (See Table 13.1 for full list) Concerns about getting pregnant or getting someone else pregnant were less common (19%) than concerns about STIs or HIV (29%; 23%, respectively). Men were significantly more likely than women to be concerned about contracting STIs (34% of men, 23% of women; 2 (1) = 7.33, p < 0.01) or HIV (29% of men, 15% of women; 2 (1) = 13.72, p <

0.001). More men were concerned about unplanned pregnancy, but the gender difference was not significant (22% of men, 16% of women).

Other research has found that women perceive the risk of an unplanned pregnancy to be more immediate and of greater concern than the risk of being infected with an STI or HIV (Kirkman et al., 1998). My interviews with the sexual health care providers corroborated these findings, yet the survey results did not. In fact, backpackers were more likely to report being concerned about sun damage to their skin than about

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becoming infected with STIs, HIV, or an unplanned pregnancy. The risk of sustaining sun damage while travelling in hot climates is real and immediate, but the backpackers’ assessment of risk relating to their sexual health suggests they had a low perception of risk despite their inconsistent condom use. In fact, backpackers who were inconsistent condom users during their trip were statistically no more likely than consistent condom users to report any concerns regarding STIs (consistent, 55% vs inconsistent, 45%),

HIV (consistent, 55% vs inconsistent, 45%), or unplanned pregnancy (consistent, 50% vs inconsistent, 50%); these findings did not differ significantly according to gender.

Table 11.1: Health concerns during backpacking trip, stratified by sex

Mena Womena Total Health concerns n (%) n (%) n (%)

Skin/Sun damage (n = 557)*** 145 (46.0) 145 (59.9) 290 (52.1) Violence (n = 557)*** 89 (28.3) 116 (48.0) 205 (36.8) Sexually transmitted infection (n = 557)** 106 (33.7) 56 (23.1) 162 (29.1) HIV/AIDS (n = 557)*** 90 (28.6) 37 (15.3) 127 (22.8) Tropical diseases (n = 557) 58 (18.4) 60 (24.8) 118 (21.2) Sickness/diarrhoea (n = 557)*** 44 (14.0) 64 (26.4) 108 (19.4) Pregnancy (n = 556) 69 (22.0) 39 (16.1) 108 (19.4) Drinking water (n = 557)* 46 (14.6) 52 (21.5) 98 (17.6) No worries (n = 556)** 74 (23.6) 35 (14.5) 109 (19.6) a316 (56.5%) men and 243 (43.5%) women completed the survey. Response rates vary for individual questions and are referenced in this table. */**/*** represent statistically significant differences between men and women at p < 0.05, 0.01 and 0.001 levels respectively. b “Other worries” recorded by survey participants included: 1) “Insects”, “reptiles”, “spiders”, “jellyfish”: 23 (4.1%); 2) “money”: 1 (0.2%); 3) “losing passport, money”: 1 (0.2%); 4) “SARS”: 2 (0.4%); 5) “Diet”: 1 (0.2%).

STI history

Consistent condom use is a very effective method to reduce the risk of acquiring STIs, in particular bacterial STIs (chlamydia, gonorrhoea, and syphilis) and HIV (Mindel &

Estcourt, 2000). At the time of the study there were no statistics available on the

280 CHAPTER 11: HEALTH IMPLICATIONS AND RECOMMENDATIONS

prevalence of STIs (including HIV) among backpacking populations. The survey respondents were asked about their STI diagnoses prior to and during the trip.

The most commonly reported STI diagnosed prior to backpacking was chlamydia

(5%) and genital warts (human papilloma virus) (2%). Approximately three per cent of backpackers acquired an STI while travelling, including three backpackers who contracted HIV during their trip. Having a history of an STI/HIV prior to the trip did not necessarily improve backpackers’ consistency of condom use during their trip: 8%

(n = 22) of backpackers who experienced at least one STI diagnosis prior to the trip continued to engage in high-risk sexual behaviour while travelling (Table 11.3). While these numbers are small, it is alarming to note that the majority of those with a history of one or more STIs continued with inconsistent condom use practices (55%; 12/22).

The few backpackers surveyed who reported an STI or HIV diagnosis believed they contracted the infections during their current trip.

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Table 11.2: STI/HIV diagnoses before and during backpacking trip, stratified by sex

Mena b Womena b Total

n (%) n (%) n (%)

STI before trip Chlamydia/NSU (n = 543) 14 (4.6) 13 (5.5) 27 (5.0) Genital warts (n = 538)** 2 (0.7) 10 (4.3) 12 (2.2) Gonorrhoea (n = 529) 2 (0.7) 0 2 (0.4) Genital herpes (n = 539) 1 (0.3) 0 1 (0.2) Syphilis (n = 538) 1 (0.3) 1 (0.4) 2 (0.4) HIV (n = 538) 2 (0.7) 0 2 (0.4) STI acquired during trip Chlamydia/NSU (n = 542) 2 (0.7) 1 (0.4) 3 (0.6) Genital warts (n = 542) 2 (0.7) 1 (0.4) 3 (0.6) Gonorrhoea (n = 540) 1 (0.3) 0 1 (0.2) Genital herpes (n = 540) 1 (0.3) 0 1(0.2) Syphilis (n = 541) 2 (0.7) 0 2 (0.4) HIV (n = 540) 3 (1.0) 0 3 (0.6) a 316 (56.5%) men and 243 (43.5%) women completed the survey. Response rates vary for individual questions and are referenced in this table. ** represents statistical differences between men and women at the p < 0.01 level. b Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Table 11.3: Tally of sexually transmitted infection (STI) history before trip and consistency of condom use during trip

Condom use during trip

Consistenta c Inconsistenta c Total n (%) n (%) n (%) STI history prior to travel (n = 538) b 0 STI 148 (93.7) 130 (91.5) 278 (92.7) 1 STI 10 (6.3) 10 (7.0) 20 (6.7) 2 STI b 0 2 (1.4) 2 (0.7) a 300 (54.0%) had sex with someone new during their trip. Response rates vary for individual questions and are referenced in this table. b Maximum number of STIs reported prior to travel was two. c Proportions were compared using the chi-squared distribution. Where cell sizes are small (<5) Fisher’s exact test was employed.

Only one of the backpacker interviewees who reported unprotected casual sexual encounters while travelling had had a sexual health screen while abroad. All the interviewees stated that it would be prudent to get tested for STIs/HIV while abroad yet wanted to wait until they returned home before seeking out sexual health services.

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Interviews with the sexual health clinic staff confirmed that many backpackers delayed seeking sexual health services and that some refused to get tested for HIV out of fear of what the test results would be, and because they did not have their usual support system. Furthermore, asymptomatic backpackers who attempt to access free sexual health services may meet with difficulties (see section on “Assessment of need/limitations of funding”). Given that many women and men who are infected with

STIs are asymptomatic, it is likely that the STI/HIV diagnoses among backpackers in this survey are an inaccurate reflection of the actual infection rates in this population.

Nevertheless, almost 1% of the sample (5 men, 0 women) knew they were infected with HIV at the time of the survey. Two of these men, both from the Netherlands, acquired HIV before travelling and the remaining three men (1 UK, 1 Netherlands, 1 unspecified) were infected with HIV during their trip. All of these men reported exclusively heterosexual sexual intercourse during their trip. Two out of the five men who were HIV positive continued to be inconsistent in condom use with their last partner, despite awareness of their seropositive status, and one of these men reported having sex more than 20 times with his last partner. Similar findings by Salit and colleagues revealed that 58% of the HIV-positive Canadian travellers surveyed who reported casual sex while overseas did not use condoms consistently with their new sex partners (Salit, Sano, Boggild, & Kain, 2005).

Given the small number of backpackers upon which the analysis is based, it cannot be claimed that the prevalence rates of STI diagnoses can be generalised to all young heterosexual backpackers visiting Australia or other international countries. The prevalence of STIs among representative populations of backpackers deserves further

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investigation. To date, the limited data on STI incidence in backpackers has been derived from ad hoc surveys in clinic samples. Therefore, while these estimates are useful they should be interpreted with caution.

The Hawkes et al. (1994) study of new patients attending a tropical diseases clinic in the UK found that 57% (n = 79) of their respondents who reported new sexual partner(s) while abroad were “long-term” travellers (at least three months on the most recent trip). Unfortunately, it is impossible to determine from the presented analyses what proportion, if any, of these travellers were among their 16 respondents who were found to be HIV positive. Other research done by Arvidson et al. (1996) and

Bavastrelli et al. (1998) with “vagabond” travellers has also highlighted the increased incidence of STIs, particularly chlamydia (Chapter 2). Finally, analysis of the medical records of 170 women diagnosed at Sydney Sexual Health Centre (SSHC) with chlamydia between 1997 and 2003 revealed that “being overseas-born or having a sexual partner from abroad were independently associated with an increased risk of chlamydia” (Chen, Rohrsheim, & Donovan, 2005, p. 413). This study prompted

SSHC to collaborate with me to investigate further the incidence of STIs among backpackers attending the centre. We found that backpackers were more likely than the comparison group to have STI screening as the reason for their visit (p < 0.0001), to report a history of genital chlamydia infection (15% vs 9%, p < 0.0001), and to be diagnosed with chlamydia at their initial visit (8% vs 5%, p < 0.0001) (see Appendix M for further detail on this study) (Egan et al., 2005). Overall, the data from SSHC and other clinic studies presented here confirm that international long-term travellers are at high risk of contracting an STI. Clearly, clients attending a public sexual health centre are not representative because they may exhibit greater sexual risk-taking and genital

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symptoms of STIs than the backpacking population as a whole, yet previous research has argued that it is appropriate to study sexual health clinic attendees because “they are likely to be precisely the travelers most at risk of sexually transmitted infections”

(Clift & Carter, 2000; p. 16–17).

Interviews with clinic staff

Interviews were conducted with 18 doctors, nurses, and counsellors working at free sexual health clinics, travel clinics and general medical practices in Sydney. The information gathered offered valuable insights into the sexual behaviour and risk taking of backpackers, their sexual health needs, and general perceptions of how this population’s risk behaviour compares with the general Australian young population. It also highlighted barriers to opportunistic screening and diagnoses in the backpacking population visiting Sydney. In this chapter, the terms “sexual health care providers”,

“health care providers” and “clinic staff” are used interchangeably to describe the participants who worked in any of the six Sydney clinics that participated in this study.

Reasons for seeking sexual health screening

Generally, sexual health clinic services include contraceptive advice, emergency contraception, STI testing, treatment, and counselling. More women than men use sexual health clinics. Women are often socially positioned as responsible for accessing information about sexual health and monitoring their sexual health. Women routinely attend clinics for Pap smears and so are in an ideal position during these assessments to be screened for STIs. However, there is a common misapprehension among young women that a Pap smear certifies a “clean and clear” STI result rather than just

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screening for precancerous changes in the cervix (Head, Crosby, Shrier, & Moore,

2007, p. 273). Nevertheless, all of the health care providers interviewed perceived women to have better health-care-seeking and monitoring behaviours than men.

I think that women generally have a better health-seeking behaviour than

men and they are more likely to come into clinics and have check-ups but

as receptive partners they are at higher risk of some of the infections

anyway … [Nurse: #12/FG]

Women’s proactive attitude with regard to their sexual health monitoring offers them more opportunity and familiarity with contraceptive options and the STI screening process. In contrast, young men’s lack of familiarity with sexual health monitoring makes them reluctant to engage with sexual health services until their fear overcomes their reticence.

I see more women than men. Men tend to come in only when they are

symptomatic … Australia-wide. Women tend to come in for screens. […] if

women have unprotected sex they will come in and have a test, whereas

men will only come in if they have a [purulent] penis.[Doctor: #4/D4]

In general, fear of HIV rather than other more prevalent STIs is what motivates backpackers to seek sexual health screens.

People tend to come in and want to be only tested for HIV. They forget

about other things. [Nurse: #13/FG]

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According to sexual health care providers, heterosexual backpackers are far more at risk of contracting STIs other than HIV in Australia. All providers concurred that only a handful of backpackers who had been screened at their clinics were seropositive.

Backpackers wanting a screen: they mostly present as being worried about

HIV. They are, in fact, most frequently being at risk of other STDs, more

likely to be chlamydia or gonorrhoea. [Nurse: #10/N3]

Delaying the inevitable. Backpackers that did request an STI screen often did not present to clinics until the end of their trip. It appears that some backpackers delayed getting tested for STIs/HIV out of fear of what the results might show. For many backpackers, this was their first time away from home and they were distant from their usual support systems. Many backpackers had never had sexual health screens done before and became acutely embarrassed and anxious about disclosure of their sexual risk-taking behaviour and about what a sexual health screening might entail. Staff said backpackers were often extremely anxious and nervous about receiving the test results.

Seeking an “all clear”. Although they rarely used condoms while travelling, they often panicked at the thought of infecting their regular partner at home, so they attended the clinic seeking an “all clear” immediately before returning home. This suggests that the source of backpackers’ motivation for screening was either their concern for their partner’s sexual health or fear of being exposed as a philanderer, rather than concern for their own sexual health. Perhaps the impending date of departure to their home country and associated daily routines reminded them of the health monitoring practices they would normally follow at home. It is also possible that for some

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backpackers, getting tested for STIs/HIV prior to returning home was a way of separating their sexual behaviour on the trip from their behaviour at home: “what happens on the trip, stays on the trip”, thus reinforcing the liminal nature of their backpacking experience.

Backpackers’ delayed decisions to seek sexual health services presented a notification dilemma for sexual health providers. Frequently, backpackers attended for STI/HIV screening on the eve of their return flight home and the time lag of processing clinical samples meant that the results were often not available until after backpackers had already departed from Australia.

