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Efficacy of Human Immunodeficiency Virus/Sexually Transmitted Infection Trial on Condom Use Among Heterosexual Men Patronizing Entertainment Establishments Who Engaged in Casual or Paid Sex in Singapore

Lim, Raymond Boon Tar MPH*; Tham, Dede Kam Tyng BSc*; Tai, Bee Choo PhD*; Adaikan, P Ganesan PhD; Wong, Mee Lian MD*

doi: 10.1097/OLQ.0000000000000642
Original Studies

Background We assessed the efficacy of a multi-component sexual health promotion program on condom use and human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing among heterosexual men (HSM) patronizing entertainment establishments who engaged in casual or paid sex in Singapore.

Methods This was a quasi-experimental trial with a comparison group using cross-sectional surveys at baseline and 6 months postintervention. A locality patronized by local HSM was assigned the intervention, a comparable and distant area served as the comparison site. Using time location sampling, cross-sectional samples of these men were assessed on sexual behaviors using an anonymous questionnaire at baseline (n = 604) and 6 months postintervention (n = 360) in both groups. The coprimary outcomes were condom use at last vaginal and oral sex with casual partner respectively. Mixed effects Poisson regression model accounting for clustering by establishment was used to compute the adjusted prevalence ratio (aPR) of the outcomes postintervention.

Results At postintervention, the intervention group was more likely than the comparison group to report condom use at last vaginal (aPR, 1.41; 95% confidence interval [CI], 1.05–1.89) and oral (aPR, 1.70; 95% CI. 1.11–2.61) sex, respectively, with casual partner. Similar findings were found for consistent condom use in the last 6 months for vaginal (aPR, 1.67; 95% CI, 1.13–2.48) and oral (aPR, 1.97; 95% CI, 1.16–3.32) sex, respectively, with casual partner. The HIV/STI testing was not significantly higher in the intervention than the comparison group (aPR, 1.43; 95% CI, 0.98–2.09).

Conclusions This trial was effective in promoting condom use with casual partners but not HIV/STI testing among HSM in Singapore.

A human immunodeficiency virus/sexually transmitted infection trial was effective in promoting condom use for vaginal and oral sex with casual partners among heterosexual men patronizing entertainment establishments in Singapore. Supplemental digital content is available in the text.

From the *Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation; and †Department of Obstetrics and Gynaecology, Yoo Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore

Conflicts of Interest: None declared.

The trial was funded through the Communicable Diseases Public Health Research Grant by the Ministry of Health, Singapore (Grant application number CDPHRG12NOV020). The funder did not play a role in the design, conduct or analysis of the trial nor in the drafting of this manuscript.

The authors would like to thank Dr Jeffery Cutter, Mr Alwyn Ng Mao Tong, Dr Olive NY Cheung, Mr Shiyu Phan, the Action for AIDS (AfA), the Department of STI Control (DSC) Clinic, entertainment establishment owners, key informants, student helpers and all others who have rendered support for this study.

Correspondence: Mee Lian WONG, MBBS, MPH, MD, National University of Singapore, Singapore, Singapore. E-mail:

Received for publication March 14, 2017, and accepted April 20, 2017.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

© Copyright 2017 American Sexually Transmitted Diseases Association