“The Drug Will Help Protect My Tomorrow”: Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi

Shea, Jaclyn; Bula, Agatha; Dunda, Wezzie; Hosseinipour, Mina C.; Golin, Carol E.; Hoffman, Irving; Miller, William C.; Go, Vivian F.; Lungu, Thandie; Lancaster, Kathryn E.

doi:10.1521/aeap.2019.31.5.421

Cited by 16 publications

(12 citation statements)

References 26 publications

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“…Despite psychosocial and structural level factors presenting barriers to PrEP uptake [11][12][13][14][15][16], we found strong interest in this biomedical HIV prevention intervention among FSW in both study settings. HIV and sex-work related stigma along with realities of work conditions and environment are among the most pervasive factors creating barriers to oral PrEP among FSW, making LAI PrEP particularly appealing as it shows promise to overcome some of these challenges.…”

Section: Discussionmentioning

confidence: 97%

“…Participants called for educating peers, partners, and clients about PrEP as a strategy for reducing stigma. Previous studies have also shown that FSW believe increased awareness of PrEP among the general public is necessary to minimize stigma and facilitate access and adherence to PrEP [12,20,25]. Specifically, educating communities about HIV treatment versus prevention has been identified by FSW as critical to PrEP roll out [64,65].…”

Section: Discussionmentioning

confidence: 99%

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“She is the one who knows”: A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania

Mantsios¹,

Muraleetharan²,

Donastorg

et al. 2022

PLOS Glob Public Health

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Despite documented interest among female sex workers (FSW), uptake of oral pre-exposure prophylaxis (PrEP) for HIV prevention has been low. Recent trials and regulatory approval of long-acting injectable (LAI) PrEP offer new hope for the potential of this biomedical intervention. We examined FSW's PrEP-related interest and preferences regarding both oral and LAI PrEP situating these dynamics within their specific social and occupational realities. We conducted this work using qualitative methods across two distinct contexts by conducting 40 in-depth interviews with FSW in Tanzania and the Dominican Republic. Textual data was coded using iterative thematic content analysis. Analytic summaries were developed and reviewed to identify recurring themes. We systematically organized themes within each country and then compared across settings. Women in both settings expressed strong interest in PrEP seeing it as an important option to protect themselves in their work. Most participants preferred LAI PrEP due to expectations of reduced stigma and concerns about daily pill adherence and side effects. Occupational factors such as alcohol use, overnight dates with clients, and fear of violence from clients were identified as barriers to daily oral PrEP. LAI PrEP was seen as having the potential to reduce stress related to oral PrEP. Women who preferred pills discussed fear of needles, skepticism about the injections, and others relayed that taking a daily pill would not be challenging for them. There was a predominant sentiment that women know best whether they are better suited for oral or LAI PrEP. Participants stressed the importance of FSW understanding both options to ensure informed decision-making around PrEP and described community-led peer education as PLOS GLOBAL PUBLIC HEALTH

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

“She is the one who knows”: A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania

Mantsios¹,

Muraleetharan²,

Donastorg

et al. 2022

PLOS Glob Public Health

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“…In our study, respondents identifying as sex workers (regardless of gender) reported higher levels of anticipated, perceived and internalized PrEP‐related stigma, suggesting PrEP‐related stigma may be different among sex workers than others. While we did not measure sex work stigma directly, this relates to other literature describing intersecting PrEP and sex work stigmas [8, 11, 39]. Indeed, scholars have identified intersections between PrEP‐related stigma and other forms of stigma and discrimination (including racial discrimination, transphobia, sexual stigma and others) in other populations [7, 17, 40, 41].…”

Section: Discussionmentioning

confidence: 99%

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

Atkins

Kan

Musau³

et al. 2022

J Int AIDS Soc.

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Introduction As oral pre‐exposure prophylaxis (PrEP) services scale up throughout sub‐Saharan Africa (SSA), clients continue to face challenges with sustained PrEP use. PrEP‐related stigma has been shown to influence engagement throughout the HIV PrEP care continuum throughout SSA. Validated quantitative measures of PrEP‐related stigma in SSA are of critical importance to better understand its impacts at each stage of the HIV PrEP care continuum. This study aimed to psychometrically evaluate a PrEP‐related stigma scale for use among key and vulnerable populations in the context of a Kenya national PrEP programme. Methods As part of a larger prospective cohort study nested within Kenya's Jilinde programme, this study used baseline data collected from 1135 participants between September 2018 and April 2020. We used exploratory factor analysis to evaluate the factor structure of a PrEP‐related stigma scale. We also assessed convergent construct validity of the PrEP‐Related Stigma Scale by testing for expected correlations with depression and uptake of HIV services. Finally, we examined the relationship between PrEP‐related stigma and key demographic, psychosocial and behavioural characteristics. Results We identified four dimensions of PrEP‐related stigma: (1) interpersonal stigma, (2) PrEP norms, (3) negative self‐image and (4) disclosure concerns. The scale demonstrated strong internal consistency (α = 0.84), was positively correlated with depressive symptoms and negatively correlated with uptake of HIV services. Multivariable regression analysis demonstrated associations between PrEP‐related stigma and sex worker identity. Conclusions The adapted and validated PrEP‐Related Stigma Scale can enable programmes to quantify how PrEP‐related stigma and its dimensions may differentially impact outcomes on the HIV PrEP care continuum, evaluate stigma interventions and tailor programmes accordingly. Opportunities exist to validate the scale in other populations and explore further dimensions of PrEP‐related stigma.

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“…While there are studies examining barriers and facilitators to WESW’s access and use of health services related to HIV testing and counseling, and HIV treatment, there is limited research on the acceptability and appropriateness of comprehensive HIV prevention interventions that specifically target WESW, apart from studies that examine the acceptability of specific HIV risk reduction strategies, such as PrEP or condom use among this population [ 20 – 23 ]. Also, few studies reported on the feasibility and acceptability of interventions targeting WESW prior to implementation [ 24 , 25 ] or examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs among WESW [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“I decided in my heart I have to complete the sessions”: A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda

et al. 2023

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Background The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. Methods We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018–2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. Results The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. Discussion and conclusions Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. Clinical trial registration NCT03583541.

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“The Drug Will Help Protect My Tomorrow”: Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi

Cited by 16 publications

References 26 publications

“She is the one who knows”: A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania

“She is the one who knows”: A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

“I decided in my heart I have to complete the sessions”: A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda

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