They all tend to come before they go home to their partners and want an

“all clear”, we get that a lot: “I am flying out in a week, I thought I would

get all these tests”. It is like oh, great, okay, number one we don’t get all

these tests back in a week and you know, don’t you think you should have

done this sooner rather than you know after you have been having

unprotected sex for a year while you have been travelling around? [Nurse:

#8/N1]

According to Australian clinic protocols, test results should only be disclosed to patients by a doctor and in a personal consultation, but the growing problem of positive test results not being delivered to backpackers has spurred health providers to explore alternative channels of notification. Email, the most commonly used form of communication among backpackers, would appear to be the most effective way to notify backpackers of the necessity of STI treatment before they infect others.

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However, this approach does have shortcomings, which make it problematic. Email is a notoriously insecure method of communication, so there are issues regarding violation of privacy laws for a sexual health centre. Email communication would be limited to a request to make telephone contact with the sexual health centre. If the backpacker had already moved on to another region, they would have to contact another sexual health clinic in order to obtain detailed results of testing and to receive post-test counselling. It would present additional workload for the first sexual health centre to transfer the test results to a clinic in another region.

Nevertheless, it is imperative that health providers find an effective method of communicating test results to this transient population, as the potential for an STI epidemic among backpackers grows with every subsequent sexual partnership.

Perceptions of prevalence

Health care providers reported that approximately 10 to 50 per cent of the clients who accessed sexual health services were backpackers. Free public health clinics reported significantly greater numbers of backpackers than fee-based clinics.

At the time of my interviews with sexual health care providers, no data had been published on the results of STI tests in backpackers attending clinics. Thus it was difficult for the staff to accurately compare the frequency of STI diagnoses among backpackers. Yet almost all of the clinic staff estimated that approximately 15 to 20 per cent of their backpacker clients tested positive for one or more STIs. A doctor working at a clinic in the Bondi area of Sydney reported that one in three backpackers

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who attended his clinic had an STI on testing, and remarked that the “commonest contact sport in Bondi is not football”. A doctor working in a public clinic commented:

I’d say that amongst the asymptomatic screens we’d see as high, if not a

higher, than average prevalence of things like chlamydia and certainly in

recent times there is a sense, certainly in the last few years, you are more

likely to have chlamydia if you have come in as a backpacker than as a

local asymptomatic person coming in for a check-up. I don’t have any data

to back that up but it is a sense. [Doctor: #1/D1]

Sexual health protection challenges

Knowledge. Sydney health care providers perceived that backpackers were knowledgeable about how to protect themselves from STIs but not very knowledgeable on how to detect the related symptoms. This lack of knowledge may delay the pursuit of health advice and sexual health screening and consequently increase reproductive morbidity among backpackers. Chen et al. (2005) found that women infected with Chlamydia trachomatis were more likely than those who were not, to present with dysuria and/or postcoital bleeding, but were no more likely than the comparison group to report intermenstrual bleeding, abdominal pain, or vaginal discharge. This lack of knowledge may, in part, reflect the absence of pre-travel advice about STIs (Table 11.4).

Pre-travel sexual health advice. What needs to be done before backpackers leave their home countries? What sexual health services should be available to them on arrival in

Australia? All of the health care providers regarded the pre-travel health advice

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received by the backpackers as woefully inadequate. The pre-travel vaccination consultation is an ideal opportunity to impart sexual health education to prospective travellers (Allard & Lambert, 1992; Hynes, 2005; Marrazzo, 2005; Rogstad, 2004;

Ward & Plourde, 2006a), yet health care providers in Sydney reported that few of their backpacker clients had received any sexual health information before departure. They were particularly concerned with the lack of pre-travel sexual health counselling to UK backpackers. As one doctor said:

[I am] surprised at the level of discussion of these matters overseas and the

amount of backpackers that I see arriving who haven’t had hep B

immunisations. I find this particularly from people in the UK. I think it is

because of the situation with the NHS [National Health Service] and most

of the vaccinations are provided by the NHS and they seem to go and see

their practice nurse over there and nurse tells them how hep B is

transmitted and the backpackers will say “Oh I won’t be needing any of

that” and so the nurse gives them the hep A shot and not the hep B

instead of the combined hep A/B shot which would be much more

suitable for these travellers. And I think that more young travellers should

be immunised with [against] hep B. And the other good thing about talking

with them about hep B immunisation is that it gives me an in to inquire

about sexually transmitted infections, so I will say it is really good to have

this vaccine because it is a very good vaccine, it is a life-long vaccine, it is

the most common sexually acquired infection, and it is the only sexually

acquired infection that is preventable with a vaccine. Of course, you still

need to be very, very careful because there are others. And I do get the

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impression from those who come in for this vaccine that they do not have

this information. [Doctor: #3/D3]

In my conversations with backpackers it was clear that they were interested in preserving their sexual health yet many were not offered accurate information prior to travel, of the sexual health risks associated with unprotected sex in developing and third world countries. In the questionnaire component of this study, backpackers were asked to identify one or more sources of pre-travel advice prior to their trip, and whether this advice included information on HIV.

The survey sample received their travel advice from a variety of sources, including: medical doctor (GP, travel clinic or other), an ancillary source (travel agent, medical insurance documents), a personal source (family/friends), or more than one source.

One fifth of the sample received no health advice at all (Table 11.4). Women were more likely than men to seek health advice before their trip. In particular they were significantly more likely to receive health advice from their family doctor (men 34%; women 43%; p < 0.05), family (men 27%; women 37%; p < 0.01), or from their medical insurance (men 18%; women 25%; p < 0.05). Of concern was the finding that only 28% of the survey sample recalled receiving any pre-travel advice on how to avoid contracting HIV, which indicates more than 70% of the sample who did not receive, or can not recall if they received, any sexual health counselling prior to their trip.

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Table 11.4: Source of health advice received by backpackers visiting Australia, stratified by sex

Mena c Womena c Total n (%) n (%) n (%)

Source of health advice (n = 557)b Family doctor* 107 (34.0) 104 (43.0) 211 (37.9) Travel clinic 42 (13.3) 37 (15.3) 79 (14.2) Other medical clinic 16 (5.1) 7 (2.9) 23 (4.1) Family** 84 (26.7) 90 (37.2) 174 (31.2) Friends 82 (26.0) 79 (32.6) 161 (28.9) Medical insurance* 56 (17.8) 60 (24.8) 116 (20.8) Travel agents 37 (11.7) 32 (13.2) 69 (12.4) No advice** 76 (24.1) 37 (15.3) 113 (20.3) Did health advice include information 92 (31.1) 53 (23.3) 145 (27.7) on HIV? (n = 523) a 316 (56.5%) men and 243 (43.5%) women completed the survey. Response rates vary for individual questions and are referenced in this table. */** represents statistical differences between men and women at the p < 0.05 and 0.01 level. b “other” advice sources recorded by survey participants: school 10 (1.8%); Internet 2 (0.4%); guidebook 2 (0.4%). c Proportions were compared using the chi-squared distribution.

Receiving sexual health information did not necessarily improve the consistency of backpackers’ condom use. Consistent condom use with new partners while travelling appeared slightly more common among backpackers who received sexual health information before travel (58%, n = 55) than those who did not (42%, n = 40), but these findings were not statistically significant and did not differ across genders (58% of men and women). The insignificant influence of sexual health advice on health protective behaviours brings into question the quality of information offered. An assessment of pre-travel sexual health advice is warranted and should be a priority internationally. However, these results concur with the backpacker interview findings, which indicated that any individual is inclined to compromise their usual safe sex behaviour, particularly if certain characteristics of the situation are present. Therefore, these findings reinforce the necessity for context-specific sexual health initiatives for backpackers. Numerous study respondents voiced their feelings of appreciation to me.

Participation in this study served to remind them of the risks associated with unprotected sex, particularly during travel in the backpacking context.

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Good idea. Hopefully there will be some interesting findings made and

hopefully some good will come of it. Maybe even people filling out this

questionnaire will think more about using condoms, not just here but

when they get back home too. [#151, Male]

I think this questionnaire has made me think more about the

consequences of having sex with strangers and made me re-think a few

things. [#456, Female]

Awareness and access to Sydney STI services. Opportunistic screening in Australia of sexually active backpackers for STIs is limited because most backpackers, as I found during my fieldwork, are unfamiliar with the system of sexual health services available to them. Backpackers often cannot afford fee-for-service sexual health consultations, let alone the cost of treatments for diagnosed infections. They were recognised by health care providers as “at risk”, but unless they had symptoms, they did not have access to free sexual health services.

Assessment of need/limitations of funding. All the health care providers perceived backpackers to be at greater risk of contracting STIs than Australian young people in general. However, the clinics were limited by protocols in the services they could provide. Sexual health clinics funded by the government are currently mandated to prioritise access to population groups identified by the NSW sexually transmitted infections strategy, which are: Aboriginal people, men who have sex with men, young people, sex workers, people with HIV/AIDS, people who inject drugs, and heterosexuals with recent partner change [NSW Health, 2006]. Despite backpackers

294 CHAPTER 11: HEALTH IMPLICATIONS AND RECOMMENDATIONS

primarily being “young people” and “heterosexuals with recent partner change”, NSW

Health and the rest of Australian government funding bodies do not officially identify backpackers as belonging to any of these priority groups. Despite recognition in the policy document that some groups, like young travellers or backpackers, “may require additional focus” (NSW Health, 2006), public sexual health clinics have a finite capacity and therefore tend to restrict their services to people who are eligible for

Medicare, or have symptoms of an STI. Consequently, backpackers are under- serviced at free public health clinics in Sydney, particularly those that are larger and centrally located.

Without prevalence data on the sexual risk behaviour and sexual morbidity of this population, it is difficult for NSW Health to address the concern that backpackers may be an “at risk” group that could act as a “core group” of efficient transmitters of infectious pathogens. At the time of the study, the intake sexual health assessment forms used in sexual health clinics across Australia were not standardised. Improved and standardised assessment tools would enable all Australian clinics to gather reliable data. Information analysed from these assessment forms would assist the federal government to determine whether backpackers should be targeted as an at risk group.

Therein lies a source of frustration for health care providers working within this mandate, particularly for those clinics that see many backpackers trying to access their services. A nurse that works at a busy sexual health clinic in Sydney talked of the challenges that publicly funded clinics face in providing services to backpackers without Australian Medicare cards.

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The other thing that does not have anything to do with them practising safe

sex or not, is the issue to do with them not having a Medicare card, which

is why they come to [free] clinics like this, and a lot of public sexual health

clinics don’t want to service travellers because they are not funded to see

travellers in your area and you give that service to a traveller and that takes

time away from people from your area, which is a contentious point

because they [backpackers] are what we would call a high-risk group, they

are in our population … and then you have got the other side of things, you

know, you got NSW Health saying that you’re supposed to be providing

services to Medicare-eligible people not Medicare ineligibles. A push you-

pull you thing happening. [Nurse: #8/N1]

Denying asymptomatic yet sexually risk-taking backpackers prompt access to sexual health screens can only contribute to the proliferation of STIs between backpackers and the inhabitants of the countries that they visit. Sexual health providers are all too familiar with the unreliability of symptoms as a primary marker of STIs. As one sexual health provider stated, “our clinic is seeing asymptomatic backpackers and many are yielding infections”.

Non-English speaking travellers under-represented in clinics. A number of European countries have a reciprocal health care agreement with Australia and therefore a disproportionate number of backpackers who attend sexual health clinics originate from these countries.

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We tend to get English, Irish, Israeli, Swedish, Swiss, [and] European.

No, most of the people that I’ve seen have been English backpackers.

Through summertime, there’s a mix of … sort of more European,

occasionally American - North Americans or Canadians - and South

Africa. But mainly, mostly it’s English backpackers. [Nurse: #8/N1]

There seems to be some association between language barriers and delays in seeking assistance from sexual health clinics. Clinic staff reported that most of the backpackers who accessed their services proactively were proficient in English, but non-English- speaking backpackers that attended the clinics were often symptomatic by the time they sought assistance. This doctor talked about the language barrier being a deterrent for non-English-speaking backpackers.

English-speaking backpackers come in much quicker and earlier, it is

easier, than those who don’t have English as their first language, even if

they do speak English and it is not as their first language, they come in

later or they present later that they, yeah. [Doctor: #5/D5]

Japanese backpackers rarely attended Australian sexual health clinics, yet the histories of those that did were alarming, and most were women. They often delayed consultation until their STI symptoms were unbearable, leaving them no alternative but to seek treatment.

We don’t see many Japanese men … we have seen quite a few Japanese

women lately with STDs, quite a few Japanese women. I saw quite a few

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Japanese travellers when I was working at [a Sydney clinic] and they are

shocking with condoms, absolutely shocking. […] Well, they don’t use

them enough. And I really only saw Japanese women and whether it is

cultural that they don’t feel that they can negotiate condom use or

whatever that you would ask them to please use condoms and hardly none

[any] of them ever did. The other thing about Japanese women is that they

are more likely to come in for symptomatic screens. You know, it is like

they got to the point where they can no longer ignore this “I really have to

go see someone”. [Doctor: #4/D4]

Another health care provider reflected on her own misconception that Japanese people were generally very conservative and not risk-takers. She dispelled this stereotype and explained that the Japanese people she provided services to had, like any other individual seeking sexual health services, engaged in high-risk activity.

I mean the Japanese, particularly women, in fact I don’t seem to recall

seeing too many Japanese men, but certainly the Japanese women who

have been travelling, I think that there tends to be an image that they are

really not having sex, but they certainly are when you do see them [laughs],

[…] I suppose, there is a cultural perception that they are not out, because

they are not out there partying and drinking and it doesn’t seem to be the

cultural norm for them to be out and drink large quantities of alcohol in

public, but yeah, I have seen a lot of Japanese women over the years who

are having a lot more sex than I thought they would be. […] That is

probably my own cultural prejudice or stereotyping. [Nurse: #11/FG]

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Reaching people from different cultures, particularly non-English-speaking ones, at risk of contracting STIs continues to be a significant challenge for clinic staff. Seeking sexual health services can be daunting. The introduction of an interpreter into an otherwise private consultation can be a deterrent and is a possible reason for many to delay attendance at a clinic to address any anxiety and/or symptoms they may experience following unprotected sex. Experiences like these reinforce to health care providers, like this doctor, that they need to be sensitive to the needs of non-English- speaking people and encourage them to attend clinics after taking sexual risks, even if they are asymptomatic for STIs.

