Sex, drugs and disease: Taking a look at the other side of tourism in the Dominican Republic

The study aims to reduce the dual epidemics of both HIV and drugs in the Caribbean, which could serve as a model for South Florida.

In the Caribbean, the tourism industry is a major boost to the economy. Away from the stresses of everyday life, tourists lose their inhibitions and open their wallets, looking for an experience that truly takes them away. But FIU medical anthropologist Mark Padilla has found that what happens on the island is not staying on the island—and that has far-ranging consequences for the entire region.

Currently the Caribbean has the highest prevalence rates of HIV infection outside of sub-Saharan Africa. Nearly 75 percent of those cases occur in two countries: Haiti and the Dominican Republic, which comprise the island of Hispaniola. The Caribbean has also become a primary crossroad for cocaine and heroin from South America, a $5 billion a year trade that eventually makes its way to comprise the majority of the street level drugs in the United States and Europe.

At the same time, the Dominican Republic has also become the most popular tourist destination in the Caribbean, attracting more than six million visitors every year.

Padilla is embarking on a new, multiyear study, “Migration, Tourism, and the HIV/Drug-Use Syndemic in the Dominican Republic,” which aims to identify and address the different factors—such as sex, drugs and tourism– that are colliding and contributing to a major regional health crisis. “It’s wrong to look at one issue in isolation,” he noted. The high prevalence of HIV among sex workers and men who have sex with men in the Caribbean indicates that research, policies and prevention programs may be missing a key demographic.

“We are committed to reducing the impact of the dual epidemics of both HIV and drugs in the Caribbean in order to protect the health of both the Caribbean populations as well as Americans who are in close contact with the Caribbean,” Padilla said.

Padilla, associate professor of anthropology in FIU’s Department of Global and Sociocultural Studies, has spent more than a decade researching the men who migrate to tourist areas in the Dominican Republic looking for work. He has found that many of those men are at risk for acquiring HIV due to social isolation, the availability of drugs and the opportunity to make more money through sex work.

But this is the first comprehensive study that addresses all of the mitigating health and social issues as one problem—not five separate ones. “Our project would develop the first national intervention to reduce the impact of both HIV and drug abuse in Dominican tourism zones, and may serve as a model for the entire Caribbean region,” Padilla said.

“This is the first time the Autónoma University de Santo Domingo and FIU have the opportunity to collaborate on a project of this magnitude. It’s a great means to open doors for our researchers,” said Dr. Adrián M. Puello Guerrero, M.D., MPH, professor of epidemiology and social medicine at the Universidad Autónoma de Santo Domingo (UASD).

“The Dominican Republic has the highest HIV-infection rate in the Caribbean, and one of the highest in the world. We are also the number one tourist destination in the Caribbean. Combine those two factors with drug trafficking on the island and the need for community, evidence-based research to mitigate these problems is significant. It is a multi-layered problem and we hope to directly influence the policy-makers and decision-makers to understand the real connections between theses epidemics to recommend effective interventions.”

The project has the support of a diverse group, including a Community Advisory Board comprised of academics, members of the Dominican government, the private tourism sector and local business leaders, as well as Florida Congresswomen Ileana Ros-Lehtinen and Frederica Wilson. As Padilla explains, what is happening hundreds of miles away is actually very close to home.

Florida is one of the states with the highest incidence of new HIV cases, which are mostly reported in the Miami-Fort Lauderdale area. It is, not coincidentally, an area with a robust tourist industry and a large immigrant populations working far from home. Padilla believes his work will be able to translate to South Florida.

“This first year will be a pilot program,” said Dr. Puello Guerrero. “However, we want to create a benchmark in order to apply our findings and solutions to countries in Central America, Cuba, Puerto Rico and Florida, since our tourism industries function similarly.”

Local lawmakers agree that the research is important on a regional level. “As a member of Congress representing South Florida, the importance of FIU’s study cannot be overstated,” said Congresswomen Wilson in a letter to the National Institute on Drug Abuse. “Given our large immigrant population and frequent travel to and from the Caribbean, South Florida is especially vulnerable to epidemics such as HIV and drug use within the Caribbean region. The yields from FIU’s study could help strengthen HIV and drug abuse prevention and treatment programs.”