Heterosexual men who patronise entertainment establishments versus brothels in an Asian urban setting – which group practises riskier sexual behaviours?

Abstract

BackgroundSex work has shifted from brothels to entertainment establishments (EEs) in Asia. Men who patronise EEs could act as a bridging population for human immunodeficiency virus (HIV) and sexually transmitted infection (STI) transmission through unprotected sex with the female EE workers to their spouses and regular partners. The aim of this study was to compare the prevalence and factors associated with risky sexual behaviours among the heterosexual men who patronised the EEs and brothels in Singapore.MethodsThis was a cross-sectional survey involving 569 heterosexual men (297 recruited from brothels and 272 from EEs). A 2-stage sampling involving proportional stratified random sampling of the brothels and EEs, followed by time location sampling of the men, was conducted. For multivariable analysis, we used a mixed effects logistic model with backward elimination to account for clustering by venue and to obtain the adjusted odds ratio (aOR) for the association of various factors with consistent condom use in vaginal and oral sex respectively.ResultsMen who patronised EEs were younger, more likely to be single, more highly-educated and comprised more professionals compared to the brothel group. On multivariable analysis, consistent condom use for vaginal sex decreased at the EE setting (aOR 0.64; 95 % CI: 0.42 –0.97) and with alcohol use before sex (aOR 0.67; 95 % CI: 0.46 – 0.98) and increased with perceived high risk of getting HIV/STIs from partner (aOR 2.08; 95 % CI: 1.30 – 3.32) and partner’s request for condom use (aOR 5.48; 95 % CI: 1.20 – 25.11). For consistent condom use with oral sex, this decreased at the EE setting (aOR 0.64; 95 % CI: 0.39 – 0.98) and with alcohol use before sex (aOR 0.50; 95 % CI: 0.31 – 0.81) and increased with partner’s request for condom use (aOR 5.19; 95 % CI: 1.38 – 19.57).ConclusionsMen who patronised EEs practised risker sexual behaviours compared to the brothel group. Priority should be given for intervention programmes to target men who patronise EEs, which could involve the female EE workers, the EE owners as well as the managers for effective HIV/STI prevention.

Geographic Distribution and Temporal Trends of HIV-1 Subtypes through Heterosexual Transmission in China: A Systematic Review and Meta-Analysis

“…Notably, IDUs and high-risk heterosexual sex populations might facilitate the recombination of HIV strains that are currently present [ 71 ]. Similarly, our results showed that the proportion of CRF07_BC was an increasing trend since 2007, this likely attributed to the continual activities between heterosexual behaviors and drug use in these areas where the drug trafficking activities are frequent [ 14 , 72 , 73 ], especially for the phenomenon of prostitution to support drug use.…”

Factors associated with consistent condom use and STIs among foreign female entertainment workers: results from a cross-sectional survey in Singapore

“…Contrarily, the 100% condom use policy is implemented in registered brothels 17 18. Another possible explanation for the low condom usage with paid and casual partners and hence the lack of difference with these partner types is that FEWs are not trained in condom negotiation unlike brothel-based FSWs 19. Condom negotiation has been reported to be a significant predictor of condom use regardless of where the FSWs operate 20 21.…”

“…Agents source and recruit these FEWs from overseas for indirect sex work. Although the EE owners do not officially employ them as sex workers, they allow FEWs to solicit in their premises because they attract heterosexual men to patronise the EEs 19. Since the last survey in 2008, sex work in EEs continues to be illegal in Singapore.…”

What are the factors associated with human immunodeficiency virus/sexually transmitted infection screening behaviour among heterosexual men patronising entertainment establishments who engaged in casual or paid sex? – Results from a cross-sectional survey in an Asian urban setting

“…In recent years, sex work has increasingly shifted from brothels to EEs, particularly in Asia [22]. Heterosexual men patronising EEs who engage in casual or paid sex is an important and yet often neglected at-risk group because these men could potentially act as a bridging population for HIV/STI transmission through unprotected sex to their spouses and regular partners, resulting in extensive transmission to the community [23, 24]. …”

“…The percentage of heterosexual Singapore male residents engaging in sexual risk behaviour (defined as having commercial and/or casual sexual exposures) has increased from 4.7% in 1989 [26] to 18.5% in 2007 [27]. One common setting where casual and paid sex takes place in Singapore is in the EEs [23, 24]. Similar to previous years, HIV cases were predominantly males in Singapore, with a male to female ratio of 12:1 in 2014 [28].…”