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Efficacy of multicomponent culturally tailored HIV/ STI prevention interventions targeting foreign female entertainment workers: a quasi-experimental trial
  1. Raymond B T Lim1,
  2. Olive N Y Cheung1,
  3. Bee Choo Tai1,
  4. Mark I-C Chen1,2,
  5. Roy K W Chan1,3,
  6. Mee Lian Wong1
  1. 1 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
  2. 2 Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
  3. 3 Department of Sexually Transmitted Infections Control, National Skin Centre, Singapore
  1. Correspondence to Dr Mee Lian Wong, Saw Swee Hock School of Public Health, National University of Singapore, Singapore city 117549, Singapore; ephwml{at}


Objectives We assessed the efficacy of a multicomponent culturally tailored HIV/STI prevention intervention programme on consistent condom use and STI incidence among foreign Thai and Vietnamese female entertainment workers (FEWs) in Singapore.

Methods We conducted a quasi-experimental pretest and post-test intervention trial with a comparison group. We recruited 220 participants (115 Vietnamese and 105 Thai) for the comparison group, followed by the intervention group (same number) from the same sites which were purposively selected after a 3-month interval period. Both groups completed a self-administered anonymous questionnaire and STI testing for cervical gonorrhoea and Chlamydia, as well as pharyngeal gonorrhoea at baseline and 6-week follow-up. The peer-led intervention consisted of behavioural (HIV/STI education and condom negotiation skills), biomedical (STI screening and treatment services) and structural components (access to free condoms). We used the mixed effects Poisson regression model accounting for clustering by establishment venue to compute the adjusted risk ratio (aRR) of the outcomes at follow-up.

Results At follow-up, the intervention group was more likely than the comparison group to report consistent condom use for vaginal sex with paid (aRR 1.77; 95% CI 1.71 to 1.83) and casual (aRR 1.81; 95% CI 1.71 to 1.91) partners. For consistent condom use for oral sex, this was aRR 1.50; 95% CI 1.23 to 1.82 with paid and aRR 1.54; 95% CI 1.22 to 1.95 with casual partners. STI incidence at follow-up was significantly lower in the intervention (6.8 per 100 FEWs) than the comparison (14.8 per 100 FEWs) group (aRR 0.42; 95% CI 0.32 to 0.55).

Conclusions This trial was effective in promoting consistent condom use for vaginal and oral sex as well as reducing STI incidence among the foreign Thai and Vietnamese FEWs in Singapore. The feasibility of scaling up the interventions to all entertainment establishments in Singapore should be assessed.

  • behavioural interventions
  • commercial sex
  • program evaluation
  • public health
  • bacterial infection

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  • Handling editor Jackie A Cassell

  • Contributors RBTL: analysed the data, developed the tables and figures and drafted the manuscript. ONYC: was involved in data collection and data entry. BCT, MICC and RKWC: revised the manuscript critically for important intellectual content. MLW: conceptualised and designed the study as PI and revised the manuscript critically for important intellectual content.

  • Funding The trial was funded through the Communicable Diseases Public Health Research Grant by the Ministry of Health, Singapore (grant application number CDPHRG12NOV020).

  • Disclaimer The funder did not play a role in the design, conduct or analysis of the trial nor in the drafting of this manuscript.

  • Competing interests None declared.

  • Ethics approval National University of Singapore Institutional Review Board.

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

  • Data sharing statement Raw data will not be available for sharing since we are still analysing some aspects of the data and developing other manuscripts.