Factors associated with sexually transmitted diseases among prostitutes in Singapore

Theory and action for effective condom promotion: illustrations from a behavior intervention project for sex workers in singapore

Acquired immunodeficiency virus (AIDS) and sexually transmitted diseases (STD) control programs targeted at sex workers have focused on condom use. Reasons for non-condom use among female brothel-based sex workers in Singapore were found to be low self-efficacy, lack of condom negotiation skills, and barriers such as fear of annoying clients. Green's PRECEDE framework and Bandura's self-efficacy theory were applied to develop a project aimed at equipping sex workers with negotiation skills, overcoming barriers to condom use, and gathering support from brothel keepers and peers. The experimental group showed significant improvements in negotiation skills and outcome behavior of always refusing sex without a condom, that were supported by a decline in gonorrhea incidence. This article describes the application of behavior change and health education theories to achieve reduction in gonorrhea risk.

Long-term effects of condom promotion programmes for vaginal and oral sex on sexually transmitted infections among sex workers in Singapore

OBJECTIVES

To evaluate the long-term impact of condom promotion programmes for vaginal and oral sex among female brothel-based sex workers in Singapore.

DESIGN

A pre-test/post-test comparison group followed by a time series design was used to compare trends in condom use for vaginal sex and cervical gonorrhoea incidence from 1990 to 2002 across cross-sectional samples of sex workers before and after programme implementation in 1995. The subsequent condom promotion programme for oral sex was evaluated using the interrupted time series with a retrospective pre-test to post-test matched control group design.

METHODS

Sex workers completed a questionnaire before and 6 months after participation in educational sessions. Cervical and pharyngeal swabs were taken monthly for cultures for Neisseria gonorrhoeae.

RESULTS

Consistent condom use for vaginal sex increased significantly from < 45.0% before 1995 (pre-intervention period) to 95.1% in 2002, with a corresponding decline in cervical gonorrhoea incidence from > 30 to 2/1000 person-months. Adjustment for temporal changes in sociodemographic characteristics did not materially alter the trends. Consistent oral condom use increased significantly from < 50% before 1996 to 97.2% in 2002, with a corresponding decline in pharyngeal gonorrhoea from > 12 to 4.7/1000 person-months.

CONCLUSION

The interventions produced sustained high levels of condom use for vaginal and oral sex with corresponding declines in cervical and pharyngeal gonorrhoea incidence.

Sexually transmitted diseases and condom use among female freelance and brothel-based sex workers in Singapore

BACKGROUND AND OBJECTIVES

Most studies in Asia exclude freelance female sex workers because of difficulties in access and the illegality of their work. Data are lacking on their risk behaviors.

GOAL

To compare sexually transmitted disease (STD) rates, condom use, and health screening behavior between freelance and brothel-based sex workers in Singapore.

STUDY DESIGN

This is a cross-sectional survey of 111 free-lance sex workers arrested from November 1996 to March 1997 for illicit prostitution and 333 randomly selected brothel-based sex workers. All were tested for STDs.

RESULTS

STDs were significantly more prevalent among freelance than brothel-based sex workers (34.8% vs. 24.0%). Inconsistent condom use was significantly higher among freelance than brothel-based sex workers and was significantly associated with younger age, decreasing number of clients, and perception of non-condom use among peers.

CONCLUSION

Educational programs to promote condom use should target freelance sex workers and their clients.

A sustainable behavioral intervention to increase condom use and reduce gonorrhea among sex workers in Singapore: 2-year follow-up

BACKGROUND

Prostitution is the most important source of transmission of AIDS and sexually transmitted diseases in Asia. We developed and evaluated the sustainability of an intervention to increase condom use and reduce gonorrhea among brothel-based sex workers in Singapore. The intervention focused on developing sex workers' negotiation skills, educating clients, and mobilizing support from peers and health staff in promoting condom use.

METHODS

A pretest-posttest design with one intervention site (n = 124) and another comparable control site (n = 122) was maintained for 5 months followed by a time series design to follow up the intervention group for 2 years.

RESULTS

At 5 months, the intervention group improved significantly in negotiation skills and were almost twice as likely as controls to always refuse unprotected sex (adjusted rate ratio 1.90, 95% CI 1.22-2.94). Gonorrhea incidence declined considerably by 77.1% in the intervention group compared with 37.6% in the controls. Consistent refusals of unprotected sex in the intervention group increased from 44.4% at baseline to 65.2% at 5 months, 73.6% at 1 year, and 90.5% at 2 years with a corresponding decline in gonorrhea.

CONCLUSION

Sustained condom use with a corresponding decline in gonorrhea was achieved by a behavioral and environmental intervention for sex workers.

Evaluation of a safe-sex intervention programme among sex workers in Singapore

The purpose of this study was to evaluate the effects of a brief intervention programme on STD knowledge, condom use and gonorrhoea incidence among sex workers in Singapore. A controlled before-and-after study design with non-random assignment of sex workers was used, supplemented by multivariate analysis to adjust for baseline differences. Control (n = 221, denoted C1) and experimental (n = 221, denoted E1) groups were interviewed on 2 occasions 3 months apart. Two supplementary groups were interviewed once each at the end of the 3-month period (n = 145 who had received the intervention and n = 151 who had not). Basic knowledge of STD symptoms and HIV transmission was high in all groups. There were misconceptions about casual transmission of HIV which improved dramatically at the second interview for group E1 (from 37-56% correct responses to 82-90%). Overall condom use was high (about 75%) and did not change after the intervention. Gonorrhoea rates were correspondingly low (0.4 episodes/worker/year) and also did not change. This brief intervention improved the STD knowledge of sex workers. However, behaviour as measured by reported condom use and gonorrhoea incidence did not change. Implications for future intervention programmes are discussed.