Japanese usually come in symptomatic and often there is a language

barrier too. And it is usually that we need to get an interpreter in and to go

to that amount of trouble we think that there is a problem there that needs

to be solved. It would be great if they could have access to some

asymptomatic screening and advice and information on contraception but

it is probably difficult for them to access if they don’t have a good

command of English. [Doctor: #1/D1]

Condom use among sexual health clinic clients is inconsistent at best and cannot be interpreted as a reflection of risk taking in the general population. However, these findings do offer valuable information on the differences in the level of knowledge and sexual risk taking between cultures and genders. Overall, British travellers were perceived to take more risks and more likely to be diagnosed with an STI than people from other cultures. Clinic staff reported that individuals who appeared uncomfortable and embarrassed in talking about sexual health matters generally were less consistent

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condom users and were more likely to present with an STI, whereas others who were more proactive in monitoring their sexual health demonstrated a good understanding of risk taking behaviours and were more empowered in negotiating condom use.

The perceptions by sexual health providers in this study may be falsely inflated by the fact that the majority of backpackers visiting Australia originate from the UK. The current “public health crisis” related to the sexual health of Britain’s young people is attributed to the poor quality and quantity of sex education in schools (“Health sexual risk to Britain’s teenagers”, 1999), the woeful state of the British GUM system

(“Britain in sexual health ‘crisis’”, 2005), and the trend toward a recreational attitude toward casual sex among many British young people. A recent survey for the BBC’s

Panorama programme found that over a quarter of all UK sexual health clinics were unable to treat patients needing urgent attention within the recommended 48 hours

(“Britain in sexual health ‘crisis’”, 2005). Britain has also been found to have the highest rate of teenage pregnancy (Donnelly, 2007) and binge drinking among young people (Standerwick et al., 2007) in Europe. The women in Standerwick et al.’s clinic study who were diagnosed with an STI drank 40% more alcohol per week than those who were not diagnosed with an STI.

Contact tracing

“Because so many people are currently travelling, the risk-taking behaviour of individuals can add up to epidemic spread rather quickly” (Ward & Plourde, 2006a, p.

8). Tracing the sexual contacts of backpacking patients who have an STI is difficult and often impossible. Most backpackers have no way to contact their sexual partners. The urgency for health providers to trace backpackers’ sexual contacts is compounded by

300 CHAPTER 11: HEALTH IMPLICATIONS AND RECOMMENDATIONS

their awareness of the increasing incidence of genetically permutated strains of

STIs/HIV among international travellers. The sexual intermixing of international backpackers and locals around the world will markedly increase the possibility of contracting more virulent (genotypes and serotypes) and antibiotic-resistant strains

(Ison, Dillon, & Tapsall, 1998).

Recommendations

The interviews with health professionals generated an abundance of ideas and suggestions to improve backpackers’ sexual health. The obvious challenge to the dissemination of pre-travel sexual health advice is that if backpackers are not required to obtain vaccinations prior to their trip, they frequently do not perceive any obvious reason to seek health advice or services. The health care providers recommended that all health practitioners enlighten patients who intend to travel of the structural, communal, and situational forces inherent to specific travel cultures (including backpacking) that may affect their sexual conduct. In particular, travellers need to be informed about health risks associated with unprotected sex, particularly in countries with high HIV prevalence. The popularity of the Thai bar girl scene with male travellers demands that travellers to South-east Asia be enlightened about the informal sex work system.

Health care providers recognised that innovative strategies were needed in order to reach young people unfamiliar with how to access sexual health information and services in foreign countries. Several recommendations for outreach to backpackers travelling in Australia included:

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(1) Improving awareness and access to free sexual health services in areas near hostels;

(2) Raising awareness through poster advertisements and print media such as free backpacker and music magazines, particularly regarding the prevalence of over- consumption of alcohol and the related risks to sexual decision-making. Health promotion messages should also be displayed on the back of toilet cubicle doors in hostels, backpacker bars/pubs, and airports.

(3) Proactively connecting with backpackers by making regular scheduled health visits to hostels in order to disseminate sexual health information, answer questions, and offer sexual health screening;

(4) Improving access to condoms by distributing free condoms to hostels and advocating the installation of condom vending machines in discreet locations where backpackers pursue new sexual partners.

(5) Conducting opportunistic chlamydia screening by collecting urine samples from sexually active men and women staying in backpacker hostels, as recommended by

Chen et al. (2005). These young travellers could be notified of their test results via email or mobile phone text message (SMS).

An example of an excellent sexual health resource currently available to travellers is in the form of a small, portable, and quick reference guide called Your Passport to

Sexual Health. Marie Stopes International collaborated with the Travel Doctor TMVC

(Traveller’s Medical and Vaccination Centre) to produce this free booklet. It contains

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information on the availability of emergency contraception, contraceptive methods, abortion, STIs, and sexual health services (including helpline telephone numbers) offered in more than 100 countries (Marie Stopes International, 2005). Unfortunately, this publication is not widely available, and it is left to travellers to obtain their booklets from Marie Stopes International centres, the Travel Doctor TMVC clinics, or through the Internet. Without global promotion, extensive distribution, widespread availability, and proper dissemination of such a valuable resource, backpackers are unlikely to benefit from it.

Conclusion

Many STIs are silent and asymptomatic, yet largely preventable. An STI plays a pivotal role in facilitating the transmission of HIV. Backpackers’ marginalisation, poor access to services, and new or already existing behavioural risks while travelling contribute to their vulnerability to STIs. In view of the compelling evidence that backpackers engage in high-risk sexual behaviour, the number of young backpackers at risk of being infected is considerable.

Infected backpackers serve as effective conduits for the international dissemination of genetically diverse and antibiotic-resistant pathogens. Therefore, increased awareness by backpackers of the existence of asymptomatic STIs, and improved access to primary health care services for testing, diagnosis, and treatment are critical to their long-term health and the health of people they have contact with around the world.

The difficulties that asymptomatic backpackers currently face in accessing free sexual health services in Australia may have a disproportionate impact on rates of STIs in

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their concurrent partnerships and within local communities. Almost half the backpackers who had sex with new partners during their trip had sex with locals

(Chapter 7). So, while providing free STI screening, diagnoses, and treatment to international backpackers carries a financial burden to the Australian health care system, it is a necessary part of controlling local epidemics.

Sexual health providers recognised the necessity for a general screening program for backpackers in Sydney in order to ascertain their sexual health needs and to generate accurate statistics of STI prevalence. They acknowledged that the most effective method of conducting such a representative survey of backpackers would be to offer free voluntary screening to hostel residents. Prevalence of chlamydia could be assessed by conducting urine cultures on samples received from backpackers staying in a variety of Sydney hostels. Yet, at the time of these discussions, no funding was available to conduct such research, particularly when state and national government funding bodies do not categorise young long-term travellers as an at-risk population. While the findings of this study and Sydney Sexual Health Centre’s most recent study on the incidence of STIs among backpackers attending their clinic (Appendix M) cannot be generalised to represent the sexual behaviours of all backpackers internationally, they do indicate that backpackers need better access to sexual health screening in Australia, regardless of whether they are symptomatic or not. Thus, this young travelling subculture needs to be considered a priority population to be targeted for STI prevention and testing.

Conclusion

This chapter summarises the major findings, examines the limitations of this study, and discusses future directions for health initiatives that should target travellers. It discusses the implications for theory and for future research in relation to investigating the sexual behaviours and risk taking of backpackers.

Major findings

A social constructionist perspective was crucial to understanding the role of context in backpackers’ sexual behaviour and decision-making. Studying backpackers in their natural setting provided valuable insight into the manner in which relationships are formed, the patterns of interaction between people, the rules that govern behaviour in this travel context, and the range of “key players” in each setting.

The theoretical concept of liminal theory is useful to understand how backpacking is experienced. Backpackers collectively share an ideology of travel that differentiates them from short-term holidaymakers. However, many backpackers acknowledged that their travel behaviour was more in keeping with recreational tourists rather than intrepid travellers. Many backpackers spent months in Sydney drinking and socialising and ultimately achieved hostel veteran status rather than road status. Nevertheless, the transience, anonymity, and bonds of communitas in the backpacking environment CHAPTER 12: CONCLUSION 305

promoted intense personal connections over a very short period. Thus backpackers experienced authenticity through their interactions more than through sites visited and experience of the “road less travelled”. They experienced intense feelings by living “in the moment” with others while exchanging travel stories, having a laugh at the local pub, or during sex. These intimate moments with strangers generated a false sense of security.

Sexual attitudes and behaviour

In this travel context, backpackers lived in an atmosphere of sexual availability and opportunity that, for most, was anomalous to their normal lives. But it was not the liminal nature of travel alone, but rather a collection of factors unique to each of the social circumstances surrounding sexual encounters, that influenced backpackers’ sexual behaviour. For example the holiday atmosphere, excessive alcohol consumption, and feelings of disinhibition generated by sharing extraordinary, yet temporary, life circumstances often influenced these young adults to adopt a more liberal code of sexual behaviour that was predominant in this travel context.

There clearly was a dominant sexual script that was acted out by most of the participants in this setting. Sex was seen as another form of play, free of the emotional sentiments frequently attached to sexual partners in their home environment.

Consistent with the egalitarian bonds of communitas, both men and women were open in their pursuit of sexual pleasure and neither were subject to judgment by others in their own community because of it.

306 CHAPTER 12: CONCLUSION

Further research would be useful in gleaning a fuller understanding of the diversity of interpersonal sexual scripts and the intrapsychic meaning that the social and sexual norms unique to the backpacking culture have for young travellers. In addition, future research is needed to rigorously determine whether, and how, traditional scripts are modified, as backpackers’ compliance with the sexual scenarios common in this setting may exacerbate sexual risk-taking behaviours. It would be interesting to investigate in future research whether the sexual disinhibition that backpackers often experience while abroad is limited to this transient context or whether this behaviour carries over to their usual home environment upon their return.

Condom use and risk taking

The findings reinforce that sexual behaviour is extremely context specific, and while the former can contribute to the sexual decision making process, it is really the characteristics of each situation that shaped backpackers’ propensity to engage in sexual risk taking or not. Therefore, there is no profile of an “at risk” backpacker, but rather a constellation of high-risk behaviours that predispose a backpacker to contracting STIs while abroad.

Being caught up in the flow of the moment was a consistent theme. Flow is inextricably woven into the fabric of physical and social experience while backpacking. For many, being caught up in moments of interpersonal authenticity during sex was reported as the reason for their sexual risk taking. However, voluntary sexual risks taken by backpackers cannot be explained by liminality alone. Travel in itself does not predict increased sexual risk taking. For most backpackers, condom use behaviours did not vary from the context of home to that of travel. The concern is that some over-indulge

CHAPTER 12: CONCLUSION 307

in new or familiar patterns of behaviours, like drinking and sex without the use of condoms, and may be exposed to a higher degree of risk as a result of the increased frequency, partners, and settings in which they indulge.

Self and identity

The experience of backpacking can have a powerful impact on one’s sense of self and identity. Backpacking clearly offers therapeutic benefits to young people by providing protected time and space away from home to relax, reflect, and respond to their desires. It often had a profound effect on how they saw the world and themselves, in many cases for the first time. Frequently backpackers voiced disappointment with the recreational nature of their travel pursuits while in Australia, yet through their disappointment they learned valuable life lessons. During this period of personal reflection, backpackers were most receptive to learning about cultures, behavioural norms, and themselves. This may be an optimal time for health promotion campaigns to increase backpackers’ awareness on the risks of unprotected sex, given that their receptiveness to learning, and willingness to internalise these messages, would be optimal.

Narratives collected from backpackers demonstrated that identity development is both a primary motivating factor and positive outcome of this type of travel experience.

Extensive exploration into these lines of inquiry was beyond the purview of this study, however is a prime opportunity for future research.

308 CHAPTER 12: CONCLUSION

Health implications

Global mobility has increased the scope and speed of intermixing between populations. The number of backpackers visiting Australia is significant, backpackers often have multiple partners while abroad, and the proportion having unprotected sex is also substantial, so the absolute numbers of backpackers at risk is high. Yet, the majority of backpackers in this study had a low perception of risk. The convergence of characteristics of the situation and patterns of sexual risk taken place backpackers and their partners in an unenviable position to act as vectors for the spread of STIs internationally. These young travellers need to be made aware of the ramifications of their sexual risk taking while abroad, in order to minimise the spread of infectious pathogens.

These findings highlight the need for more broad-based dissemination of information on STIs to young people, particularly those who backpack overseas and those who visit Australia. They need to be made aware of the free and low-cost sexual health services available to them in Australia in order to control the dissemination of STIs including HIV to foreign and local populations. Because backpackers share a cultural identity, the findings of this study are likely to have implications for the design of education and health promotion initiatives to target international backpackers in

Australia and the rest of the world.

Limitations of the study

The observations of the participants, and those made by the key service providers of backpackers, should not be generalised to represent all backpackers who travel

CHAPTER 12: CONCLUSION 309

globally. Moreover, the study was undertaken in Sydney and Cairns. These cities have a reputation in tourism as two key cities for backpackers to visit when travelling to

Australia. If the data had been collected in more remote or rural areas of Australia, the results may have been different. Therefore, the findings related to the locale specific sexual context of hostels in Sydney and Cairns are not necessarily transferable to hostels in other Australian cities or countries internationally.

In this study, the majority of the participants self-identified as heterosexual. The few gay, bisexual, or lesbian individuals who did participate in this study were too few to be representative of all non-heterosexual backpackers. Cross-cultural differences between backpackers were examined in this study. Australia is a popular travel destination for

British travellers and as a result the majority of study participants originated from the

UK. This may have limited how well backpackers from other countries of origin were represented. Furthermore, language barriers precluded study participation by those who were not able to read or speak English, and so the participants were primarily comprised of English-speaking young people who originated from Europe, North

America, Australia, New Zealand, and Israel.

