A Review of Pre-Exposure Prophylaxis Adherence among Female Sex Workers

Abstract

Globally and in Africa specifically, female sex workers (FSWs) are at an extraordinarily high risk of contracting human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) has emerged as an effective and ethical method with which to prevent HIV infection among FSWs. PrEP efficacy is, however, closely linked to adherence, and adherence to PrEP among FSWs is a complex and interrelated process that has been shown to be of importance to public health policies and HIV control and intervention programs. This comprehensive review categorizes barriers to and facilitators of adherence to HIV PrEP for FSWs, and describes five strategies for promoting PrEP adherence among FSWs. These strategies encompass 1) a long-term educational effort to decrease the stigma associated with sex work and PrEP use, 2) education on how PrEP works, 3) lifestyle modification, 4) research on nextgeneration PrEP products to address the inconvenience of taking daily pills, and 5) integration of PrEP into existing services, such as social services and routine primary care visits, to reduce the economic burden of seeking the medication. Our review is expected to be useful for the design of future PrEP intervention programs. Multidisciplinary intervention should be considered to promote PrEP adherence among FSWs in order to help control the HIV epidemic.

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

“…A recent metaanalysis found that anticipated stigma from partners and family, concerns about side effects, and low perceived risk were also salient barriers to PrEP use in this population (Abou Ghayda et al, 2020). Further, several studies have shown that greater knowledge of PrEP is integral to improved uptake among female sex workers (Abou Ghayda et al, 2020). In a qualitative study conducted in Kenya, authors reported that female sex workers expressed an interest in learning about PrEP from other sex workers, illuminating that a peer-model of engagement could be particularly useful for disseminating key information about PrEP and overcoming barriers to clinic-led education (Bazzi et al, 2019).…”

“…In one paper, the authors presented the results of two studies which showed that, among GBMSM, desiring more closeness with a primary partner and believing that condoms interfere with intimacy were independent predictors of PrEP adoption attitudes and behaviors (Gamarel & Golub, 2019). In a second paper (Abou Ghayda et al, 2020), these same authors collected mixed-methods data from 145 HIV-negative GBMSM in primary relationships. They asked participants to report on their sexual health goals and three main goal content categories emerged: HIV/STI prevention, sexual satisfaction, and intimacy.…”

“…However, several studies have reported strong interest in PrEP among female sex workers, who are quick to recognize the benefits for themselves and other female sex workers (Abou Ghayda et al, 2020;Van der Elst et al, 2013;Ye et al, 2014). However, knowledge of PrEP among female sex workers remains low in many countries, with several studies reporting low awareness among samples of female sex workers in Malawi, Kenya, Mexico, South Africa, China, and the U.S. (Abou Ghayda et al, 2020;Eakle et al, 2019;Lancaster et al, 2020;Tomko et al, 2019;Wang et al, 2017). In addition to low awareness, studies suggest that barriers to PrEP use among this population include criminalization of sex work, inadequate healthcare access, and stigmatizing clinical environments (Lancaster et al, 2020;Tomko et al, 2019).…”

“…In addition to low awareness, studies suggest that barriers to PrEP use among this population include criminalization of sex work, inadequate healthcare access, and stigmatizing clinical environments (Lancaster et al, 2020;Tomko et al, 2019). A recent metaanalysis found that anticipated stigma from partners and family, concerns about side effects, and low perceived risk were also salient barriers to PrEP use in this population (Abou Ghayda et al, 2020). Further, several studies have shown that greater knowledge of PrEP is integral to improved uptake among female sex workers (Abou Ghayda et al, 2020).…”

Effect of HIV Self-Testing on PrEP Adherence Among Gender-Diverse Sex Workers in Uganda: A Randomized Trial

“…10 The effectiveness of PrEP, however, is highly dependent on adherence, which has been challenging for many, including sex workers. 12,13 HIVST and PrEP are potentially complementary tools that could be combined to empower sex workers to prevent HIV acquisition, but few studies have jointly evaluated PrEP and HIVST in any setting.…”