PrEP Use Among Female Sex Workers: No Evidence for Risk Compensation

Giguère, Katia; Béhanzin, Luc; Guédou, Fernand; Talbot, Denis; Leblond, François; Goma-Matsétsé, Ella; Zannou, Djimon Marcel; Affolabi, Dissou; Kêkê, René K; Gangbo, Flore; Bachabi, Moussa; Alary, Michel

doi:10.1097/qai.0000000000002134

Cited by 21 publications

(32 citation statements)

References 34 publications

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“…These results add up to the lack of evidence of condom migration (decrease in condom use as a result of being substituted by another preventive intervention) or risk compensation (increase in HIV risk-taking behavior) reported in this cohort of FSWs despite concerns raised on increasing risky sexual behaviors and sexually transmitted infections (STIs) among PrEP users. 24 In addition, a significant decrease in STIs episodes was also reported in the cohort of interest. 17 , 24 This is encouraging because it seems that in this context, PrEP is acting as a supplementary STI prevention intervention rather than an alternative to condom use.…”

Section: Discussionmentioning

confidence: 62%

Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors

et al. 2021

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Section: Discussionmentioning

confidence: 62%

Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors

et al. 2021

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“…Data on PEP in this group are extremely scarce (30). With proven acceptability of PrEP among female SW (31)(32)(33) and no evidence of risk compensation (34), this suggests ample space to scale up access to both prevention tools in the country among this group and underlines the need for further research into awareness and use of both tools among sex worker communities.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Simões

Meireles

Rocha³

et al. 2021

Front. Public Health

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Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been increasingly available in Europe. Due to the high burden of HIV in key populations, these could benefit from their use. In 2016, in Portugal, an open, non-interval, prospective cohort study was established in a network of 26 community-based voluntary HIV/STI counseling and testing centers. Data collected included questions on PEP and PrEP knowledge and use. We aimed to estimate the proportion of PEP and PrEP knowledge and its use among key populations, visiting the centers between 2016 and 2019.Method and results: Individuals who self-identify as being among at least one key population for HIV, men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), migrants, and male-to-female transgender individuals (MTF), responded to questions on PEP and PrEP knowledge and use while waiting for their test results between 2016 and 2019 (n = 12,893 for PEP; n = 10,973 for PrEP). Reported knowledge was low in all key populations for both tools: 15.7% of respondents reported knowing about PEP and 10.9% about PrEP over the course of 4 years. PEP was used by 1.8% and PrEP by 0.4% of the respondents, MSM being 88.9% of PrEP users, and 52.8% of PEP users. Multivariate logistic regression showed multiple factors associated with knowing the tools, including age, education, country of birth, gender, year of test, having a reactive HIV test in the same visit, reporting an STI or condomless sex in the last 12 months, and identifying with being MSM or SW.Conclusions: Knowledge and use of PEP and PrEP remain low among key populations in Portugal. The need remains to increase knowledge and use among those at risk for HIV infection.

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“…While some studies have seen evidence of risk compensation with the use of PrEP, 12,35,36 this has not been consistently seen across all trials or all populations. 37,38 Participants in our study were given the choice between two PrEP delivery options: weekly clinic pickup or home delivery by a peer educator every other day. Approximately half of participants chose clinic pickup and half chose home delivery, and no significant differences were seen between PrEP users who chose one delivery method over the other.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies have seen evidence of risk compensation with the use of PrEP, 12 , 35 , 36 this has not been consistently seen across all trials or all populations. 37 , 38 …”

Section: Discussionmentioning

confidence: 99%

Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India

et al. 2021

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We assessed the impact of pre-exposure prophylaxis (PrEP) in the context of a community-based HIV program among female sex workers (FSWs) in Kolkata, India. This was an open-label, uncontrolled demonstration trial. HIV seronegative FSWs over 18 years were eligible. Participants were administered daily tenofovir/emtricitabine (TDF-FTC) with follow-up visits at months 1, 3, 6, 9, 12, and 15. Drug adherence was monitored by self-report, and a random subset of participants underwent plasma TDF testing. 843 women were screened and 678 enrolled and started on PrEP. Seventy-nine women (11%) did not complete all scheduled visits: four women died of reasons unrelated to PrEP and 75 withdrew, for a 15-month retention rate of 89%. Self-reported daily adherence was over 70%. Among those tested for TDF, the percentage of women whose level reached ≥40 ng/mL was 65% by their final visit. There were no HIV seroconversions, and no evidence of significant changes in sexual behavior. This study demonstrated the feasibility and effectiveness of PrEP for FSWs in Kolkata, with very high levels of adherence to PrEP and no HIV seroconversions. The integration of PrEP into an existing community-based HIV prevention program ensured community support and facilitated adherence.

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PrEP Use Among Female Sex Workers: No Evidence for Risk Compensation

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 21 publications

References 34 publications

Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors

Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India

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