3 / 9
Virology research J 2017 Vol 1 Issue 2
Page 11
July 26-27, 2017 | Vancouver, Canada
WORLD CONFERENCE ON STDs, STIs & HIV/AIDS
allied
academies
Mee Lian Wong
National University of Singapore, Singapore
HIV/STI prevention interventions for sex workers in different settings in Singapore:
Impact, challenges and lessons learned from two decades of research
M
ale patronage of female sex workers has been reported
as the main mode of transmission of HIV and Sexually
Transmitted Infections (STIs) in Asia. In Singapore, sex
workers operate from diverse settings ranging from licensed
brothels, to streets and entertainment establishments. A
survey of licensed brothel-based sex workers in Singapore
in 1992 found that 40% tested positive for STIs. Only 45%
used condoms consistently with their clients because they
could not persuade them to use condoms. I collaborated
with the Department of STI Control (DSC), and we developed
an intervention, using behavioral and work environment
strategies to get health staff to motivate the sex workers
to use condoms, develop their condom negotiation skills
and mobilize support from brothel owners for condom use.
Evaluation of the intervention, using a quasi-experimental
design, showed a statistically significant increase in condom
use with a corresponding decline in STIs. The intervention
program was scaled up to all brothel-based sex workers in
which they were required to attend STIs/HIV talks and skills
development sessions on condom use and negotiation at
the DSC Clinic. Program activities for brothel management
included HIV/STI talks and mandatory display of posters on
100% condom use. Free condoms were given to all clients
in the brothels. The program led to a sustained increase in
condom use to more than 90% with a corresponding decline
in STIs from 40 per 1000 person months to less than 1 per
1000 person-months among the sex workers. In recent
years, globalization and wide income disparities across
countries in Asia led to an influx of women from the region
to work in entertainment establishments in Singapore.
Our survey on entertainment establishments in Singapore
in 2008 found that 70% of entertainment establishments
provided sexual services. Almost all (>90%) of the female
entertainment workers came from Asia and some came
on short term social visit passes. Condom use with clients
was low (<50%) among them. We faced more challenges
in designing interventions for this group than for brothel-
based workers because of their geographic mobility, illegal
and hidden nature of their work, their lack of access to STI/
HIV screening and treatment, and the influence of alcohol
on condom use. We collaborated with non-governmental
organizations and developed outreach peer-led sessions
on condom negotiation and alcohol consumption. Free
condoms and STI screening were also provided. At 6-week
follow-up, the intervention group was more likely than the
control group to report consistent condom use with paid
partners (75% vs. 42%; adjusted risk ratio [aRR] 1∙78; 95%
CI: 1∙73 – 1∙84). There was also a corresponding significant
decline in STI incidence (8∙2 % vs. 13.5%, p<0.05). Given the
heterogeneity of sex work, we need to develop context-
specific and culturally appropriate multilevel interventions
that address structural and behavioral barriers to condom
use. It is crucial to address the social and structural influences
on condom use among foreign sex workers in Singapore by
working with relevant stakeholders and by using community
empowerment strategies.
Speaker Biography
Mee-Lian Wong is Associate Professor of Public Health at the National University of Sin-
gapore - Saw Swee Hock School of Public Health. She received her MBBS and MPH from
the University of Malaya and her Doctor of Medicine from the National University of
Singapore. Her current research interests include health promotion, behavioral change
and prevention of sexually-transmitted infections (STIs) and HIV among adolescents,
heterosexual men and sex workers in Singapore and Cambodia. She has devoted 24
years to research in the development and evaluation of STI/HIV/AIDS programs and be-
havioral interventions for sex workers. She has published more than 100 papers on STI/
prevention and health promotion. Her research on HIV/STI prevention has earned her
many awards, including (i) the Wilf Howe Memorial Prize 2008, Faculty of Occupational
Health Physicians, United Kingdom, for outstanding intervention/research project on
STI prevention among sex workers with demonstrable health benefits, (ii) Red Ribbon
Award, Singapore 2014 for her invaluable research contributions in HIV prevention and
control (iii) National Skin Centre (NSC) Distinguished Friend Award 2009, for signifi-
cant contributions to the Department of STI Control, NSC in translational research in
HIV/STI prevention and control (iv) SEAMEO-JASPER award, second best research on
women and health for her research study, Women and Sexually transmitted Diseas-
es: A Sustainable Intervention to Increase Condom Use and Reduce Gonorrhea among
Sex Workers in Singapore, 1996 and (v) the Rockefeller Foundation’s (US) Reflections
on Development Fellowship award, 1989 for her research on Women in Health and
Community Development. She is also Visiting Consultant to the Department of STI
Control, National Skin Center, Singapore. She has previously served as Assistant Dean
of Preclinical Education at the Yong Loo School of Medicine, National University of Sin-
gapore; and Program Director of the National Preventive Medicine Residency Program,
Singapore.
e:
ephwml@nus.edu.sg