STI and HIV diagnosis information gathered in this study was through self-report via completion of a self-administered questionnaire and during face-to-face interviews.

Confirmation of diagnostic test results were not requested, nor were participants expected to undergo clinic testing to confirm reported HIV serostatus.

The questionnaire was designed primarily to elicit descriptive data on demographics, travellers’ expectations, health knowledge, sexual behaviour, and condom use during

310 CHAPTER 12: CONCLUSION

the trip. In a purely quantitative study based on a model of behavioural predictors and outcomes such as the theory of reasoned action, it might have been desirable to use certain variables such as unprotected sex before the trip as “predictors” of condom use during the trip. However, the variability among survey participants in preceding conditions, such as age and sexual experience, would have made it difficult to construct such models even if this had been the aim of the study. For example, condom non-use before the trip may have been in the context of a committed relationship with a clear understanding of sexual exclusivity. Collecting data about respondents’ previous lives to this level of detail was not practical. However, with hindsight, it is clear that some different questions could usefully have been asked. For example, survey participants were not asked whether they had ever used a condom. Also, it was not possible to locate respondents’ reports of sex during the trip on a time frame (i.e., how long they had been travelling before each sexual episode occurred and how long the time intervals were between each new partner). This prevented analysis of the relationship between time spent travelling and sexual behaviour.

Qualitative comments made by backpackers on their questionnaire indicated that oral contraceptive use was a significant factor in some women’s decision not to use condoms. However, the survey did not ask respondents whether they were currently taking the oral contraceptive pill or using any alternative contraceptive methods. This information might have been useful in offering insight into a possible reason why some women in the study were less worried about an unplanned pregnancy than were the men with whom they engaged in sex.

CHAPTER 12: CONCLUSION 311

Alcohol and drug use were investigated and participants frequently offered it as the main motivation or excuse for their sexual behaviour and risk taking while abroad.

Given that excessive alcohol consumption was reported as pervasive in the backpacking context, in retrospect it would have been useful to include questionnaire items that investigated the factors surrounding participants’ frequent intoxication: the rate of alcohol consumption, the time interval between consuming their last drink and initiating intercourse, and the level of intoxication at the time of intercourse. This line of inquiry would have provided insight into the rate and frequency of excessive consumption of alcohol, how this compared to their drinking behaviour at home, and whether alcohol and drug use interfered with their safe sex decisions.

Methodological issues

Some backpackers asserted that they always used condoms with every partner, then later revealed that they did have unprotected casual encounters, but justified their behaviour by saying “I was too drunk”, “I can’t remember”, or “there weren’t any condoms around”. The findings from the questionnaires may therefore not accurately reflect the safety of some individuals’ sexual practices. This illustrates the further insight into sexual decision-making that can be gained from in-depth interviews that allow thorough exploration of the circumstances and context in which safe sex negotiation occurs. Some people are still susceptible to the influences of social desirability (Catania, Gibson, Chitwood, & Coates, 1990) and so the accuracy of the participants’ responses, both through surveys and interviews, may have been affected.

Further, participation bias is always a factor in sexuality research (Dunne, Martin,

Bailey, Heath, Bucholz & Madden et al., 1997). Clearly, there are inherent limitations in using surveys. More insight into the decision making process can be gained from a

312 CHAPTER 12: CONCLUSION

thorough exploration of the circumstances and context in which safe sex negotiation occurs.

Backpacker sexual health promotion campaigns

International concern about the links between sexual health and global mobility is reflected in the growing number of sexual health promotion initiatives designed for travellers. In Australia, a few sexual health promotion campaigns have been initiated since the early 1990s to target international travellers: Travel Safe in 1991 and 1994;

Sex Happens, 1997; and the NSW Travellers Sexual Health Program, 1999. Both Sex

Happens and the NSW Travellers Sexual Health Program specifically targeted backpackers in their project directives.

Future directions for health initiatives

This study highlights the need for backpackers to be informed of the complexities that accompany sexual decision-making in an unfamiliar context. However, in order for health promotion messages to be understood and heeded, it is essential that future sexual health initiatives with backpackers be implemented in the context in which they live, sleep, and socialise with future sex partners. Future health campaigns need to take into consideration the contextual factors that play a role in backpackers’ sexual decision making. Future interventions addressing backpackers’ sexual risk taking behaviour need to alert backpackers to the dangers associated with consuming high levels of alcohol while abroad. Recent research with backpackers in Sydney suggests a link between alcohol consumption and unsafe sex leading to STI acquisition

CHAPTER 12: CONCLUSION 313

(Appendix M). In addition, campaign messages need to be reinforced heavily during peak travel seasons. Effective interventions to reduce sexual risks associated with backpacking will require a coordinated collaboration between medical and social health researchers, health promotion agencies, health clinics, the media (including backpacker magazines), entertainment venues (backpacker bars), and the travel industry (airlines, hostels, travel guide books). For instance, travel industry staff in frequent contact with backpackers (for example tour guides, travel agents, hostel staff) are in a vital position to act as ambassadors for sexual health campaigns by displaying and distributing the health promotion initiatives. When travellers pick up their airline tickets from travel agencies, travel agents could distribute travel packs filled with condoms, an information sheet with instructions how to say, in a variety of languages,

“We need to use this [provided] condom”, and the Marie Stopes “passport to sexual health”.

The Safe in the Sack Backpacker Sexual Health Promotion Campaign (2004) is a good example of a recent successful health initiative that specifically targeted backpackers travelling in Australia. This campaign was designed for, and in part by, backpackers, and implemented in the context in which they travel. While conducting this study, I had the opportunity to contribute to the design, development, implementation, and evaluation of this sexual health promotion campaign (2004). For further information on this campaign and visual images of the campaign materials, please see Appendix L.

This study examined the situational and social contexts of backpacking, rather than just individual factors, in hopes that the findings would assist in the development of more effective sexual health interventions to target this travel population. The study offered a

314 CHAPTER 12: CONCLUSION

greater understanding of the individual and context-specific factors that shape backpackers’ safe sex practices and exposure to STIs.

APPENDIX A 315

Appendix A

Hostel recruitment letter

Approval No: 02094

Dear Hostel Manager:

Recently, we had a phone conversation regarding your participation in the research study that I am conducting. I am a PhD student with the Department of Arts and Social Sciences at the University of New South Wales. In partial fulfilment of my Doctoral thesis, I am conducting a study on the sexual attitudes and behaviours of young international backpackers. The backpackers that volunteer to participate in this study will be completing a brief questionnaire. In addition, backpackers will be invited to participate in an interview to gain an in-depth perspective on the backpacker’s sexual attitudes and behaviours.

In order to include a diverse sample of the international backpacking population, I am hoping to interview participants at your hostel. I anticipate that the data collection will begin in July, 2002. I would be approaching hostel patrons early in the evening. Potential subjects would be informed orally and with printed information sheet that the purpose of the research is to study the sexual attitudes and behaviours of young international backpackers, and that the study targets single travellers between the ages of 18 and 35. The eligible patrons who volunteer to participate in the interview will be asked to sign a consent form.

This research is being conducted in accordance with the ethical standards and guidelines of research at the University of New South Wales. If you have any questions or concerns, you may contact the study supervisor, Dr J. Richters, at the National Centre in HIV Social Research at the University of New South Wales (02-9385-6407). You may also contact me personally at 9385-6397, or [email protected]. Upon completion of the study, you will receive a copy of the findings.

Thank you for your time and your cooperation.

Sincerely,

Cari Egan Doctoral Candidate, National Centre in HIV Social Research, UNSW

316 APPENDIX B

Appendix B

Backpacker information letter & consent form

Approval No: 02094

PARTICIPANT INFORMATION STATEMENT AND CONSENT FORM The Backpacker Sex Survey

You are invited to participate in a study exploring the sexual attitudes and behaviours of young international backpackers. We hope to learn about how men’s and women’s sexual attitudes and behaviours may or may not be different from your attitudes and behaviours at home.

If you decide to participate, you will be interviewed about your experience of, and opinions about, sex while backpacking. The interview will take between one to two hours. It will be recorded and later transcribed, with any possibly identifying details removed. After editing of the transcripts, all tapes will be destroyed.

We cannot and do not guarantee or promise that you will receive any benefits from this study.

Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or except as required by law. We plan to publish the results by giving papers at conferences and submitting an article for publication in an academic journal. In any publication, information will be provided in such a way that you cannot be identified.

Complaints may be directed to the Ethics Secretariat, University of New South Wales, Sydney, 2052 (phone: 9385 4234, fax: 9385 6648, email: [email protected]).

You may keep this information letter.

APPENDIX B 317

BACKPACKER SEX SURVEY INTERVIEW: SUBJECT INFORMATION STATEMENT AND CONSENT FORM (continued)

If you decide to participate, you are free to withdraw your consent and to discontinue participation at any time without prejudice.

If you have any questions, please feel free to ask us. If you have any additional questions later, Cari Egan (phone 9385 6397; email – [email protected]) will be happy to answer them.

You will be given a copy of this form to keep.

You are making a decision whether or not to participate. Your signature indicates that, having read the information provided above, you have decided to participate. Subject Witness Signature______Signature______

PRINT name ______PRINT name______

Date ______Nature of witness______

Signature(s) of investigator(s) ______PRINT name(s) ______

REVOCATION OF CONSENT

The Sexual Behaviour and risk factors among young international travellers “backpacking” in Australia

I hereby wish to WITHDRAW my consent to participate in the research proposal described above and understand that such withdrawal WILL NOT jeopardise my relationship with the University of New South Wales.

Signature ______Date ______PRINT Name ______

If you wish to withdraw from the study, the section for Revocation of Consent should be sent to Cari Egan, National Centre in HIV Social Research, University of New South Wales, Sydney 2052.

318 APPENDIX C

Appendix C

Accommodation service provider information letter and consent form

Approval No: 02094

PARTICIPANT INFORMATION STATEMENT AND CONSENT FORM The Backpacker Sex Survey

You are invited to participate in a study exploring the sexual attitudes and behaviours of young international travellers. We hope to learn about your experiences working in the hostel industry and thoughts about the sexual attitudes and behaviours of young backpackers.

If you decide to participate, you will be interviewed about your experiences of providing hostel services to backpackers. The interview will up to two hours. It will be recorded and later transcribed, with any possibly identifying details removed. After editing of the transcripts, all tapes will be destroyed.

Complaints may be directed to the Ethics Secretariat, University of New South Wales, Sydney, 2052 (phone: 9385 4234, fax: 9385 6648, email: [email protected]).

You may keep this information letter.

APPENDIX C 319

BACKPACKER SEX SURVEY KEY INFORMANT INTERVIEW: SUBJECT INFORMATION STATEMENT AND CONSENT FORM (continued) If you decide to participate, you are free to withdraw your consent and to discontinue participation at any time without prejudice.

If you have any questions, please feel free to ask us. If you have any additional questions later, Cari Egan (phone 9385 6397; email – [email protected]) will be happy to answer them.

You will be given a copy of this form to keep.

You are making a decision whether or not to participate. Your signature indicates that, having read the information provided above, you have decided to participate. Subject Witness

Signature______Signature______

PRINT name ______PRINT name ______

Date______Nature of witness______

Signature(s) of investigator(s)

______

PRINT Name(s) ______

REVOCATION OF CONSENT

The Sexual Behaviour and risk factors among young international travellers ‘backpacking’ in Australia

Signature______Date______

PRINT Name ______

If you wish to withdraw from the study, the section for Revocation of Consent should be sent to Cari Egan, National Centre in HIV Social Research, University of New South Wales, Sydney, 2052.

320 APPENDIX D

Appendix D

Health service provider information letter & consent form

Approval No: 02094

PARTICIPANT INFORMATION STATEMENT AND CONSENT FORM The Backpacker Sex Survey

You are invited to participate in a study exploring the sexual attitudes and behaviours of young international travellers. We hope to learn about your experiences treating and/or counselling young international travellers at the clinic where you are employed.

If you decide to participate, you will be interviewed about your experiences of counselling, educating and providing treatment to backpackers. The interview will up to two hours. It will be recorded and later transcribed, with any possibly identifying details removed. After editing of the transcripts, all tapes will be destroyed.

Complaints may be directed to the Ethics Secretariat, University of New South Wales, Sydney 2052 (phone 9385 4234, fax 9385 6648, email [email protected]).

You may keep this information letter.

APPENDIX D 321

BACKPACKER SEX SURVEY KEY INFORMANT INTERVIEW: SUBJECT INFORMATION STATEMENT AND CONSENT FORM (continued)

If you decide to participate, you are free to withdraw your consent and to discontinue participation at any time without prejudice.

If you have any questions, please feel free to ask us. If you have any additional questions later, Cari Egan (phone 9385 6397; email – [email protected]) will be happy to answer them.

You will be given a copy of this form to keep.

You are making a decision whether or not to participate. Your signature indicates that, having read the information provided above, you have decided to participate.

Subject Witness

Signature ______Signature______

PRINT name ______PRINT name ______

Date ______Nature of witness______

Signature(s) of investigator(s)

______

PRINT name(s) ______

REVOCATION OF CONSENT

The Sexual Behaviour and risk factors among young international travellers ‘backpacking’ in Australia

Signature______Date ______PRINT Name ______

If you wish to withdraw from the study, the section for Revocation of Consent should be sent to Cari Egan, National Centre in HIV Social Research, University of New South Wales, Sydney, 2052.

