The PEARL study: a prospective two-group pilot PrEP promotion intervention for cisgender female sex workers living in Baltimore, MD, U.S.

Abstract

HIV remains elevated among female sex workers (FSW) globally, with a number of structural (e.g., poverty, access to care) factors driving these persistently high rates. Pre-exposure prophylaxis (PrEP), a user-controlled prevention method, is a promising means of empowering vulnerable populations to protect themselves and enhance agency. Yet there is a dearth of PrEP research and interventions targeting cisgender women in the United States, and even fewer aimed to reach FSW. We developed and implemented a multifaceted PrEP pilot intervention, the Promoting Empowerment And Risk Reduction (PEARL) study, to meet this gap. This paper describes the development process and nature of a community-informed intervention for tenofovir/emticitrabine (TDF/FTC) pre-exposure prophylaxis engagement among street-based cisgender FSW in Baltimore, Maryland, U.S. In the course of the study's implementation, structural, programmatic, and medical barriers have already posed significant barriers to full engagement. PEARL implemented a number of strategies in an effort to counter barriers and facilitate increased success of PrEP uptake and maintenance. The study will provide critical insights into the nature of intervention components that could help FSW to initiate PrEP and reduce PrEP care cascade gaps.

A Capacity-Strengthening Intervention to Support HIV Pre-exposure Prophylaxis (PrEP) Awareness-Building and Promotion by Frontline Harm Reduction Workers in Baltimore, Maryland: A Mixed Methods Evaluation

“…Likewise, the flyers provided FRHWs opportunities to discreetly offer clients PrEP information, especially in the context of limited privacy during drop-in and outreach encounters. Given the persistence of HIV-related stigma and the importance of affirming spaces to confidentially sensitize clients towards PrEP [ 5 , 30 ], these strategies must be considered in future implementation of PPT and comparable interventions.…”

HIV awareness, pre-exposure prophylaxis perceptions and experiences among people who exchange sex: qualitative and community based participatory study

“…higher income from sex without a condom) and includes concerns such as medical mistrust, and avoidance of medication side effects. A PrEP intervention trial among female sex workers (FSW) in Baltimore, MD described similar barriers such as medication side effects and medical mistrust [ 30 ]. While those researchers also described barriers such as difficulty obtaining venipuncture for recommended testing before initiation of PrEP, our study did not capture these barriers, which may be due to the heterogeneity of our participants while the Baltimore study included FSW with a high proportion of prior or current injection drug use [ 30 ].…”

Factors associated with retention on pre-exposure prophylaxis among female sex workers in Kigali, Rwanda

“…In the same period, female sex workers (FSW) accounted for 12% of new HIV infections globally [1]. It is widely reported that FSW have a high risk of acquiring HIV infection ranging from 12-30 fold compared to other females in the general population [1][2][3][4][5][6]. Given these figures, FSW and other KPs, were singled out in the 2021 political declaration on Acquired Immunodeficiency Syndrome (AIDS) as being at heightened risk of HIV acquisition requiring critical interventions to stem the tide [6].…”