title: Examining the policy climate for HIV prevention in the Caribbean tourism sector: a qualitative study of policy makers in the Dominican Republic.
abstract: BACKGROUND
  The Caribbean has the highest prevalence rates of HIV/AIDS outside sub-Saharan Africa, and a broad literature suggests an ecological association between tourism areas and sexual vulnerability. Tourism employees have been shown to engage in high rates of sexual risk behaviours. Nevertheless, no large-scale or sustained HIV prevention interventions have been conducted within the tourism industry. Policy barriers and resources are under-studied.
  
  
  METHODS
  In order to identify the policy barriers and resources for HIV prevention in the tourism sector, our research used a participatory approach involving a multisectoral coalition of representatives from the tourism industry, government, public health and civil society in the Dominican Republic. We conducted 39 in-depth semi-structured interviews with policy makers throughout the country focusing on: prior experiences with HIV prevention policies and programmes in the tourism sector; barriers and resources for such policies and programmes; and future priorities and recommendations.
  
  
  RESULTS
  Findings suggest perceptions among policy makers of barriers related to the mobile nature of tourism employees; the lack of centralized funding; fear of the 'image problem' associated with HIV; and the lack of multisectoral policy dialogue and collaboration. Nevertheless, prior short-term experiences and changing attitudes among some private sector tourism representatives suggest emerging opportunities for policy change.
  
  
  CONCLUSIONS
  We argue that the time is ripe for dialogue across the public-private divide in order to develop regulatory mechanisms, joint responsibilities and centralized funding sources to ensure a sustainable response to the HIV-tourism linkage. Policy priorities should focus on incorporating HIV prevention as a component of occupational health; reinforcing workers' health care rights as guaranteed by existing law; using private sector tourism representatives who support HIV prevention as positive role models for national campaigns; and disseminating a notion of 'investment' in safer tourism environments as a means to positively influence tourist demand.
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory St., Ann Arbor, MI 48109, USA. padillam@umich.edu
authors.forename: Mark B
authors.initials: MB
authors.lastname: Padilla
authors.forename: Armando Matiz
authors.initials: AM
authors.lastname: Reyes
authors.forename: Maureen
authors.initials: M
authors.lastname: Connolly
authors.forename: Shaw
authors.initials: S
authors.lastname: Natsui
authors.forename: Adrian
authors.initials: A
authors.lastname: Puello
authors.forename: Helena
authors.initials: H
authors.lastname: Chapman
mesh_terms: D004293:Dominican Republic; D015658:HIV Infections / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D011050:Policy Making; D014195:Travel / Q000191:economics; D047568:Unsafe Sex / Q000517:prevention & control