Long-term effects of condom promotion programmes for vaginal and oral sex on sexually transmitted infections among sex workers in Singapore.
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.
Wong
Mee Lian
ML
Department of Community, Occupational and Family Medicine (MD 3), Faculty of Medicine, National University of Singapore, Singapore.
Chan
Roy
R
Koh
David
D
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*