322 APPENDIX E

Appendix E

Backpacker sex survey questionnaire (Women)*

1. What is your age? years 11. Is this your first major trip away from home without your 2. What is your home country? family? ______Yes 1 No 0 3. What is the highest level of education you have obtained? 12. On this trip, how long are you planning on being away Less than 12 years 1 12 years (finished high school) from home? (Please choose only 1 box) 2 Some college/university Less than 1 month 1 3 Completed college/university 1 month 2 4 Completed post-graduate qualifications 2 months 3 5 3 – 6 months 4 4. What is your current marital status? 7 – 11 months 5 1 year Single – never married 1 6 More than 1 year Married 2 7 Don’t know Divorced 3 8

Separated 4 13. How long have you been on this trip so far? 5. Do you think of yourself as: Days Months Years Heterosexual 1 14. During this trip, have you worked/will you work for Lesbian/Dyke 2 money? Bisexual 3 Yes No Other (please specify) 1 0 4 ______15. Which of these destinations have you already travelled to on this trip (excluding short stopovers/ transits)? 6. Which of the following are you concerned about during (Please tick all that apply) this trip? Australia Drinking water New Zealand/South Pacific Sickness/diarrhoea South East Asia Tropical diseases East Asia (including China, Japan) Sexually transmitted infections South Asia (including India) HIV/AIDS Middle East/North Africa Sun/skin damage Sub-Saharan Africa Violence/Robbery Western Europe (including UK) Pregnancy Eastern Europe & Russian Federation No worries (none of these) North America Other (please specify) South America ______Central America

7. Before this trip were you given health advice by: 16. After you leave Australia, what countries are you (Please tick all that apply) planning to visit on this trip? Medical insurance information ______Travel agent ______Family doctor Travel clinic 17. Who are you travelling with right now? Other medical clinic (Please tick all that apply) Friends Alone Family member Boyfriend/Girlfriend I met on this trip No advice given Boyfriend/Girlfriend who came with me Other (please specify) Husband/Partner ______Brother/Sister Friends of same sex 8. Did this advice include information on HIV or AIDS? Friends of opposite sex Yes 1 No 0 Don’t know 2 Other ______9. On this trip, do you think of yourself as a: (Please tick all that apply) 18. If you are travelling to more than one city/country on this Tourist trip, how far ahead have you planned/arranged your Business traveller travel destination(s)? Holiday-maker/Vacationer Before leaving home 1 Backpacker/Long-term traveller Weeks before the next travel destination 2 Other ______ Days before 3 Same day/Not planned 4 10. Which of the following is the most important reason you Not applicable 5 came on this trip? (Please choose only 1 response) 19. Do you know when you are returning home? Education 1 Yes 1 No 0 Culture 2 Adventure 3 Party 4 Escape/Be a different person 5 Relaxation 6 Rite of Passage/Expand horizons 7

APPENDIX E 323

The next section is regarding your experiences BEFORE this trip.

Your answers are entirely CONFIDENTIAL.

20. How often did you engage in any of the following 25. Before this trip, had you done any of the following activities before this trip? with a female? Tick one box only in each row ( ) Oral sex (mouth on genital area) Yes 1 No 0 often3 once/rarely2 never1 Hand–genital stimulation Yes 1 No 0 Car/motorbike speeding Vaginal penetration Yes 1 No 0 Hitch hiking (hand or sex toys) Gambling Parachuting IF YOU HAVE NEVER HAD SEXUAL INTERCOURSE Paragliding GO TO QUESTION 33. Bungee jumping *Sexual Intercourse refers to anal or vaginal White water rafting penetration* Shoplifting/stealing Smoking tobacco 26. What age were you when you first had sexual intercourse? ______years Having a blind date Climbing mountains 27. How many partners had you had sexual Getting drunk intercourse with before this trip? Travelling through a None 0 11 – 20 4 foreign country whose customs, laws and climate 1 1 21 – 50 5 you know very little about. 2 – 5 2 51 – 100 6

6 – 10 3 101+ 7 21. Did you use any of these drugs before this trip? marijuana/hash Yes 1 No 0 28. On the last occasion you had sexual intercourse amphetamines Yes 1 No 0 (NOT including sex on this trip) did you use a (speed, MDA, etc.) condom? GHB/liquid “e” Yes 1 No 0 Yes 1 No 0 hallucinogens Yes 1 No 0 (LSD, mushies, etc.) 29. During the 12 months before your trip, how often cocaine Yes 1 No 0 did you use a condom? ecstasy Yes 1 No 0 Always 1 Frequently 2 Sometimes 3 heroin Yes 1 No 0 Occasionally 4 Never 5 “special K” Yes 1 No 0 (ketamine) 30. Before this trip, had you ever had sexual Valium/Serepax/Rohypnol Yes 1 No 0 intercourse with someone you had just met (i.e. other (please specify) Yes No met that same day or evening)? 1 0 ______Yes 1 No 0

22. Did you ever inject any illicit drugs before this trip? 31. The last time you had sexual intercourse with someone you had just met that same day or No, never 1 evening (not on this trip), was a condom used? Yes, once 2 Yes 1 No 0 Not applicable 2 Yes, sometimes 3

Yes, often 4 32. Before this trip, had you had sexual intercourse with someone you met recently (within the last 3 23. What was your relationship status just before this days)? trip? Yes No 1 0 Living with a partner 5 Regular partner – not living together 4 Dating/seeing 1 or more persons 3 Only casual sex 2 Not dating (seeing) anyone/no sex 1

24. Before this trip, had you ever engaged in any of the following with a male? Oral sex (his mouth, your genitals) Yes 1 No 0 Oral sex (your mouth, his genitals) Yes 1 No 0 Vaginal intercourse Yes 1 No 0 Anal intercourse Yes 1 No 0

EXPERIENCES WHILE ON THIS TRIP

33. What were your expectations of sexual activity on this trip? 34. How often have you engage(d) in any of the I expected to have sexual intercourse with someone following activities during this trip?(Tick one box new (a person you had not had sexual intercourse only in each row) with before this trip). Yes 1 No 0 often3 once/rarely2 never1 Car/motorbike speeding I was open to the possibility of sexual intercourse. Hitch hiking Yes No 1 0 Gambling I expected to fool around in a sexual way, but not Parachuting have sexual intercourse with someone new. Paragliding Yes 1 No 0 Bungee jumping I expected to have safe sex (use a condom) if I had White water rafting Shoplifting/stealing sexual intercourse. Yes 1 No 0 Smoking tobacco I had no expectations of any sexual activity. Having a blind date Yes 1 No 0 Climbing mountains I intended to have no sexual activity on this trip. Getting drunk Travelling through a Yes 1 No 0 foreign country whose customs, climate and laws you know very little about.

* Font size is smaller than original questionnaire due to formatting requirements of UNSW dissertation submission guidelines.

324 APPENDIX E

35. Have you used any of these drugs during this trip? THE NEXT QUESTIONS ARE ABOUT THE LAST marijuana/hash Yes 1 No 0 PERSON YOU HAD SEX WITH ON THIS TRIP amphetamines (speed, MDA, etc.) Yes 1 No 0 GBH/liquid “e” Yes 1 No 0 45. The last time you had sexual intercourse during hallucinogens (LSD, trips, mushies)Yes1 No 0 this trip was with a: man 1 woman 0 cocaine Yes 1 No 0 46. Was the last person you had sexual intercourse ecstasy Yes 1 No 0 heroin Yes No with during this trip a…: 1 0 “special K” (ketamine) Yes No Traveller from your own country 1 1 0 Valium/Serepax/Rohypnol Yes No Traveller from a different country 2 1 0 other (please specify) Yes No Local resident of the country you visited 3 1 0 ______Other, (please specify) 4 ______36. Have you injected any illicit drugs during this trip? 47. Was the last person you had sexual intercourse No, never 1 Yes, once with someone you are travelling with during this 2 trip? Yes, sometimes 3 Yes No Yes, often 1 0 4 48. Was this someone you had just met or met 37. Since coming on this trip, have other travellers had recently during this trip? sexual activity with each other while you were in Yes No the room? 1 0 Yes No 1 0 49. How many times did you have sexual intercourse

with your last sexual partner during this trip? 38. During this trip, have you engaged in any of the 1 1 6 – 10 4 following with a new male partner? Oral sex (his mouth, your genitals) Yes No 2 2 11 – 20 5 1 0 Oral sex (your mouth, his genitals) Yes No 3 – 5 3 21 – 50+ 6 1 0 Vaginal intercourse Yes No 1 0 50. How often was a condom used with your last Anal intercourse Yes No 1 0 sexual intercourse partner during this trip?

Always 1 Frequently 2 Sometimes 3 39. During this trip, have you done any of the following Rarely 4 Never 5 with a new female partner? Oral sex (mouth on genital area) Yes 1 No 0 51. On the occasions that you did not use a condom Hand–genital stimulation Yes 1 No 0 with your last sexual intercourse partner, which of Vaginal penetration Yes 1 No 0 these reasons applied to you: (hand or sex toys) (Please tick all that apply) Heat of the moment IF YOU HAVE NOT HAD SEXUAL INTERCOURSE Alcohol

WITH SOMEONE NEW ON THIS TRIP, PLEASE I thought that my partner was safe SKIP TO QUESTION 54. My partner did not like them 40. How many people have you had sexual intercourse I could not find any to buy when travelling with that you met on this trip? I was on the pill No condoms were available during sex 1 1 6 – 10 6 Other (please specify) 2 2 11 – 15 7 ______3 3 16 – 20 8

4 4 21 – 30 9 5 31+ 52. The last time you had sexual intercourse during 5 10 this trip, was a condom used?

Yes No 41. Were any of the new partners that you had sexual 1 0 intercourse with that you met on this trip a… (Please tick all boxes that apply) 53. Who suggested/initiated using a condom the last Traveller from your own country time? You Your partner Traveller from a different country 1 2 Both Nobody Local resident of the country you visited 3 4

Other, (please specify) 54. Do any of these statements about condoms apply ______to you? (Please tick all that apply)

I think condoms are fun and erotic 42. Since coming on this trip, have you had sexual I think condoms are not romantic intercourse with someone you just met (that same day or evening)? I think condoms disrupt the flow of sex Yes No I think condoms prevent infection 1 0 I do not like the feel of condoms 43. Since coming on this trip, have you had sexual I feel embarrassed to suggest condoms intercourse with someone you met recently My partner might think that I am infected (within the last 3 days)? I think they are a reliable contraceptive Yes 1 No 0 My partner might think I am promiscuous I think condoms might lead to loss of erection 44. Since coming on this trip, have you had sexual I think sex is less messy with condoms

activity with someone while other people were in I think condoms reduce sensitivity the room? It is my partner’s responsibility to initiate Yes 1 No 0 condom use

Condoms give me a sense of security 44b. If YES, was it someone you had met within the previous three days? 55. Are you currently carrying condoms with you? (Please tick all that apply) Yes 1 No 0 On your person Yes No 1 0 In your luggage Yes No 1 0 In your room Yes 1 No 0 Not carrying any condoms Yes 1 No 0

APPENDIX E 325

56. Have you ever been diagnosed with any of the 59. How would you rate your chances of getting following infections before this trip? HIV/AIDS during this trip? (Please tick all that apply) No chance 0 Moderate 3 Gonorrhoea Yes 1 No 0 Very low 1 High 4 Genital warts Yes 1 No 0 Low 2 Very high 5 Chlamydia/NSU Yes 1 No 0 Genital herpes Yes 1 No 0 60. Do you think people are more likely to get HIV Syphilis Yes 1 No 0 while travelling overseas than they are at home? HIV Yes 1 No 0 Yes 1 No 0 Not Sure 2

57. Have you had any of the following infections 61. Which destinations do you think people are most at diagnosed during this trip? risk of contracting HIV while travelling? (Please tick all that apply) (Please tick up to 3 boxes) Gonorrhoea Yes 1 No 0 Australia Genital warts Yes 1 No 0 New Zealand/South Pacific Chlamydia/NSU Yes 1 No 0 South East Asia Genital herpes Yes 1 No 0 East Asia (including China, Japan) Syphilis Yes 1 No 0 South Asia (including India) HIV Yes 1 No 0 Middle East/North Africa Sub-Saharan Africa 58. If so, do you think you caught the infection(s) on Western Europe (including UK) this trip? Eastern Europe & Russian Federation Yes 1 No 0 Not applicable 2 North America South America Central America

None of the above

Do you have any comments about this topic or this questionnaire? ______

______

Please place your completed questionnaire in the envelope provided, seal the envelope and return it to me. Thank you for helping us with our research and enjoy the rest of your trip!

* Font size is smaller than original questionnaire due to formatting requirements of UNSW dissertation submission guidelines.

326 APPENDIX F

Appendix F

Backpacker sex survey questionnaire (Men) *

1. What is your age? years 11. Is this your first major trip away from home without your family? 2. What is your home country? Yes 1 No 0 ______3. What is the highest level of education you have obtained? 12. On this trip, how long are you planning on being away Less than 12 years from home? (Please choose only 1 box) 1 12 years (finished high school) Less than 1 month 1 2 Some college/university 1 month 2 3 Completed college/university 2 months 3 4 Completed post-graduate qualifications 3 – 6 months 4 5 7 – 11 months 5 4. What is your current marital status? 1 year 6 Single – never married 1 More than 1 year 7 Married 2 Don’t know 8 Divorced 3 Separated 13. How long have you been on this trip so far? 4 Days Months Years 5. Do you think of yourself as: 14. During this trip, have you worked/will you work for Heterosexual 1 money? Gay/homosexual/queer 2 Yes 1 No 0 Bisexual 3

Other (Please specify) 4 ______15. Which of these destinations have you already travelled to on this trip (excluding short stopovers/ transits)?

