Roy Chan

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.

Premarital Sexual Intercourse Among Adolescents in an Asian Country: Multilevel Ecological Factors

OBJECTIVE: The goal was to assess personal and environmental factors associated with premarital sex among adolescents. METHODS: We conducted a case-control study. Between 2006 and 2008, we recruited 500 adolescents who reported having engaged in voluntary sex for most recent sex. Five hundred control subjects were matched for age, gender, and ethnicity. RESULTS: Independently significant factors for premarital sex among boys were pornography viewing (adjusted odds ratio [OR]: 5.82 [95% confidence interval [CI]: 2.34–14.43]), lack of confidence to resist peer pressure (OR: 3.84 [95% CI: 2.27–6.50]), perception that more than one half of their friends had engaged in sex (OR: 3.37 [95% CI: 1.92–5.92]), permissiveness regarding premarital sex (OR: 3.41 [95% CI: 2.10–5.55]), involvement in gang activities (OR: 3.45 [95% CI: 1.66–7.15]), drinking (OR: 1.77 [95% CI: 1.07–2.94]), smoking (OR: 1.91 [95% CI: 1.14–3.20]), and living in low-cost housing (OR: 3.25 [95% CI: 1.64–6.43]). For girls, additional factors were previous sexual abuse (OR: 7.81 [95% CI: 2.50–24.41]) and dropping out of school (OR: 2.72 [95% CI: 1.32–5.61]), and stronger associations were found for lack of confidence to resist peer pressure (OR: 5.56 [95% CI: 2.94–10.53]) and permissiveness regarding premarital sex (OR: 6.25 [95% CI: 3.30–11.83]). Exposure to persons with HIV/AIDS or sexually transmitted infections in the media was negatively associated with sex for boys (OR: 0.27 [95% CI: 0.16–0.45]) and girls (OR: 0.24 [95% CI: 0.13–0.47]). CONCLUSION: Sex education programs for adolescents must address social, media, and pornographic influences and incorporate skills to negotiate sexual abstinence.

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.

Gonorrhoea treatment failure and ciprofloxacin resistance

Summary: Ciprofloxacin-resistant strains of Neisseria gonorrhoeae have been on the increase over the past few years in Singapore and worldwide. The aim of this study is to correlate treatment failures with in vitro ciprofloxacin resistance of N. gonorrhoeae . A total of 694 patients attending the Department of STD Control (DSC) clinic in 1996 who were diagnosed to have gonococcal infection confirmed by culture were analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) of ciprofloxacin were traced for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant ( 1 mug/ml) and less sensitive (0.125-0.5 mug/ml) range were also reviewed to determine the clinical outcome. Ciprofloxacin treatment failure rate was 1.7% (8/461) which was lower than the percentage of ciprofloxacin-resistant strains isolated in the laboratory. Of these 8 cases, 6 were resistant and 2 were less sensitive to ciprofloxacin. Cure rates with ciprofloxacin for resistant and less sensitive strains were 40% and 92% respectively. In conclusion, in vitro resistance to ciprofloxacin may not translate into clinical treatment failure. Clinical treatment failures, on the other hand, are also seen in less sensitive strains.

A prospective study of pharyngeal gonorrhoea and inconsistent condom use for oral sex among female brothel-based sex workers in Singapore

Oral sex among female sex workers in Singapore has risen sharply from 27.1% in 1992 to 81.7% in 1997. A prospective cohort study was carried out on 724 female brothel-based sex workers who practised oral sex, to determine the risk of contracting pharyngeal gonorrhoea through inconsistent condom use. The prevalence of consistent condom use for oral sex was 70.4% compared to 96.8% for vaginal sex. One hundred and twenty-nine (17.8%) were lost to follow up because they quit prostitution. The other 595 sex workers were followed up for a maximum period of 6 months. Thirty-eight (5.2%) sex workers contracted pharyngeal gonorrhoea compared to 2.5% who contracted cervical gonorrhoea. Sex workers with inconsistent condom use for oral sex were 17.1 times (95% CI: 8.0-36.5) more likely than consistent condom users to develop pharyngeal gonorrhoea, after controlling for ethnic group, class and number of clients. STD control programmes for sex workers should place stress on consistent condom use for oral sex.

Promoting condoms for oral sex: impact on pharyngeal gonorrhea among female brothel-based sex workers.

Background Low condom use for oral sex among female brothel-based sex workers in Singapore has led to a rise in pharyngeal gonorrhea. Goal The goal of the study was to evaluate a program promoting the use of condoms for oral sex. Study Design We used the time–series design to compare condom use and pharyngeal gonorrhea trends before and after program intervention in 1996 and the pretest–posttest matched control group design to determine the impact of brothel interventions on sex workers. Results Consistent oral condom use increased significantly from 42.2% in 1996 to 89.9% in 2000, with a corresponding decline in pharyngeal gonorrhea (in comparison with no significant changes before intervention). Among sex workers in brothels with interventions there was a 10.8% absolute increase in condom use, compared with an 11.7% decrease in condom use in the control group. The gonorrhea incidence rate was also significantly much lower in the intervention group than in the control group (adjusted risk ratio: 0.22; 95% CI: 0.06–0.78). Conclusion The intervention increased oral condom use, with a decline in the incidence of pharyngeal gonorrhea.

A comparative study of cervical cytology, colposcopy and PCR for HPV in female sex workers in Singapore

This study examined the prevalence of human papillomavirus (HPV) infection in a cohort of female sex workers in Singapore. HPV infection was diagnosed by clinical examination, Papanicolaou (Pap) smears, histology and polymerase chain reaction (PCR). One hundred and eighty-seven female sex workers who came for their routine medical screening were enrolled into the study. PCR was positive for HPV in 27 (14.4%), 20 of these had a single HPV type detected, while 7 had multiple types of HPV detected. The most common HPV types identified were types 16, 58 and 18. In conclusion, HPV infection is moderately prevalent among sex workers as tested by PCR, but routine screening with Pap smears does not appear to be a sensitive method of diagnosis for HPV infection.

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 El (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.

Staphylococcus aureus and topical fusidic acid use: results of a clinical audit on antimicrobial resistance

Fusidic acid (FA) resistance in Staphylococcus aureus poses a problem for treating systemic methicillin‐resistant S. aureus infection, in which FA may otherwise remain a viable option. It can also result in treatment failure of common dermatological conditions such as impetigo and infected atopic eczema. Several studies have linked trends in prescribing medication and topical use of FA to development of resistance. However, few case–control studies have evaluated risk factors for developing FA resistance in S. aureus.

A comparative study of condom use and self-reported sexually transmitted infections between foreign Asian and local clients of sex workers in Singapore.

Objective: We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore. Study: A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore. Results: Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients. Conclusion: There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.