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

Wong, Mee Liana; Chan, Royb; Koh, Davida

Epidemiology & Social

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.

From the aDepartment of Community, Occupational and Family Medicine (MD 3), Faculty of Medicine, National University of Singapore and the bDepartment of STD Control, National Skin Center, Ministry of Health, Singapore.

Correspondence to Dr M. L. Wong, Department of Community, Occupational and Family Medicine (MD 3), Faculty of Medicine, National University of Singapore, Lower Kent Ridge Rd, Singapore 119260.

Received: 24 April 2003; revised: 2 July 2003; accepted: 16 July 2003.

© 2004 Lippincott Williams & Wilkins, Inc.