6. Which of the following are you concerned about during (Please tick all that apply) Australia this trip? Drinking water New Zealand/South Pacific Sickness/diarrhoea South East Asia Tropical diseases East Asia (including China, Japan) Sexually transmitted infections South Asia (including India) HIV/AIDS Middle East/North Africa Sun/skin damage Sub-Saharan Africa Violence/robbery Western Europe (including UK) Getting someone pregnant Eastern Europe & Russian Federation No worries (none of these) North America Other (please specify) South America ______Central America

7. Before this trip were you given health advice by: 16. After you leave Australia, what countries are you (Please tick all that apply) planning to visit on this trip? Medical insurance information ______Travel agent ______Family doctor Travel clinic 17. Who are you travelling with right now? Other medical clinic (Please tick all that apply) Friends Alone Family member Boyfriend/Girlfriend I met on this trip No advice given Boyfriend/Girlfriend who came with me Other (please specify) Wife/Partner ______Brother/Sister Friends of same sex 8. Did this advice include information on HIV or AIDS? Friends of opposite sex Yes 1 No 0 Don’t know 2 Other ______9. On this trip, do you think of yourself as a: (Please tick all that apply) 18. If you are travelling to more than one city/country on this Tourist trip, how far ahead have you planned/arranged your Business traveller travel destination(s)? Holiday-maker/Vacationer Before leaving home 1 Backpacker/Long-term traveller Weeks before the next travel destination 2 Other ______ Days before 3 Same day/Not planned 4 10. Which of the following is the most important reason you Not applicable 5 came on this trip? (Please choose only 1 response) 19. Do you know when you are returning home? Education 1 Yes 1 No 0 Culture 2 Adventure 3

Party 4 Escape/Be a different person 5

Relaxation 6 Rite of Passage/Expand horizons 7

326 APPENDIX F 327

The next section is regarding your experiences BEFORE this trip.

Your answers are entirely CONFIDENTIAL.

20. How often did you engage in any of the following 25. Before this trip, had you done any of the following activities before this trip? with a male? (Tick one box only in each row) Oral sex (your mouth, his penis) Yes 1 No 0 often 3 once/rarely 2 never1 Oral sex (his mouth, your penis) Yes 1 No 0 Car/motorbike speeding Hand–genital stimulation Yes 1 No 0 Hitch hiking Anal sex: your penis in him Yes 1 No 0 Gambling Anal sex: his penis in you Yes 1 No 0 Parachuting Paragliding IF YOU HAVE NEVER HAD SEXUAL INTERCOURSE Bungee jumping GO TO QUESTION 33. White water rafting *Sexual Intercourse refers to anal or vaginal penetration* Shoplifting/stealing Smoking tobacco Having a blind date 26. What age were you when you first had sexual intercourse? ______years Climbing mountains Getting drunk 27. How many partners had you had sexual Travelling through a intercourse with before this trip? foreign country whose customs, laws and climate None 0 11 – 20 4 you know very little about. 1 1 21 – 50 5

2 – 5 2 51 – 100 6 21. Did you use any of these drugs before this trip? 6 – 10 101+ 3 7 marijuana/hash Yes 1 No 0 amphetamines(speed, MDA, etc. )Yes 1 No 0 28. On the last occasion you had sexual intercourse GHB/liquid “e” Yes 1 No 0 (NOT including sex on this trip) did you use a hallucinogens (LSD, mushies,etc)Yes 1 No 0 condom? cocaine Yes 1 No 0 Yes 1 No 0

ecstasy Yes 1 No 0 heroin Yes 1 No 0 29. During the 12 months before your trip, how often did you use a condom? “special K” (ketamine) Yes 1 No 0 Always 1 Frequently 2 Sometimes 3 Valium/Serepax/Rohypnol Yes 1 No 0 Occasionally 4 Never 5 other (please specify) Yes 1 No 0 ______30. Before this trip, had you ever had sexual

22. Did you ever inject any illicit drugs before this trip? intercourse with someone you had just met (i.e. met that same day or evening)? No, never 1 Yes 1 No 0 Yes, once 2 Yes, sometimes 3 31. The last time you had sexual intercourse with Yes, often 4 someone you had just met that same day or 23. What was your relationship status just before this evening (not on this trip), was a condom used? trip? Yes 1 No 0 Not applicable 2

Living with a partner 5 32. Before this trip, had you had sexual intercourse Regular partner – not living together 4 Dating/seeing 1 or more persons with someone you met recently (within the last 3 3 days)? Only casual sex 2 Yes No Not dating (seeing) anyone/no sex 1 0 1

24. Before this trip, had you ever engaged in any of the

following with a female?

Oral sex (her mouth, your genitals) Yes 1 No 0 Oral sex (your mouth, her genitals) Yes 1 No 0 Vaginal intercourse Yes 1 No 0 Anal intercourse Yes 1 No 0

EXPERIENCES WHILE ON THIS TRIP

33. What were your expectations of sexual activity on 34. How often have you engage(d) in any of the this trip? following activities during this trip?(Tick one box I expected to have sexual intercourse with someone only in each row) new (a person you had not had sexual intercourse often 3 once/rarely 2 never1 with before this trip). Yes 1 No 0 Car/motorbike speeding Hitch hiking I was open to the possibility of sexual intercourse. Yes No Gambling 1 Parachuting I expected to fool around in a sexual way, but not Paragliding have sexual intercourse with someone new. Bungee jumping Yes 1 No 0 White water rafting I expected to have safe sex (use a condom) if I had Shoplifting/stealing Smoking tobacco sexual intercourse. Yes 1 No 0 Having a blind date I had no expectations of any sexual activity. Climbing mountain s Yes 1 No 0 Getting drunk I intended to have no sexual activity on this trip. Travelling through a foreign country whose customs, climate and Yes 1 No 0 laws you know very little about.

* Font size is smaller than original questionnaire due to formatting requirements of UNSW dissertation submission guidelines. 328 APPENDIX F

35. Have you used any of these drugs during this trip? THE NEXT QUESTIONS ARE ABOUT THE LAST marijuana/hash Yes 1 No 0 PERSON YOU HAD SEX WITH ON THIS TRIP amphetamines(speed, MDA, etc.) Yes 1 No 0 GBH/liquid “e” Yes 1 No 0 45. The last time you had sexual intercourse during hallucinogens (LSD, trips,mushies)Yes1 No 0 this trip was with a: man 1 woman 0 cocaine Yes 1 No 0 46. Was the last person you had sexual intercourse ecstasy Yes 1 No 0 heroin Yes No with during this trip a…: 1 0 “special K” (ketamine) Yes No Traveller from your own country 1 1 0 Valium/Serepax/Rohypnol Yes No Traveller from a different country 2 1 0 other (please specify) Yes No Local resident of the country you visited 3 1 0 ______Other, (please specify) 4 ______36. Have you injected any illicit drugs during this trip? 47. Was the last person you had sexual intercourse No, never 1 Yes, once with someone you are travelling with during this 2 trip? Yes, sometimes 3 Yes No Yes, often 1 0 4 48. Was this someone you had just met or met 37. Since coming on this trip, have other travellers had recently during this trip? sexual activity with each other while you were in Yes No the room? 1 0 Yes No 1 0 49. How many times did you have sexual intercourse

with your last sexual partner during this trip? 38. During this trip, have you engaged in any of the 1 1 6 – 10 4 following with a new female partner? Oral sex (her mouth, your genitals) Yes No 2 2 11 – 20 5 1 0 Oral sex (your mouth, her genitals) Yes No 3 – 5 3 21 – 50+ 6 1 0 Vaginal intercourse Yes No 1 0 50. How often was a condom used with your last Anal intercourse Yes No 1 0 sexual intercourse partner during this trip?

Always Frequently Sometimes 39. During this trip, have you done any of the following 1 2 3 Rarely Never with a new male partner? 4 5 Oral sex (your mouth, his penis) Yes No 1 0 51. On the occasions that you did not use a condom Oral sex (his mouth, your penis) Yes 1 No 0 with your last sexual intercourse partner, which of Hand–genital stimulation Yes 1 No 0 l these reasons applied to you: (Please tick al that Anal sex: your penis in him Yes 1 No 0 apply) Anal sex: his penis in you Yes 1 No 0 Heat of the moment Alcohol

IF YOU HAVE NOT HAD SEXUAL INTERCOURSE I thought that my partner was safe WITH SOMEONE NEW ON THIS TRIP, PLEASE My partner did not like them SKIP TO QUESTION 54. I could not find any to buy when travelling 40. How many people have you had sexual intercourse My partner was on the pill with that you met on this trip? No condoms were available during sex 1 1 6 – 10 6 Other (please specify) 2 2 11 – 15 7 ______

3 3 16 – 20 8 52. The last time you had sexual intercourse during 4 4 21 – 30 9 5 31+ this trip, was a condom used? 5 10 Yes 1 No 0 41. Were any of the new partners that you had sexual intercourse with that you met on this trip a… 53. Who suggested/initiated using a condom the last (Please tick all boxes that apply) time? Traveller from your own country You 1 Your partner 2 Traveller from a different country Both 3 Nobody 4 Local resident of the country you visited Other, (please specify) 54. Do any of these statements about condoms apply to you? (Please tick all that apply) ______I think condoms are fun and erotic

I think condoms are not romantic 42. Since coming on this trip, have you had sexual intercourse with someone you just met (that I think condoms disrupt the flow of sex same day or evening)? I think condoms prevent infection I do not like the feel of condoms Yes 1 No 0 I feel embarrassed to suggest condoms 43. Since coming on this trip, have you had sexual My partner might think that I am infected intercourse with someone you met recently I think they are a reliable contraceptive (within the last 3 days)? My partner might think I am promiscuous Yes 1 No 0 I think condoms might lead to loss of erection I think sex is less messy with condoms

44. Since coming on this trip, have you had sexual I think condoms reduce sensitivity activity with someone while other people were in It is my partner’s responsibility to initiate the room? condom use Yes 1 No 0 Condoms give me a sense of security

44b. If YES, was it someone you had met within 55. Are you currently carrying condoms with you? the previous three days? (Please tick all that apply) On your person Yes 1 No 0 Yes 1 No 0 In your luggage Yes No 1 0 In your room Yes No 1 0 Not carrying any condoms Yes No 1 0

APPENDIX F 329

56. Have you ever been diagnosed with any of the 60. Do you think people are more likely to get HIV following infections before this trip? (Please tick while travelling overseas than they are at home? all that apply) Yes 1 No 0 Not Sure 2 Gonorrhoea Yes 1 No 0 Genital warts Yes 1 No 0 61. Which destinations do you think people are most at Chlamydia/NSU Yes 1 No 0 risk of contracting HIV while travelling? Please tick up to 3 boxes) Genital herpes Yes 1 No 0 ( Syphilis Yes 1 No 0 Australia HIV Yes 1 No 0 New Zealand/South Pacific South East Asia 57. Have you had any of the following infections East Asia (including China, Japan) diagnosed during this trip? South Asia (including India) (Please tick all that apply) Middle East/North Africa Gonorrhoea Yes 1 No 0 Sub-Saharan Africa Genital warts Yes 1 No 0 Western Europe (including UK) Chlamydia/NSU Yes 1 No 0 Eastern Europe & Russian Federation Genital herpes Yes 1 No 0 North America Syphilis Yes 1 No 0 Central America HIV Yes 1 No 0 None of the above

58. If so, do you think you caught the infection(s) on this trip? Yes 1 No 0 Not applicable 2

59. How would you rate your chances of getting HIV/AIDS during this trip? No chance 0 Moderate 3 Very low 1 High 4 Low 2 Very high 5

Do you have any comments about this topic or this questionnaire? ______

______

Please place your completed questionnaire in the envelope provided, seal the envelope and return it to me. Thank you for helping us with our research and enjoy the rest of your trip!

* Font size is smaller than original questionnaire due to formatting requirements of UNSW dissertation submission guidelines. 330 APPENDIX G

Appendix G

Backpacker interview schedule

Note that this schedule served as a guide only. The wording and order of questions asked varied during the interviews and new directions of inquiry often occurred in response to answers received.

The culture of backpacking and identity development How long have you been travelling? What countries have you travelled to? What is it about backpacking that attracted you to it? What is your definition of a backpacker? What are the defining characteristics that backpackers possess? What are some differences you have noticed among backpackers? What does backpacking mean to you? Do you think you have changed as a person since backpacking? How? Please give examples of how you have changed while living as a backpacker. Sociability and sex: Attraction, pre-sexual contact, negotiation of sex, sexual activity, and setting What kinds of relationships have you made while travelling? Friends? Sexual encounters? How many sexual encounters have you had since backpacking? How did you meet each other? Were you immediately attracted to one another? Were they another backpacker or traveller? Why were you attracted to them? Were they someone you would have been attracted to at home? Why? How long did you know this person? How long was it before you had sex? When did you know that you were going to have sex with this person (use sexual partner’s names if applicable)? What factors may have influenced you to have sex with this person? Were you under the influence of any substance? If so, what? Who initiated the discussion to have sex? How did the discussion or negotiation regarding sex happen? How did it feel to know you were going to have sex with this person? Where did you have sex? How did you gain access to this area? What impact did the setting that you had sex in, have on your sexual encounter? Did it make it more exciting, or was it awkward? Why? While you were having sex, were you aware of anything else? Were there any distractions? If so, what were they? If not, please describe how you felt while having sex. What did you do while you were having sex? What was your first thought when you finished having sex? What happened next? How did you feel? Would you have done anything differently? How? How many times did you have sex with this person(s)?

APPENDIX G 331

Condom use: negotiation of condom use, carrying condoms, sexual decision making and risk taking

Did you use a condom with this person(s)? Did you want to use a condom? Did either of you discuss condom use prior to having sex? When, if at all, did the discussion take place? Who initiated the discussion? How was it initiated? Is there anything that would have made it easier (or harder) to talk about? When was the condom put on? If there was no condom, did you or that person ejaculate inside? Were you carrying condoms on you at the time? Have you carried condoms with you at all during the trip? Why? Where did you get the condoms? (If applicable) Why didn’t you use a condom? Have you ever been tested for sexually transmitted infections? Did you ask them if they had been tested? Why?

