Controlled evaluation of a behavioural intervention programme on condom use and gonorrhoea incidence among sex workers in Singapore

Abstract

We evaluated the impact of a behavioural intervention programme on condom use and gonorrhoea incidence among female brothel-based sex workers in Singapore. All 128 sex workers from one locality were assigned to an intervention group and 125 sex workers from another relatively comparable locality served as controls. The intervention programme concentrated on developing sex workers' condom negotiation skills, and on gathering support from peers, brothel keepers and health staff in promoting condom use. The three outcome measures are self-reported success in persuading clients to use condoms, refusal of sex without a condom, and cumulative gonorrhoea incidence as measured by the percentage of sex workers with a new occurrence of a positive culture in the 5 month period before and after the intervention. The intervention group showed a statistically greater improvement in negotiation skills as compared to the controls. Sex workers exposed to the intervention were almost twice as likely than controls to always refuse unprotected sex (adjusted rate ratio of 1.90, 95% CI: 1.22–2.94). Cumulative gonorrhoea incidence declined considerably (77.1%) in the intervention group but only moderately (37.6%) in the control group.