Efficacy of Human Immunodeficiency Virus/Sexually Transmitted Infection Prevention Interventions Targeting Female Entertainment Workers: A Systematic Review and Meta-analysis

Abstract

Female entertainment workers (FEWs) working in karaoke lounges, bars, pubs, nightclubs, discotheques, dance halls, massage parlours, restaurants (as hostesses or singers) and beer gardens are at high risk for human immunodeficiency virus (HIV)/sexually transmitted infection (STI). The aim of the systematic review and meta-analysis is to evaluate the efficacy of HIV/STI intervention programmes targeting FEWs. Among the 14 included studies, majority were in Asia and targeted native FEWs. Most studies were quasi-experimental and the overall quality was relatively low. While most studies employed only behavioural strategies, structural interventions were the least common. In studies with structural interventions, there was a preference for behavioural and biomedical-based outcome measurements rather than structural-related indicators. FEWs in the intervention group were significantly more likely to report condom use with paying (odds ratio OR 1.7; 95% CI 1.0-2.9, p 0.04), but not with regular (OR 1.0; 95% CI 0.8-1.3, p 0.84) partner than the control/comparison group post-intervention.

Using qualitative and community-based engagement approaches to gain access and to develop a culturally appropriate STI prevention intervention for foreign female entertainment workers in Singapore

“…Female sex workers (FSWs) are a diverse population operating in different settings such as brothels, streets, online sex forums and entertainment establishments (EEs) [ 1 ]. EEs are karaoke lounges, bars, pubs, nightclubs and discotheques providing entertainment activities such as singing, dancing and social drinking [ 2 ]. Female entertainment workers (FEWs) working in EEs are often indirect sex workers who sell sex in the EEs to supplement their income [ 3 , 4 ].…”

“…The prevalence of HIV/STI was higher among FEWs than brothel-based FSWs in a systematic review [ 9 ]. As FEWs often face difficulties in accessing preventive or healthcare services, they are vulnerable to HIV/STIs [ 2 , 8 , 9 ].…”

“…Foreign FEWs are more vulnerable to HIV/STIs than their native counterparts as they experience additional barriers that diminished their ability to seek preventive care services. These included their foreign status in the country of work and having to operate in a foreign working environment which is culturally and linguistically different from their native land [ 2 ].…”

Efficacy of multicomponent culturally tailored HIV/ STI prevention interventions targeting foreign female entertainment workers: a quasi-experimental trial

“…The participation rate was higher compared with previous intervention studies on FEWs9 due to the use of culturally appropriate recruitment strategies (eg, provision of peer support information for their work) developed from needs assessment along with assistance of peer educators with similar sociocultural background to engage participants during recruitment. Prior to study implementation, the second author (ONYC) also volunteered with NGOs and participated in activities organised for FEWs for nearly a year.…”

“…In addition, the outcome effects might not be attributed to the intervention in some of these studies due to limitations in study design. They either lacked multiple pretest and post-test assessments to qualify to be a time-series design or were pretest and post-test designs involving only the intervention group 9. Most of these studies also relied only on self-reported behavioural without biomedical outcome indicators 7–9.…”