According to latest statistics, South and Southeast Asia is the second highest region affected by HIV worldwide. This is after Sub-Saharan Africa. In 2012, 3.7 million adults were reported to be living with HIV while 250,000 new cases of infection aged at least 15 years were reported from South and Southeast Asia. Sexual intercourse between heterosexual individuals has been reported to be the major mode of HIV/STI transmission in this region.
However, just recently, casual sex was reported as another major mode of transmission because it is a trend that is continually becoming more common in Asia. It is also important to note that women casual partners are now the largest group of STI transmitters among heterosexual men in Singapore, replacing sexual workers.
Changing Sex Work Landscape in Asia
The social setting of sex work has largely changed in Asia. There is an increasing change of sex work from the traditional brothels to entertainment establishments. These are places where people socialize with one another while engaging in entertainment activities including dancing and drinking. Popular entertainment joints include bars, karaoke lounges, night clubs, pubs and discotheques. Both commercial and casual sex occur in such places.
More sex workers are frequenting entertainment joints in Asia than they are frequenting brothels. This change of settings has seen heterosexual men who visit entertainment joints be at higher risk of contracting HIV more than those who visit brothels. This has also made such men become a linking population for HIV and STI spread through unprotected sex with the women working in entertainment joints to their wives and regular partners.
A study conducted by Lim et al. and published in the BMC Public Health aimed at comparing the prevalence and factors associated with risky sexual behaviors among the heterosexual men who hang out at entertainment joints and brothels in Singapore. The study used a cross-sectional survey that involved 569 heterosexual men. 297 of these men were recruited from brothels and 272 were recruited from Entertainment Establishments. This study was conducted between December 2011 and October 2012. The participants of the study were between 21 and 70 years and reported engaging in vaginal, oral or anal sex either with a female sex worker or a female Entertainment Establishment worker in the past 12 months prior to the study.
Characteristics of Men Frequenting EEs
According to the study findings, men who frequented Entertainment Establishments were younger, more likely to be single, highly-educated and had more professionals compared to the group of men who frequented brothels. The study also found out that consistent condom use for vaginal sex decreased in the Entertainment Establishment group especially where alcohol was used before sex. Consistent condom use with oral sex also decreased in the Entertainment Establishment group and increased with partner’s request to use a condom.
The study also looked at the participants’ past sexual behaviors within the past year and found that the popularity of casual sex was higher in the Entertainment Establishment group at 78.3 % than in the brothel group at 26.3 %. However, more men in the brothel group engaged in paid sex at 91.9 % compared to the Entertainment Establishment group at 37.1 %. The Entertainment Establishment group also recorded higher rates of vaginal, anal and oral isex with both casual and regular partners such as wives or girlfriends than the brothel group. Similarly, 28.0% of the men who frequented the Entertainment Establishments were less likely than 44.4% of the brothel group to screen for HIV/STI even though their rates of using condoms were consistently lower with all types of partners and for all types of intercourse when compared to the men who frequented brothels.
According to the study, men who visited Entertainment joints practiced riskier sexual behaviors compared to the men who frequented brothels. The researchers, therefore, advocate that priority be given to intervention programs targeting Entertainment Establishment male patrons. The programs should also involve the female workers, managers and owners of these Entertainment Establishment for effective HIV/STI prevention.
See the research paper here: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2132-4