Awareness and knowledge of pre- and post-exposure prophylaxes (PrEP and PEP) is low but willingness to use is high among sex-workers in Kenya, according to a new study led by Arjee Restar, current doctoral student in the Department of Behavioral and Social Sciences.
Sex workers have become a focal population for the implementation of PrEP and PEP as a component of HIV prevention strategies due to their multiple risk factors, such as multiple sex partners and inconsistent condom use. Yet, many sex workers report experiencing stigma and discrimination in health care settings, which may erect barriers to their accessing sexual health services like PrEP and PEP. In Kenya, adult HIV prevalence is estimated to be 5.6% and there is a concentrated epidemic among sex workers (29.3%). Although PrEP and PEP hold promise as part of comprehensive HIV prevention for sex workers, important questions remain about what women and men who sell sex know about PrEP and PEP.
To answer this important question, the researchers conducted semistructured interviews with 21 female and 21 male HIV-negative sex workers who solicited 18 bars and nightclubs in Mombasa, Kenya. When asked if they had heard of PrEP or PEP for HIV prevention, only 5 and 16 out of 44 sex workers were aware of PrEP and PEP, respectively. Reported use was also low, although willingness to use PrEP and PEP was high. Perceiving themselves to be at risk of HIV infection due to their exposure from having many sexual partners, most participants believed that PrEP would afford them added protection and be useful in situations in which they used condoms inconsistently or were unable to use them, although some participants expressed concerns about side effects. Despite PEP’s availability, few participants knew about it and even fewer had used it, but most who had would use it again. Sex workers valued confidentiality, privacy, trustworthiness, and convenient location in health services and wanted thorough HIV/STI assessments.
The results of this study, published in AIDS Education and Prevention, suggest the importance of situating PrEP and PEP within sex worker-friendly health services and conducting outreach to promote these biomedical prevention methods for Kenyan sex workers.