Post-sexual fallout Did you see/talk with this person(s) again? Were there any changes to how you talked or acted around each other? If so, what were they? Are you still in contact with this person? What are your feelings for this person now? How has your interaction changed, if at all? Would you have done anything differently? How? How have these sexual experience(s) affected you? Do you feel the same or different? Why do you think that is? Do you think it is common for backpackers to have sex with someone they don’t know during their trip? Why is that? Reflections on the personal impact of backpacking trip Have your life goals changed since being on this trip? In what ways? Do you think you will go home the same person that you were when you left home? How will you be different or the same? What have you learned since you have been backpacking? What pearls of wisdom will you take home with you?

332 APPENDIX H

Appendix H

Accommodation service provider interview schedule

Role, responsibility and interaction with backpackers How long have you worked in this hostel? What is your job description? What are some of the duties that are included in your job? Why are you in this job? How long do you anticipate being employed in the position that you are currently in? How much interaction do you have with backpackers? Have you developed friendships with the backpackers that stay here?

Perceptions of sexual activity among backpackers Do you think backpackers have sexual relationships with people while they are travelling? Why? How do you feel about backpackers having casual sex during their trip? Have you ever witnessed evidence of backpackers having sex in this hostel? What time of day was it? Was it with another patron of this hostel? If not, with who, do you know?

Locations for sex and access to privacy Where did they have sex? How did they gain access to this area? I have been told by backpackers that some staff in hostels will give the keys to locked areas in the hostel so that backpackers can have a private place to go to have sex. Have you heard of this? How common is this practice? Have you ever done this? How often does that happen in this hostel? Do you have any stories that you would like to share about this? Can anybody get the keys from a staff member, or is it only certain kinds of backpackers or people that get access to these areas? How would you describe these people?

Substance use What factors, in your opinion, contribute to the development of sexual encounters with backpackers? Is drinking or substance use common in this culture? What evidence have you seen of this occurring? Why do you think partying is, or is not, popular within this culture?

Perceptions of condom use and suggestions for sexual health promotion by hostels Do you think backpackers are having safe sex? Why? What do you think hostels could do to increase the possibility that backpackers will use a condom while having sex, particularly in hostels? What suggestions do you have to help prevent sexually transmitted infections in this population? What have you been most surprised about with the sexual/health practices of this population?

APPENDIX H 333

Would you like to raise any issues that you are dealing with, or would like to deal with, related to your patrons?

Has this hostel organization ever done anything to encourage safe sex among its patrons? Any final words or thoughts that you would like to contribute? What value do you think research of this kind has for the backpacking community and service providers?

334 APPENDIX I

Appendix I

Health service provider interview schedule

Job description, experience with backpacking populations and medical issues Where do you work? What is your role or job in this clinic? How long have you worked here? What experience have you had in providing care to backpacking populations? What are the primary medical concerns that backpackers present with? What are backpackers most worried about?

Sexual health of backpackers attending clinics Have any of the backpackers that come into this clinic been diagnosed with an STI? HIV? What proportion is your educated guess? What is the most common STI diagnosed in this population? Would you say that backpackers in general practice safe sex? What characteristics, if any, are there of those backpackers who acquire STIs while travelling? What level of awareness do backpackers have on how STIs are transmitted? Are they well informed on how to prevent various STIs? In what areas do backpackers need to be better informed?

Barriers and facilitators to condom use What are the reasons that some backpackers do not use a condom? Have any backpackers told you that they have behaved different sexually since travelling, in comparison to their sexual behaviour at home? In what ways? Are men or women more at risk of getting an STI while backpacking? Why is that? What have you been most surprised about with the sexual/health practices of this population? What appear to be the barriers and facilitators to backpackers practicing safe sex? Is substance use a common practice amongst the backpacking patients in this clinic? Have any backpackers identified substance use to be an influencing factor in their sexual behaviour and condom use? In what ways? Do you have any examples that you could share with me?

APPENDIX J 335

Appendix J

Code list

Alcohol – sex and alcohol Health Provider Interviews –alcohol use perceptions Benefits of this research study o Effect condom use Condoms – always use condoms Health Provider Interviews –HIV testing Condoms – always use condoms except in o everybody wants HIV test ‘relationship’ while backpacking o backpackers want everything tested Condoms – inconsistent condom use o they choose not to have HIV test Condoms – condom use changes during trip o most worried about HIV Condoms – carrying condoms o HIV paranoia o do carry condoms Health Provider Interviews –abnormal pap smears o carry condoms but never use them Health Provider Interviews –presenting symptoms o never carry condoms Health Provider Interviews –behaviour change from Condoms – women and condoms home environment Condoms – condoms and alcohol use o anxiety Condoms – can’t remember condom use o guilt/self blame Condoms – where do you buy condoms in Health Provider Interviews –gender differences Thailand? o common female story Condoms – negative experiences related to not using Health Provider Interviews –don’t have usual checks condoms prior to travel in place Condoms – reasons for not using condoms while Health Provider Interviews –blue collar workers travelling as backpacker Health Provider Interviews –barriers/facilitators to o caught up in the heat of the moment safe sex with backpackers o condom split and kept going Health Provider Interviews –condom use o ran out of condoms Health Provider Interviews –pregnancy o drunk and forgot Health Provider Interviews –underestimated risk of Condoms – attitudes toward condoms unprotected sex common Condoms – discussion of condom use during trip Health Provider Interviews –reports of sex with o condoms discussed locals vs travellers o condoms not discussed Health Provider Interviews –identifiable sexual risks o discussion of condoms with friends during trip Health Provider Interviews –sexual assault Condoms – condom practices at home Health Provider Interviews –language barrier to Contraception - pill testing and treatment Contraception - morning after pill Health Provider Interviews –HIV positive travellers Drugs – problems with drugs and sex Health Provider Interviews –sex in Thailand Freedom – no obligations Health Provider Interviews –surprises for health staff o benefits Health Provider Interviews –health promotion Geographic exploration – backpacking experience suggestions o first time Health Provider Interviews –challenges of health o more than one trip history promotion for backpacking populations o distance from home Health Provider Interviews –health funding • furthest away ever in life restrictions for backpackers Geographic exploration – eager explorer Identity – changed as a person Geographic exploration – home away from home Identity – find yourself o Australia similar to United Kingdom Identity – gives confidence to be me o in Sydney too long Identity – no identity development perceived by • use Sydney as base for travel backpackers Geographic exploration – travel destinations Meaning of trip – life goals changed or the same Geographic exploration – poverty of the ‘other’ following trip? Geographic exploration – want to make Australia o lessons learned from trip permanent home o plans when returning home Health Provider Interviews – presenting health Money concerns No sex – reasons for not having sex Health Provider Interviews –cultural background of Reasons for backpacking – age backpackers attending clinics Reasons for backpacking – always wanted to go Health Provider Interviews –STI testing before sex travelling Health Provider Interviews –STI testing after break- Reasons for backpacking – Australia is English up speaking Health Provider Interviews –STI incidence among Reasons for backpacking – build confidence/sexual backpackers confidence Health Provider Interviews –common STIs Reasons for backpacking – cheap cost makes it attainable

336 APPENDIX J

Reasons for backpacking – crossroads in life Sex – discussion/negotiation of sex Reasons for backpacking – dream to travel to Sex – discussions of sex history Australia Sex – ejaculate inside Reasons for backpacking – escape from home town Sex – embarrassed after sex Reasons for backpacking – figure out what to do Sex – frequency of sex with new partner with future Sex – gained sexual confidence on this trip Reasons for backpacking – find self Sex – girls Making their move Reasons for backpacking – freedom Sex – had sex Reasons for backpacking – friends recommended o code words to say ‘let’s have sex’ backpacking o sex with backpackers Reasons for backpacking – gap year o sex with locals Reasons for backpacking – get away from job at o sex with someone you would have home sex with at home Reasons for backpacking – get away from Uni Sex – have you changed much sexually? Reasons for backpacking – get more sexual Sex – lady-boy girlfriend story experience Sex – last minute sex before leaving town Reasons for backpacking – get space from a Sex – making out relationship Sex – masturbation Reasons for backpacking – go where other Sex – new Experiences backpackers go Sex – no memory of sex Reasons for backpacking – have fun with friends Sex – no privacy from home Sex – no sexual experimentation Reasons for backpacking – last chance to go Sex – not casual sex travelling Sex – numbers of sex partners Reasons for backpacking – limited time away from Sex – numbers of sex partners before trip home Sex – oral sex Reasons for backpacking – meet new cultures Sex – orgasm Reasons for backpacking – meet new people/other Sex – perceptions of sexual activity among travellers backpackers Reasons for backpacking – organized travel Sex – places to have sex Reasons for backpacking – party o camper van Reasons for backpacking – prove to yourself you can o car do it on your own o Coogee Cliffs Reasons for backpacking – putting my life on hold o Coogee Oval for men, need to examine why o garden Reasons for backpacking – seeking independence o hostel Reasons for backpacking – test yourself o in a backpacker house Reasons for backpacking – travel bargains for o pool backpackers o rented apartment Reasons for backpacking – travel to a hot climate o sex all over the hostel Reasons for backpacking – want to travel alone o sex in dorm room Reasons for backpacking – wanted to see sibling rules in dorm room Relationships – don’t want commitment o sex in off limits rooms Relationships – want commitment o sex in other person’s bedroom Relationships – learn a lot in a short time about o sex in roomwhilefriends are also other people while backpacking there Relationships – quick bonds while travelling o sex in shower Relationships – partner at home o sex on beach Relationships – sex buddies o stairwell Relationships – dating o tent Relationships – linking up with people met earlier o toilets Same sex experiences – perception of gay Sex – places to meet new sex partners backpackers o hostel Same sex experiences – gay saunas o hitchhiking Same sex experiences – gay discrimination Sex – plans to see them later Sex – reasons for sex Sex – age differences o ‘a bet between guys’ Sex – anal sex o alcohol Sex – avoids sex o anger at ex boyfriend Sex – bed sheet trip o anonymity Sex – casual attitudes about sex o attraction to person Sex – casual Sex o availability – more opportunity Sex – caught up in the sex moment o beach atmosphere Sex – cultural differences o caught up in the atmosphere Sex – date rape o caught up in the heat of the moment Sex – difference between guys and girls travel o chemistry and liking the person Sex – difficulties of saying no to sex o competition among friends

APPENDIX J 337

o didn’t think they would see them Tourist vs traveller – accommodation again o Hostel o everything is new benefits of staying in hostels o exciting – thrill how many backpackers stay in hostels o for the fun of it working hostels o have sex with own culture hostel life o looking for sex hostels have no privacy o mix with new cultures o House o not so picky lived with erotic dancers o sex is part of the backpacker lifestyle Tourist vs Traveller – backpackers elsewhere may o sexually charged environment be tourists in Australia o to have company Tourist vs Traveller – backpacking is a small world o women are ‘more up for it’ Tourist vs Traveller – better off travelling alone Sex – regrets of sex Tourist vs Traveller – communication during travel Sex – sex education o mobile Sex – sex in Thailand o email o sex with Thai bar girls Tourist vs Traveller – definition of a backpacker condom use with Thai bar girls o champagne backpacker cost of sex with Thai bar girls Tourist vs Traveller – don’t like to be called how do you meet bar girls backpacker ID cards Tourist vs Traveller – hierarchy of backpacking sharing Thai bar girls o better off travelling alone Thai bar girls showering ritual o hierarchy depends on how long you have videotape incident Thai bar girl travelled or been in hostel o brothels in Thailand o high position in hierarchy might get you o lady boys more sex o sex with local Thai girls o hostel becomes home Sex – sex stories o in crowd, in jokes, nick names Sex – sex with a friend o takes time to be accepted Sex – sex with own nationality drinking together Sex – sexual awakening helps Sex – sexual experimentation Tourist vs Traveller – identifies as tourist Sex – sexual history at home Tourist vs Traveller – identifying as a backpacker Sex – sexual Surprises Tourist vs Traveller – in crowd, in jokes, nick names Sex – strategies to have sex Tourist vs Traveller – jobs while travelling as Sex – tend to have sex with someone from other backpacker cultural background Tourist vs Traveller – negative reputation of Sex – the fun of the chase backpackers o more opportunities for sex with Tourist vs Traveller – sacrifices made to come backpackers travelling Sex – was it good sex? Tourist vs Traveller – seeking authenticity in travel Sex – what is it like with a new partner? Tourist vs Traveller – STIs - history of STIs Tourist vs Traveller – working holiday STIs - scared of STIs Travel companions – challenges of travelling with STIs - STI testing friend STIs - discussion of STI history with sex partner Travel companions – travel from home alone o No one talks about STIs Travel companions – travel from home with friend

338 APPENDIX K

Appendix K

Qualitative comments on backpacker questionnaire

#11 (M): Interesting exercise. Backpackers are all fairly open to adventure and sometimes the adventure leads to more serious relationships.

#14 (F): Didn’t expect to have sex this trip, but don’t regret it happening either.

#19 (M): Good idea, make more people think before they have sex, because you only get HIV once.

#20 (M): Can you get HIV via oral sex, without cuts?

#25 (F): If it is of any use, met my current sexual partner last time I was in OZ and hooked up with him this time too!

#28 (F): I think this topic needs more promotion, perhaps via youth hostels. Free condoms, etc. Particularly in remote places.

#36 (M): the just met, met recently questions seem a bit difficult to comprehend. Maybe its just me! Otherwise the questionnaire seems very comprehensive!

#48 (F): On vacation/holiday – Flew alone to visti my friend – whose here (from England) 6 weeks – I’ve been here one month tomorrow. We met 2 & years ago in Hawaii and have kept in touch by email. Nothing happened in Hawaii but we were both interested. So when I got here I knew that something would happen physically but wasn’t sure mentally if it should be. I say this because guys can be physical with no emotions more easier than a girl can. So basically I wasn’t sure if I should because of my emotions and getting attached. Well, of course now its happened (us being together) so now I am confused. I have to make a big decision now…stay or go!

#49 (F): Good luck, hope it goes well!

#42 (M): It seems a very well researched & planned subject. All the best with the results. If ya fancy a shag give us a bell on this no: 02 9134 [….].

#50 (M): Thanks for the confidentiality!

