HIV Pre-Exposure Prophylaxis Interest among Female Sex Workers in Guangxi, China

Abstract

ObjectivesAcceptability of pre-exposure prophylaxis (PrEP) and willingness to participate in a clinical trial for both safety and efficacy of PrEP were investigated among female sex workers (FSWs) in Guangxi, China.MethodsA cross-sectional study was performed in three cities in Guangxi. Structured, self-administered questionnaires were used to assess the acceptability of PrEP and the willingness to participate in a clinical trial. Multivariable logistic regression models were fitted to identify predictors.ResultsAmong 405 participants, 15.1% had heard of PrEP. If PrEP was deemed to be effective, safe and provided for free, 85.9% reported that they would accept it, and 54.3% of those who accepted PrEP said that they would participate in a clinical trial. The increased acceptability of PrEP was associated with working in male dominated venues, higher income, a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, not being forced to use condoms by the gatekeepers, consistent use of condoms, and use of drugs to prevent STD infection. The increased willingness to participate in a clinical trial was associated with a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, a willingness to adhere to daily PreP use, and not being concerned about discrimination by others. The main reason for rejecting PrEP or participating in a clinical trial was the concern about the side effects of PrEP.ConclusionsAcceptability of PrEP among Guangxi FSWs is relatively high, indicating that PrEP intervention programs may be feasible for Chinese FSWs. Given the fact that most of the participants had never heard of PrEP before, and that family, gatekeepers, and social discrimination could significantly affect its acceptability, a comprehensive mix of multiple interventions is necessary for the successful implementation of a PrEP program among this population in Guangxi.

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]. …”

“…High alcohol consumption by some sex workers was also a repeated concern [46]. Three Chinese studies found that the higher a sex worker assessed her own HIV risk, the more likely she was to find PrEP acceptable [68, 106, 108]. …”

Acceptability of microbicidal vaginal rings and oral pre-exposure prophylaxis for HIV prevention among female sex workers in a high-prevalence US city

“…To assess willingness to participate in a biomedical study to study PrEP or microbicidal rings in this population, participants were asked, “How willing would you be to provide a self-collected vaginal swab for a research study like this?” and “How willing would you be to provide a blood sample for a research study like this?” Questions were adapted from published studies. 21,22 …”

The willingness to participate in biomedical research involving human beings in low‐ and middle‐income countries: a systematic review

“…This was a particular issue for vaccine or drug trials, but not for observational studies. Safety concerns were mentioned in 45 papers [1, 20-23, 26, 28, 30-32, 34, 36, 37, 39-42, 45, 47, 48, 50-53, 55, 56, 58, 59, 61, 62, 67-69, 71, 76, 77, 88, 92-99], ranked in the top three reasons 32 times [1, 20, 21, 23, 30-32, 36, 37, 40, 41, 45, 47, 48, 50-53, 55, 56, 58, 61, 65, 67-69, 71, 77, 93, 94, 96-98], and identified as the top reason for non-participation 16 times [31,32,40,45,47,48,55,58,61,65,68,71,77,93,94,96,98]. Safety concerns were consistently ranked as most important in all categories, with the exception of North Africa and the Middle East, where they ranked second.…”