title: HIV prevention among travelers: why do men not use condoms when they engage in commercial sex overseas?
abstract: OBJECTIVE
  We investigated factors associated with condom use among men patronizing female sex workers abroad and locally.
  
  
  METHODS
  We conducted a survey on 372 local men attending the only public sexually transmitted infections clinic in Singapore between 2001 and 2003.
  
  
  RESULTS
  Condom use was higher among clients patronizing sex workers in Singapore than those patronizing sex workers abroad (87.5% vs. 54.4%, P<0.001). Condom use in both groups was associated with initiation of condom use by the sex workers (adjusted prevalence ratios: 1.67, 95% confidence interval: 1.11-2.49; 1.87, 1.21-2.90) but was not associated with clients' knowledge of disease, self-perceived risk, confidence in condom use, and dislike of condoms. Less sex workers abroad than in Singapore (32.7% vs. 75.6%, P<0.001) initiated condom use.
  
  
  CONCLUSIONS
  Lower condom use among Singaporean travelers abroad was determined by extrinsic factors, whereby sex workers abroad were less likely to initiate condom use rather than by clients' factors.
authors.affiliation: Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, Faculty of Medicine, National University of Singapore. cofwml@nus.edu.sg
authors.forename: Mee-Lian
authors.initials: ML
authors.lastname: Wong
authors.forename: Roy K W
authors.initials: RK
authors.lastname: Chan
authors.forename: David
authors.initials: D
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008571:Men / Q000523:psychology*; D008875:Middle Aged; D011477:Sex Work / Q000523:psychology*; D012846:Singapore; D011795:Surveys and Questionnaires; D014195:Travel