"Are they going to recollect who they need to contact?": understanding sexually transmitted infection transmission risks among older Canadians who winter in the United States

Abstract

Background: Sexually transmitted infections are on the rise in older populations globally, including among older travellers. International retirement migrants are older people who have retired from the workforce and travel abroad seasonally, typically during the winter months in their home countries. The transnational nature of this practice may challenge public health efforts to control the spread of sexually transmitted infection and encourage treatment. This study focuses on Yuma, Arizona, a popular destination for Canadian international retirement migrants who winter in the United States, to examine the sexual health risks associated with their seasonal travel.

Methods: Utilizing a qualitative case study approach, this research involved semi-structured interviews conducted remotely with key informants in Yuma (n = 10) who held various health care and administrative roles. Participants provided insights into sexual health risks based on their extensive interactions with Canadian seasonal migrants and their knowledge of the social dynamics within retirement communities. Interviews were transcribed verbatim, coded using NVivo software, and thematically analyzed to identify risk factors for sexually transmitted infections among Canadian international retirement migrants wintering in Yuma.

Results: Findings revealed three main risks that may contribute to exposure to sexually transmitted infections and potential transmission: social dynamics within tight-knit retirement migrant communities that facilitate unsafe sexual practices (i.e., risky practices); barriers to accessing diagnostic services, such as costs and lack of established local care (i.e., risky care access); and challenges in following standard treatment and public health protocols due to logistical difficulties in ensuring follow-up (i.e., risky treatment decisions). Key informants noted that lifestyle choices, including the use of alcohol and drugs, can exacerbate these risks. Health care access barriers driven by travel health insurance and mobility limitations further complicate the diagnosis and treatment of sexually transmitted infections for Canadian international retirement migrants while abroad.

Conclusions: This study highlights the complex interplay of social behaviours and health care barriers that heighten the risk of sexually transmitted infection transmission among Canadian retirement migrants in the transnational context of Yuma. Extended diagnostic and treatment services, comprehensive sexual health education in pre- and post-travel consultations, as well as inclusive travel health insurance coverage could significantly improve the sexual health outcomes for this population.

Keywords: Canada; International retirement migration; Sexual health risks; Sexually transmitted infections; Stigma; United States.