title: Long-term effects of condom promotion programmes for vaginal and oral sex on sexually transmitted infections among sex workers in Singapore.
abstract: OBJECTIVE
  To evaluate the long-term impact of condom promotion programmes for vaginal and oral sex among female brothel-based sex workers in Singapore.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The interventions produced sustained high levels of condom use for vaginal and oral sex with corresponding declines in cervical and pharyngeal gonorrhoea incidence.
authors.affiliation: Department of Community, Occupational and Family Medicine (MD 3), Faculty of Medicine, National University of Singapore, Singapore.
authors.forename: Mee Lian
authors.initials: ML
authors.lastname: Wong
authors.forename: Roy
authors.initials: R
authors.lastname: Chan
authors.forename: David
authors.initials: D
authors.lastname: Koh
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D015994:Incidence; D010608:Pharyngeal Diseases / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D021841:Safe Sex / Q000706:statistics & numerical data*; D011477:Sex Work / Q000706:statistics & numerical data*; D012846:Singapore / Q000453:epidemiology; D002577:Uterine Cervical Diseases / Q000453:epidemiology / Q000517:prevention & control*