“The Ambivalence of Bringing Sex and Travel into Play”- Experiences and Perspectives of Travellers and Healthcare Professionals on Integrated Sexual Health Pre-travel Counselling in the Era of PrEP

Background Integrating sexual health into pre-travel counselling is important to raise risk awareness and ensure travellers have access to preventive measures, including HIV pre-exposure prophylaxis (PrEP). Yet, it is implemented little in practice. This qualitative study describes the experience, perceptions and needs of travellers and health care professionals (HCP) concerning integrating sexual health into pre-travel counselling. It is part of a practice developmental approach strengthening sexual health counsling at the University of Zurich’s Centre for Travel Medicine (CTM), Switzerland. Methods Travellers attending the CTM as well as HCPs from travel medicine and sexual health care across Switzerland were recruited for semi-structured interviews from August 2022-February 2023. Reflexive thematic analysis with a constructivist orientation was used to analyse data. Results Interviews with 24 participants (13 travellers; 11 HCPs) revealed common themes, which were summarized along the metaphor of a theatre play, that is ment to illustrate the counselling dynamic. The overarching theme “The ambiguity of bringing sex and travel into play” describes how both groups face uncertainty about discussing sexual health in pre travel consultations. They find it important but feel uncomfortable due to stigma. “Setting the spotlight on the sideshow of sexual health counselling” highlights the challenge of drawing attention to this often-neglected topic. “Engaging in the performance of sexual health counselling” captures how travellers and HCPs are challenged to interact meaningfully during these conversations, including reflection on personal risk and “Improvising the off-script scene in sexual health counselling” reflects the challenges they face in navigating unexpected or complex counselling content, such as HIV-PrEP. Conclusions Sexual health remains a sensitive and difficult topic to discuss for both travellers and HCPs. Achieving impact will require cultural change to reduce stigma and normalise sexual health discussions. This involves targeted interventions for healthcare providers, including stigma reflection and training in person-centred and motivational communication, as well as interventions for travellers to raise awareness of sexual health as a travel-related issue, and promote reflection on personal risk, and inform about preventive options, including HIV pre-exposure prophylaxis (PrEP). Further research should develop and test a theory of change integrating these elements in clinical practice.