ABSTRACT
OBJECTIVE: To compare the prevalence of condom use and its associated factors within commercial and casual sex relationships between heterosexual men who seek sex online and those who frequent brothels in Singapore. METHODS: A survey was conducted between 2011 and 2012 among Singaporean heterosexual men aged 21-70 years who reported engaging in sexual intercourse with commercial or casual partners in the past year. Men seeking sex online (n=304) were recruited from the two most frequented local internet sex forums. Men frequenting brothels (n=297, 97% response rate) were recruited from a stratified cluster random sample of licensed brothels. RESULTS: Compared with men frequenting brothels, men seeking sex online reported significantly higher rates of oral and anal sex and sexually transmitted diseases but lower condom use for oral sex with commercial (16.5% vs 56.6%) and casual partners (21.2% vs 35.3%). In multivariate analyses, the online group showed that partner request for condom use was strongly associated with condom use for vaginal sex (adjusted ORs >3.0) but not with condom use for oral sex with both casual and commercial sex partners. The perceived risk of getting HIV from a partner was also associated with condom use for vaginal sex with commercial and casual partners; and for oral sex with casual partners. In contrast, condom use for oral and vaginal sex with both partners in the brothel group was only associated with partner request for condom use. CONCLUSIONS: Men seeking sex online should receive sexually transmitted infection (STI)/HIV prevention interventions that deal with the factors associated with condom use.
Subject(s)
Condoms/statistics & numerical data , HIV Infections/transmission , Internet , Risk-Taking , Sex Work , Sexual Behavior , Sexual Partners , Adult , Aged , Cross-Sectional Studies , HIV Infections/epidemiology , HIV Infections/prevention & control , Heterosexuality , Humans , Male , Middle Aged , Prevalence , Risk Factors , Singapore/epidemiology , Social SupportABSTRACT
We reviewed the current human immunodeficiency virus (HIV) prevention education programmes in Singapore, discussed the challenges faced and proposed prevention education interventions for the future. Education programmes on HIV prevention have shown some success as seen by reduced visits to sex workers among the general adult population and a marked increase in condom use among brothel-based sex workers. However, we still face many challenges such as low awareness of HIV preventive strategies and high prevalence of HIV stigma in the general population. Voluntary HIV testing and condom use remain low among the priority groups such as men who have sex with men (MSM) and heterosexual men who buy sex. Casual sex has increased markedly from 1.1% in 1989 to 17.4% in 2007 among heterosexuals in Singapore, with the majority (84%) practising unprotected sex. Sex workers have moved from brothels to entertainment venues where sex work is mostly hidden with lack of access to sexually transmitted infections (STIs)/ HIV prevention education and treatment programmes. Education programmes promoting early voluntary testing is hampered because of poor access, high cost and stigma towards people living with HIV. It remains a challenge to promote abstinence and consistent condom use in casual and steady sexual relationships among heterosexuals and MSM. New ways to promote condom use by using a positive appeal about its pleasure enhancing effects rather than the traditional disease-oriented approach should be explored. Education programmes promoting early voluntary testing and acceptance of HIV-infected persons should be scaled up and integrated into the general preventive health services.
