Promise and pitfalls of pre-exposure prophylaxis for female sex workers

Cowan, Frances M; Delany‐Moretlwe, Sinead

doi:10.1097/coh.0000000000000215

Cited by 26 publications

(34 citation statements)

References 55 publications

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“…Psychological empowerment might overcome the adverse effects of stigma and exclusion among FSWs (41). In line with another study (13), FSWs in this study also pointed towards stigmatizing the health care system. Easy accessibility at pharmacies or involvement of CBOs or grass root workers from health system for dispensing was preferred and an aversion for health care provider mediated oral PrEP emerged.…”

Section: 2) Preserving Beauty / Female Physical Attributes: Concernsupporting

confidence: 90%

Oral PrEP: Is it only a pill to be swallowed: a qualitative study among female sex workers in India

Sahay

Verma

Shewale

et al. 2020

Preprint

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Background Empowering female sex workers (FSWs) through women controlled HIV prevention option has been in focus globally. The success of targeted interventions among FSWs indicates that this population could become an important and feasible target for oral PrEP (Pre Exposure Prophylaxis). A qualitative study was conducted to study FSWs’ willingness to use oral PrEP in India.Methods In-depth interviews (n=39) and two focus group discussions (n=14) were conducted at 3 high HIV prevalence urban and rural sites in India among FSWs. Key informant interviews (n=34) were conducted with a bisexual man, 6 brothel keepers and 27 Health Care Providers (HCPs). The study explored issues around willingness to use oral PrEP. The study was approved by the respective institutional ethics committee of the study sites. Thematic analysis using the grounded theory approach was used to analyze the data in N-VIVO version 8.0. Results FSWs were willing to use daily oral PrEP and hoped to use it as an alternative to the male condom. One of the emerging themes showed that the situations of condom-less sex over which FSWs had no control. This made them desire oral PrEP which was easy to use and geared to provide independence, financial gains, and privacy. HCP initiated oral PrEP was not acceptable. However, HCPs pointed out safety monitoring needs. For FSWs, safety concerns pertained to their own physical/ aesthetic attributes and reproductive system in a major way. Adherence emerged as a challenge because of: 1) FSWs’ prevalent habit and need of alcohol use; 2) their notion of daily dosing being too mundane; 3) Stigma because Oral PrEP is ARV based. Alcohol use and dread of repetitive dose bring forth the need for long-acting oral PrEP. Conclusion Oral PrEP is acceptable among FSWs; it should be rolled out alongside strong messages on STI protection given the perceptions of FSWs that oral PrEP might replace condoms. Education about ARV-based oral PrEP needs to be spelled to prevent stigma. Adherence counseling should take cognizance of FSWs’ lifestyle, specifically making oral PrEP less of a mundane task.

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Section: 2) Preserving Beauty / Female Physical Attributes: Concernsupporting

confidence: 90%

Oral PrEP: Is it only a pill to be swallowed: a qualitative study among female sex workers in India

Sahay

Verma

Shewale

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Several studies related to PrEP and SRH needs of FSWs showed as well that combination prevention approaches are necessary. First, as pointed by a study in Zimbabwe,36 women need to perceive the risk of getting infected by HIV and to be able to access health services in order to take PrEP daily. Second, as shown by Dhana et al 37 in a systematic review, there is a lack of coordination between SRH and HIV services dedicated to FSWs in Africa when they are two distinct services; HIV services delivery models should integrate SRH services.…”

Section: Discussionmentioning

confidence: 99%

Sexual health needs of female sex workers in Côte d’Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention

et al. 2020

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ObjectiveTo describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.Design and settingThe ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d’Ivoire.ParticipantsA convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs’ risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.ResultsAlthough 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner’s HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.ConclusionsDespite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d’Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.

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“…Roberts and Mathews reiterated the importance of structural interventions along with biomedical and behavioral interventions for HIV prevention [ 21 ]. A study by Cowan and Delaney-Moretlwe focusing on female sex workers, found that structural issues such as stigma from medical professionals, poor social support, and fear of authorities and clients were major barriers to uptake, in addition to risk perception [ 22 ]. Ware et al found that social factors such as supportive relationships with family and sexual partners can improve PrEP uptake and adherence [ 23 ]; these findings are similar to those of studies on antiretroviral adherence for HIV-positive individuals [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women

et al. 2017

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BackgroundPre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP.MethodsFour focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area.ResultsThe women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using “HIV medicines” could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access.ConclusionSocial and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.

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Promise and pitfalls of pre-exposure prophylaxis for female sex workers

Abstract: For those FSWs who are unable to mitigate their HIV risk, PrEP, if adequately supported and integrated with combination prevention, may empower them to remain HIV-free.

Cited by 26 publications

References 55 publications

Oral PrEP: Is it only a pill to be swallowed: a qualitative study among female sex workers in India

Oral PrEP: Is it only a pill to be swallowed: a qualitative study among female sex workers in India

Sexual health needs of female sex workers in Côte d’Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention

Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women

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