#53 (M): What has drugs have anything to do with this study.

#55 (M): Good one. Very close to how a traveller feels!

#61 (M): It made me feel like I’m lame. I’m 18 and I really have not put myself out there. I want to live!

#81 (F): Not too sure about he last question, I don’t think it has much to do about the country, more about individuals.

#89 (M): I think it is a very thorough questionnaire and I learnt a bit more about myself that I didn’t realise. Very good!

#97 (M): Good

APPENDIX K 339

#99 (M): When was the last time you had sex? (A) 3 years ago!

#102(F): I think if I had not been in a committed relationship I would have been open to the idea of sexual relation on this trip.

#106 (F): Question 33 difficult to answer when travelling with long-term boyfriend and not intending 2 part.

#108 (M): Good luck in PhD

#115 (M): Yes I am now less of a man!

#117 (M): My number is…Good Luck.

#118 (M): Good luck.

#119 (M): Boring

#125 (F): Since I am not a long term traveller I’m probably not the right person to ask these questions…and besides, I’m visiting my boyfriend on his long trip.

#132 (M): Where is the juicy stuff

#133 (F): Good luck with the thesis!

#134 (M): I am only in Australia for 4 days so none of the questions are applicable to me.

#145 (M): Good luck with your PhD

#149 (M): Should state what you want with the statistics and how you plan to apply it once statistics are completed.

#150 (F): As a committed Christian I do not believe in casual sex, but have had a one night stand which was out of character - I blame KohPhiPhi islands party attitude and alcohol.

#162(M): These topics are starting to become more apparent to me. I feel I should take more care.

#190(M): The woman who gave the questionnaire is hot and we should go out sometime – 0410 [……]

#191 (F): I grew up in South Africa before immigrating an I have been exposed to a country with an HIV crisis that should have instilled more sense into me but I tend to think that if I am on the pill I won’t have a problem with pregnancy which is my main concern and I don’t tend to think about STDs. I am very cautious about who I sleep with and tend to know them through friends or over a couple of days.

#206 (M): Due to the fact that five years ago my best friend got pregnant froma one night stand I have always used a condom during sex, except for one 3 year long relationship.

340 APPENDIX K

#208 (F): I think that when both partners have been tested it is ok to have sex without condoms.

#211 (F): It is scary to see it on paper when it is already so present in my head.

#227(F): My love life needs improving!

#241 (F): Fun!

#226(M): A bit of a laff

#230 (M): Very interesting questionnaire especially whilst eating. If you need anymore info call me. You’re a very mature student.

#242 (M): Yeah; do I get sex for doing this?

#270 (M): interesting!

#279 (M): I am not a tramp at all!

#288(M): No, good luck!

#291 (M): Sex is great!

#293(M): Good idea. Hopefully there will be some interesting findings made and hopefully some good will come of it. Maybe even people filling out this questionnaire will think more about using condoms, not just here but when they get back home too.

#294(M): Very interesting subject. I would like to know the findings.

#330(M): I love sex!

#305(M): I think it quite a good questionnaire. Just please don’t tell me mum what I’m like. Thank you very much.

#306(M): Ultimate party rocks. Enough birds are easy.

#309 (M): Bit too long

#310 (M): Good luck with your PhD

#311 (F): I think backpackers don’t care a lot about the risk, they just want to have fun. That’s dangerous!

#321(M): It is not obvious which questions to answer

#328(F): Very well layed out – boxes too small to write how long been travelling. Question 20 should have a box for “occasionally” as some drugs have done not once, but not often.

#331(F): Did you meet someone whilst travelling who you get involved with in a serious relationship? Yes!

#340 (F): Interesting!

APPENDIX K 341

#345(M): Good luck with the PhD! Hope I’ve helped a little.

#346 (F): What has parachuting and white water rafting got to do with it?

#347 (F): All backpackers I know seem to think its ok to be promiscuous and have casual sex while they’re travelling because they only know people for a short amount of time and they rarely use condoms.

#348(M): Never really thought about this kind of stuff before now.

#358 (M): Thanks for creating awareness for me and everyone else here and keeping the place quiet for 15 minutes!

#363 (M): Good topic. #368 (F): Completing this questionnaire makes me think that I should be more careful sometimes and also feel like a bit of tart looking at how many people I’ve slept with! (6-10)

#369 (F): I think it’s a good idea to make people more aware. Free condoms would be a good idea because I know I’d never buy them myself but if they were freely available I would take them.

#374(F): I think condoms are very important but there is always the risk of losing sight of this during the lead up to sex or even during.

#378(F): I think generally when people travel and, travel for new experiences, they do this things in a foreign country they wouldn’t do at home, also I feel they are expected to have a few holiday romances.

#382 (M): Some questionnaires need to be more specific as with most questionnaires.

#397 (F): If I didn’t have a boyfriend waiting at home, I would have engaged in a great deal more (at least some) sexual activity. In the past, I have regarded it as a part of my travelling. I would use a condom with anyone other than my boyfriend, since we are both clean.

#401 (M): Thanks, you made me think about sex again, while I am stuck for another month without it.

#405 (M): Most hostels, pubs, and clubs do very little to raise awareness about STDs etc but actively promote drinking (excessively) and promiscuous behaviour, eg. Wet T-shirt competitions, drink promotions, etc.

#412 (M): Great questionnaire, good luck.

#425 (M): Good luck, hope this helps.

#435 (F): You have to bear in mind I’m travelling with my boyfriend of 3 1/2 years.

#444 (F): Most informative survey, like to see the results.

#450(F): Limitation of questionnaire, in a couple – sex with new partners not relevant, hard to cheat with a person 24/7, so irrelevant.

#455(M): You missed out beastiality for the welsh and the New Zealanders.

342 APPENDIX K

#456 (F): I think this questionnaire has made me think more about the consequences of having sex with strangers and made me re-think a few things.

#457 (M): This survey makes me sound very boring! Hope the information is useful to you.

#463 (F): Good questions, very clear – maybe questions were a little bit repetitive. People also may lie as they maybe embarrassed by these questions.

#466 (M): Its been emotional

#467 (F): Not using condoms as I am on the pill.

#476 (M): I think it is a good topic and a real good questionnaire. Nice one, and good luck with the PhD

#489(M): Good luck with your PhD

#500 (M): Very interesting. Makes me think. Should use condoms more, promiscuity increases while travelling.

#504 (M): I think that persons from the age of 18-22 are most likely to catch sexually transmitted diseases speaking from my own observations. Especially the east coast of OZ.

#514 (M): I’m not a bad person, honestly, the condom thing is stupid I know, should sort that out.

#531 (M): you’ve scared me and now I am going to the clinic, cheers.

#535 (M): What do you hope to gain by questionnaire. Travelling initiates different attitudes in different individuals and patterns of behaviour will be very difficult to quantify.

#536 (M): Some of the questions are the same, filling out the form next to your partner with her watching over you maybe the answers are not always truthful?

#539 (M): Interesting topic for a PhD, you lucky girl

#548 (F): you have not asked about the use of other contraceptives i.e. the pill.

APPENDIX L 343

Appendix L

“Safe in the sack”: NSW backpacker sexual health promotion

campaign

This campaign was a collaborative effort between FPA Health (Family Planning Association),

South Eastern Sydney Area Health Service, Northern Sydney Health and the National Centre in HIV Social Research (NCHSR; represented by me). This innovative initiative specifically targeted backpackers, was designed (in part) by backpackers, and was implemented in the backpackers’ milieu. For a more detailed description of the “Safe in the Sack” campaign, see the project report by Yallop and Murray (2005).

Rather than focus on detailed explanations of risk or the “mechanics” of STI/transmission

(Skidmore & Hayter, 2000), efforts in this campaign were dedicated to making explicit the influence of the social context of backpacking on sexual conduct. This campaign targeted backpackers while they were travelling. Every effort was made to ensure that the campaign messages reflected authentic elements of the backpacking experience while educating backpackers on indicators of sexual risk that are inherent to this travel culture. The overall aim of this campaign was to promote healthy choices about sexual health and safe sex practices among backpackers aged between 18 and 25 visiting NSW. The specific objectives were:

• To increase access to condoms and sexual health information at traveller

accommodation services (primarily hostels);

• To increase awareness of individual backpackers’ personal risks with regard to STIs,

including HIV;

• To increase access to condoms and sexual health information in bars and pubs

popular among backpackers; and

• To increase backpackers-knowledge of STI and HIV risk factors whilst travelling.

344 APPENDIX L

In the first phase of the campaign, young backpackers staying in Sydney hostels were recruited to participate in four focus groups to formulate campaign messages that would be positively received by other backpackers. The insight I gained during my contact with backpackers visiting Australia and during my interviews with health providers offered valuable detailed social and cultural information necessary for the “Safe in the Sack” committee to appropriately design, develop, and implement health promotion messages that incorporated the contextual forces that underlie backpackers’ sexual behaviour. My research and knowledge relating to the backpacking culture, coupled with the suggestions and feedback from backpackers and the other project committee members, provided information for the development of the campaign resources and the strategies that were utilised to deploy the campaign messages. For instance, my insight into the importance role that alcohol has for backpackers’ social connectivity was instrumental in informing the committee’s decision to disseminate and advertise the campaign messages in pubs/bars that were popular with backpackers, and to design a specific campaign message that highlighted the intoxication that commonly occurs in this transient culture:

“Going on a big night out? Don’t wake up with more than a hangover”.

Hostels and pubs/bars were targeted for dissemination of the health promotion messages that aimed to minimise risk-related sexual behaviour among backpackers. During the campaign, partnerships were formed with hostels, pubs, liquor accords, local councils, backpacker magazines, and backpacker event organisations. These partnerships increased our capacity to reach backpackers more effectively. With the aid of a graphic designer, and based on feedback from the backpacker focus groups, resource materials were developed: four coasters (see below), a condom pack, a sticker for a condom display box, and two A4 posters (see below).

These campaign resources carried information about STIs, messages promoting condom use and the telephone number of a free sexual health information and referral service. The resource packages were distributed to over 100 accommodation services and pub venues in metropolitan and regional areas in New South Wales that were popular with backpackers. In

APPENDIX L 345

addition, poster advertising space was rented in Bondi and King’s Cross train stations close to popular backpacker areas for several weeks over the summer months.

Overall, there was a high level of interest in the campaign, both from the accommodation and pub/bar venues that displayed and disseminated the campaign resource material and from the

Australian media. Despite the campaign’s apparent success, one limitation of attempting to reach such a transient population was that it was extremely difficult to evaluate the impact of the campaign on attitudes or behaviour. Many hostel managers, although not certain whether the campaign modified backpackers’ behaviour, thought that the campaign was well designed for the market it was targeting and raised awareness about sexual health and condom use among backpackers. Respondents to the post-campaign evaluation questionnaire (hostel and bar/pub staff) recommended ongoing, sustainable sexual health promotion work. Valuable partnerships with local backpacker related organisations enhanced the credibility and visibility of the campaign and these partnerships should provide a firm foundation for ongoing health promotion work with young backpackers.

346 APPENDIX L

Campaign material for “Safe in the Sack”

BEER COASTERS (4)

Front Reverse

APPENDIX L 347

Campaign material for “Safe in the Sack”

Front Reverse

348 APPENDIX L

Campaign material for “Safe in the Sack”

POSTERS (2)

APPENDIX M 349

Appendix M

Sydney Sexual Health Centre Study

Sydney Sexual Health Centre is one of the largest sexual health centres in Australia and is the main public sexual health service for Sydney’s central business district. The centre provides free anonymous sexual health services, but demand for its services outstrips its capacity, therefore patients are actively triaged. A substantial proportion of patients seeking sexual health services at the centre are overseas travellers, including backpackers (Egan et al., 2005).

Given that backpackers are not recognised as a high-need population, only those with symptoms are offered an appointment. The same is true at many other public sexual health clinics in New South Wales. Therefore these findings may not be representative of all backpackers engaging in high-risk sexual behaviour who might have been referred to other fee for service clinics.

The Sydney Sexual Health Centre study aimed to establish the demographic, behavioural, and clinical factors associated with infection in young long-term travellers compared with the local population by analysing electronic database information on 18 to 30 year-olds who attended their clinic between January, 1998 and December, 2006. Backpackers (n = 4,382) were indirectly measured as those who self-identified as a “traveller”, had lived in Australia for less than two years and lived outside Australia for most of the previous five years, and originated from a country that was known to be a popular source country for long-term travellers. The comparison group (n = 8,810) was comprised of age-matched patients who had been born in

Australia or had lived in Australia for more than two years. As the study was focused on the broader population of both groups, commercial sex workers were excluded.

Backpackers attending the clinic were more likely than the comparison group to have STI screening as the reason for their visit (p < 0.0001), to report a history of genital chlamydia

350 APPENDIX M

infection (15% vs 9%, p < 0.0001) and to be diagnosed with chlamydia at their initial visit (8% vs 5%, p < 0.0001). While rates of consistent condom use in the last three months were low in both groups, STI diagnosis was independently associated with being female, a backpacker, drinking alcohol to excess, and having had a previous STI. The probability of acquiring genital chlamydia infection was found to be four times as high if a clinic attender reported more than three sexual partners in the previous three months. The rate of genital chlamydia diagnosis in backpackers attending this clinic was 8%.

A substantial proportion of the backpackers in my study reported repeated exposures with multiple partners during their trip, and therefore were likely at high risk of acquiring an STI.

Chlamydia trachomatis has been the most common bacterial STI in the UK and USA since the early 1980’s, but efforts to control the transmission of STIs have been hampered by the fact that many of these infectious pathogens are asymptomatic and therefore diagnosis and treatment are significantly delayed. “Chlamydia is asymptomatic in 70-90% of cases and many infections remain untreated” (Walleser, Salkeld, & Donovan, 2006, p. 225). Carriers of chlamydia, if undetected, will often experience silent irreversible reproductive health morbidity in the form of fallopian tubal damage, and a subsequent increased risk of infertility.

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