Pre-Exposure Prophylaxis (PrEP) use, effects and sexual risk behaviours among female sex workers at MARPI Clinic in Kampala District

Abstract

Pre-exposure prophylaxis (PrEP), a biomedical intervention is an effective HIV prevention strategy for high-risk HIV negative people at substantial risk of acquiring HIV infections. Scant evidence exists on the social and structural factors that influence PrEP uptake and how PrEP has impacted its users. To fill this knowledge gap, the current study draws on a sample of Female Sex Workers attending Most-At-Risk-Population Initiative (MARPI) clinic to address three key objectives: (a) exploring factors associated with PrEP use; (b) examining the factors that inhibit PrEP use; and (c) exploring the association between PrEP use sexual risk behaviours among FSWs. Using mixed-method cross-sectional design, we used non-probability venue sampling method to recruit participants 259 participants for the survey. In addition, 16 In-depth interviews were conducted with FSWs. Quantitative data were analyzed using SPSS to generate descriptive statistics while qualitative data was analyzed using a thematic approach. The findings revealed that the majority of the FWs were Baganda from the central region, the majority reside in Lubaga. Although most of them has initiated PrEP with a negative HIV status, some has serial converted while on PrEP. They reported routine STI testing and treatment at MARPI clinic. Almost half of FSWs on PrEP had not used condoms in the last three months. Respondents who had stopped using PrEP attributed drop out to fear of breach of confidentiality due to limited privacy at the health facilities, unwelcoming health workers and discrimination, as well as unfavorable hours of operation of health facilities and policies. Factors facilitating PrEP use included fear of dying of AIDS, sex work as an occupation, conditions of the job as a sex worker. Inhibiting factors included packaging of PrEP in a similar way to ARVs, fear of side effects, stigma and discrimination associated with PrEP use, and mistrust of healthcare providers. The findings revealed that most FSWs engaged in sexual risk behaviour as a result of being on PrEP. The study concludes that FSWs due to the nature of their business do experience high-risk sexual exposures. FSWs generally have poor access to HIV prevention and care services. Further, HIV-related stigma, discrimination, and punitive laws against commercial sex increase their vulnerability and limit their access to PrEP use. In summary, the study recommends providing PrEP as part of a comprehensive prevention package, promoting and marketing of PrEP, health providers should have non-judgmental, non-stigmatizing attitudes, and special attention to client needs.