SoutheaSt aSian J trop Med public health 690 Vol 44 No. 4 July 2013 Correspondence: Dr Watcharapong Piyapha- nee, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol Uni- versity, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand. Tel: +66 (0) 2354 9100 ext 1428; Fax: +66 (0) 2354 9168 E-mail: watcharapong.piy@mahidol.ac.th SEXUAL BEHAVIOR OF FOREIGN BACKPACKERS IN THE KHAO SAN ROAD AREA, BANGKOK Nils Kaehler 1 , Watcharapong Piyaphanee 1 , Chatporn Kittitrakul 1 , Ye Paing Kyi 2 , Bipin Adhikari 1 , Suda Sibunruang 3 , Suwimol Jearraksuwan 1 , Noppadon Tangpukdee 1 , Udomsak Silachamroon 1 and Terapong Tantawichien 4 1 Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok; 2 College of Public Health Science, Chulalongkorn University, Bangkok; 3 Queen Saovabha Memorial Institute, The Thai Red Cross Society, Bangkok; 4 Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand Abstract. Travelers play a role in the spread of sexually transmitted diseases, including HIV because of having unprotected sex. We studied the incidence of casual sex among foreign backpack tourists in the Khao San Road area of Bang- kok, Thailand. We also evaluated their attitudes about sexual health and their actual practices. A cross sectional study was conducted using a self-administered, anonymous questionnaire. The target population was backpackers aged ≥18 years, from Europe, North America and Australia. In total, 415 questionnaires were flled out and analyzed. Sixty-four percent of participants were male, the overall median age was 27 years and the mean duration of stay was 14.6 days. One hundred seven respondents (25%) had casual sex while staying in Thailand; of these, 55% always used condoms. The selection of sex partner infuenced the use of condoms. The highest rate of condom use was among backpackers who had sex with sex workers (63%), while those who had sex with their travel partners had the lowest rate of condom use (35.6%). One-fourth of backpackers in our study had casual sex during their trip. Their attitudes towards safe sex practices were not ideal. Methods to change attitudes and behavior about unprotected sex need to be explored in this population. Keywords: backpackers, sexual behavior, Thailand INTRODUCTION Travelers have a signifcant risk of contracting sexually transmitted diseases (STDs). Travel can remove social taboos that normally restrict sexual behavior, so travelers are more likely to engage in high-risk sexual behavior when abroad than when they are at home (Ansart et al, 2009). Five to 51% of short-term travelers have casual sex while traveling; this num- ber may be as high as 60% among Peace Corps volunteers (Matteelli and Carosi, 2001). It is estimated 20-75% of travelers who did have sex did not use condoms (Hawkes et al, 1995; Gagneux et al, 1996;