In 1996, a health promotion program began to increase condom use for oral sex among female brothel-based sex workers in Singapore. It was initiated based upon increasing evidence of HIV transmission through oral sex as well as increased oral sex among these workers and their clients. Condom use for oral sex increased from 42.2 percent in 1996 prior to the program to 91.7 percent in mid-2000, with a corresponding decline in pharyngeal gonorrhea from its peak of 10.7 percent to 3.6 percent (compared to no significant changes in the two-year period before intervention). A significant increase in oral condom use with decreased pharyngeal gonorrhea incidence was observed among sex workers where brothel educational interventions took place compared with matched controls without brothel interventions. This case study describes the application of a health promotion framework to effect behavior change. Major differences in the behavioral risk-education strategies and message contents between this program and our earlier program on condom use for vaginal sex also are highlighted.
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