Willingness to use pre-exposure prophylaxis for HIV prevention among female sex workers: a cross-sectional study in China

Abstract

BackgroundPre-exposure prophylaxis (PrEP) is a strategy developed to prevent individuals who are human immunodeficiency virus (HIV)-negative from developing HIV infection. In China, while conducting a clinical trial to investigate the effectiveness and safety of PrEP, we performed this survey to assess the willingness of female sex workers to use PrEP, and identify predictors of this willingness.MethodsFrom July 2009 to April 2010, a cross-sectional study was carried out in four provinces of China. We recruited 1611 female sex workers who completed a self-administered survey to assess their awareness of and intention to use PrEP. The survey also canvassed demographic, behavioral, and psychosocial variables. Bivariate and multivariable logistic regression models were fitted to identify predictors of intent to use PrEP.ResultsIn total, 69% of the women (95% confidence interval [CI] 66.7–71.3) reported intent to use PrEP, and 12% (95% CI 10.5–13.7) had used drugs in the past to prevent a sexually transmitted infection. Further, 16.5% (95% CI 14.7–18.4) had previously heard of PrEP, and 1.4% (95% CI 0.9–2.1) had used PrEP previously to prevent HIV infection. Multivariate analysis indicated the following significant predictors of intent to use PrEP: Han ethnicity (adjusted odds ratio [AOR] 1.446; P = 0.011), urban residence (AOR 1.302; P = 0.027), knowledge about transmission of HIV/acquired immune deficiency virus syndrome (AIDS, AOR 1.817; P = 0.0007), a history of sexually transmitted infection (AOR 1.830; P < 0.0001), a history of using medication to prevent a sexually transmitted disease (AOR 2.547; P < 0.0001), and willingness to access knowledge about HIV/AIDS (AOR 2.153; P < 0.0001).ConclusionThe majority of female sex workers reported intent to use PrEP if it is safe and effective. Given that most of the participants had never heard of PrEP before, we strongly recommend that educational materials be developed with detailed introduction of PrEP. The risks and benefits of PrEP use should be fully explained to potential users when promoting PrEP in the future.

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

“…This represents missed opportunities to initiate, or at least discuss, PrEP among PWUD. Limited PrEP awareness and use among PWUD here is similar to that reported elsewhere among female sex workers in China (Peng et al, 2012) and among other studies of PWUD in the U.S. (Kuo et al, 2016; Stein et al, 2014), but PrEP awareness was lower than that reported in studies of MSM (Ferrer et al, 2016; Goedel et al, 2016; Hoagland et al, 2016; Young et al, 2013). The higher level of knowledge about PrEP in MSM may stem from a number of PrEP initiatives that have primarily focused on MSM and HIV seronegative partners in sero-discordant couples (Ware et al, 2012).…”

“…A new PrEP cascade (Liu et al, 2012) suggests that PrEP uptake and optimal protective effect requires a high level of user awareness, willingness to initiate, and ability to remain highly adherent to the medication (Peng et al, 2012). Most recent studies that focus on PrEP uptake factors are concentrated on samples of MSM (Ferrer et al, 2016; Goedel et al, 2016; Gredig et al, 2016; Hoagland et al, 2016; Peng et al, 2012; Young et al, 2013), with limited research among high-risk PWUD (Kuo et al, 2016; Stein et al, 2014). For example, Stein et al (2014) found that 47% of PWUD reported being willing to use PrEP and that a higher perception of HIV susceptibility was associated with an increased willingness to initiate PrEP (Stein et al, 2014).…”

Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature

“…[65, 106, 108] Once the concept of PrEP was introduced, female sex workers across the world expressed strong interest in using PrEP across seven studies (N = 4809 total participants) [18, 24, 46, 65, 68, 106, 108]. Interest rose across these studies over time, in the range of 61–69% in 2010 –2012 [18, 65, 68, 108] up to 86% in 2014 [106]. …”

Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients

“…Multiple international studies have demonstrated PrEP acceptability among at-risk women including sex workers. (Guest, 2010; Eisingerich, Wheelock, & Gomez, et al, 2012; Mutua Sanders, & Mugo, et al, 2012; Peng, Yang, & Zhang, et al, 2012; Zhao, Sun, & Xue, et al 2011). While qualitative evidence indicates some acceptability among urban women at risk for infection in the US (Flash, Stone & Mitty, et al, 2014; Auerbach, Kinsky, & Brown, et al, 2015), relatively little quantitative data has emerged on acceptability among women, particularly with respect to HIV risk perception (Rubstova, Wingood, & Dunkle, et al, 2013), and many questions remain regarding PrEP delivery and implementation for women.…”