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Factors associated with consistent condom use and STIs among foreign female entertainment workers: results from a cross-sectional survey in Singapore
  1. Raymond Boon Tar Lim1,
  2. Mee Lian Wong1,
  3. Olive N Y Cheung1,
  4. Dede Kam Tyng Tham1,
  5. Bee Choo Tai1,
  6. Roy Chan1,2
  1. 1Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
  2. 2Department of Sexually Transmitted Infections Control, National Skin Centre, Singapore, Singapore
  1. Correspondence to Dr Mee Lian Wong, Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore; ephwml{at}


Objectives We assessed the prevalence of consistent condom use and laboratory-confirmed STIs among foreign female entertainment workers (FEWs) who engaged in paid or casual sex in Singapore and the factors associated with these characteristics.

Methods A cross-sectional survey, using time-location sampling, was conducted on 220 FEWs (115 Vietnamese and 105 Thai) in 2015. For multivariable analysis, we used a mixed-effects Poisson regression model with backward stepwise approach to account for clustering by venue and to obtain the adjusted prevalence ratios (aPRs) of factors associated with consistent condom use and STI positivity, respectively.

Results Consistent condom use with paid or casual partners in the past month was 39.6% and 36.2% for vaginal and oral sex, respectively. The prevalence of STI (cervical chlamydia, cervical gonorrhoea or pharyngeal gonorrhoea) positivity was 13.6%. In multivariable analysis, consistent condom use for both vaginal and oral sex increased with high self-perceived risk of getting STI/HIV (vaginal: aPR 2.09; 95% CI 1.26 to 3.46; oral: aPR 2.41; 95% CI 1.23 to 4.69) and condom negotiation (vaginal: aPR 3.74; 95% CI 2.07 to 6.75; oral: aPR 2.81; 95% CI 1.51 to 5.26). STI positivity decreased with consistent condom use for vaginal sex (aPR 0.22; 95% CI 0.07 to 0.75) and increased with number of sexual partners (aPR 1.43; 95% CI 1.07 to 1.92).

Conclusion In addition to advocating for policy decisions to provide a safer work environment, behavioural interventions on condom negotiation skills and condom use and biomedical interventions on STI/HIV testing and treatment interventions are needed among the FEWs in Singapore.

Trial registration number NCT02780986; pre-results.


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  • Handling editor Jackie A Cassell

  • Contributors RBTL analysed the data, developed the tables and figures and drafted the manuscript. MLW, the principal investigator, conceptualised the study and was involved in the conduct of the study and revised the manuscript critically for important intellectual content. ONYC and DKTT were involved in the conduct of the study, data collection and data entry. BCT and RC revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

  • Funding The study 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 study or in the drafting of this manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval National University of Singapore Institutional Review Board (approval certificate number NUS 2159).

  • Provenance and peer review Not commissioned; externally peer reviewed.