8 March marks #InternationalWomensDay, and we couldn’t think of anyone more fitting than Associate Professor Wong Mee Lian to feature in the very first conversation of our series “Let’s Talk Public Health”. She has spent much of her career researching marginalised and vulnerable women in our society, and has been teaching health education and promotion to postgraduate and undergraduate students for the past 25 years.
Looking back on the work you’ve undertaken, which project stands out as memorable?
I think the research on brothel-based sex workers was my most memorable. It resulted in reduced rates of sexually transmitted infections (STIs) and really showed the benefit of a mixed-methods needs assessment in giving a strong, evidence-based voice to the most vulnerable and marginalised women in Singapore.
Surveillance data showed that there were high levels of STIs among the sex workers here, but it wasn’t until we reached out to them and conducted the groundwork that we understood why some of them used condoms all the time and others hardly ever did.
We surveyed 800 brothel-based sex workers and found that only a handful used condoms with clients all the time. Our subsequent qualitative in-depth interviews with 40 of these women revealed that it was about confidence, self-efficacy, support and empowerment.
So what we did was we designed a programme to give female sex workers the confidence and skills to negotiate condom use. The few women who already used condoms regularly were empowered to be peer educators. We also created training videos to teach them how to counter against men who insisted on not using condoms.
Educating the women on why they should be using condoms gave them the knowledge about preventing STIs and HIV/AIDS, but it wasn’t until these female sex workers were empowered to persuade clients to use condoms that there was behavioural change.
The rates of consistent condom use increased from 40 per cent to over 60 per cent in six months, and more than 90 per cent after two years, with a corresponding decline in STIs.
Not only was this research valuable in addressing a public health issue, but it also shows the positive impact of really listening to and learning from the voices of marginalised groups, as the solutions can often come from these same communities.
What are you currently working on?
Building on our previous work on HIV, we are researching the social stigma and misconceptions about how HIV is transmitted.
Medical advancements mean that HIV is no longer a death sentence, and people with HIV can live long, healthy and productive lives. There is also treatment available to reduce the viral load to very low levels such that they are no longer infectious.
We need to be able to talk more openly about HIV and reduce the stigma. I have heard some heart-breaking stories of women who did not engage in risky behaviour, but were infected with HIV by their husbands who had previously contracted the infections. These women often face discrimination in their communities, encounter difficulties in finding employment, and even lose their jobs because of their HIV status.
What’s been the biggest change you’ve seen in your research area?
The mixed-methods approach, where both quantitative and qualitative methods are used together, was less understood 30 years ago. Now it is well-established and benefits research across many areas, allowing us to gain a better understanding and appreciation of the causes and motivations of a complex health issue. This is increasingly important as we seek to understand how we can apply our findings to develop effective interventions to public health issues, such as promoting healthy ageing and preventing diabetes.
If you could make one change to positively impact public health what would it be?
My research has led me to believe that public health should be focused on promoting wellness and empowerment, as well as providing a supportive physical and social environment to promote health. Whether it is a sex worker who uses condoms to prevent STIs or a pre-diabetic changing his/her lifestyle, achieving these behavioural changes requires us to first understand people’s motivations, how they make health choices, and what makes them confident in doing so.
Tell us something surprising about you that people may not know.
I love gardening and being close to nature! I especially like to grow green leafy plants, as well as herbs and spices for cooking; I find the green refreshing. In the early 1990s, I volunteered at a leprosy mission in Bangladesh, giving talks on health promotion and community participation, and it was hard to see such poverty and illness. At the end of each day, I would look at the beautiful sunflowers and greenery and it would rejuvenate me.