Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda: a community-based cross-sectional study

Background: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sex workers in Gulu, Uganda. Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3 months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p < 0.05 was considered statistically significant. Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range: 24–32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with; regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11–6.35, p < 0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32–35.77, p = 0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI: 1.49–4.35, p < 0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43–7.74, p = 0.005), and use of postexposure prophylaxis (PEP) in the past 12 months (aPR: 0.31, 95% CI: 0.17–0.59, p < 0.001). Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.

[1]  H. Rees,et al.  Impact and cost‐effectiveness of the national scale‐up of HIV pre‐exposure prophylaxis among female sex workers in South Africa: a modelling analysis , 2023, Journal of the International AIDS Society.

[2]  D. Kerrigan,et al.  “She is the one who knows”: A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania , 2022, PLOS global public health.

[3]  J. Baeten,et al.  PrEP uptake and HIV viral suppression when PrEP is integrated into Ugandan ART clinics for HIV-negative members of HIV-serodifferent couples: A stepped wedge cluster randomized trial , 2022, EClinicalMedicine.

[4]  P. Munseri,et al.  Awareness, Willingness and Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers Living in Dar-es-Salaam, Tanzania , 2022, AIDS and Behavior.

[5]  O. Jegede,et al.  PREDICTORS OF ADHERENCE TO PRE-EXPOSURE PROPHYAXIS AMONG FEMALE SEX WORKERS IN SOUTH-WESTERN NIGERIA , 2022, Journal of Clinical Research In HIV AIDS And Prevention.

[6]  N. Makhakhe,et al.  “Whatever is in the ARVs, is Also in the PrEP” Challenges Associated With Oral Pre-exposure Prophylaxis Use Among Female Sex Workers in South Africa , 2022, Frontiers in Public Health.

[7]  J. Sundewall,et al.  Condom failure and pre-exposure prophylaxis use experience among female sex workers in Ethiopia: a qualitative study , 2022, BMC Public Health.

[8]  T. Hallett,et al.  Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study , 2022, The lancet. HIV.

[9]  C. Guure,et al.  Willingness to take and ever use of pre-exposure prophylaxis among female sex workers in Ghana , 2022, Medicine.

[10]  Y. Tozan,et al.  PrEP acceptability and initiation among women engaged in sex work in Uganda: Implications for HIV prevention , 2022, EClinicalMedicine.

[11]  J. Busza,et al.  “It went through the roof”: an observation study exploring the rise in PrEP uptake among Zimbabwean female sex workers in response to adaptations during Covid‐19 , 2021, Journal of the International AIDS Society.

[12]  M. Angolkar,et al.  Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India , 2021, BMC Infectious Diseases.

[13]  F. Matovu,et al.  Adherence to oral HIV pre-exposure prophylaxis among female sex workers in Kampala, Uganda , 2021, African health sciences.

[14]  J. Kimani,et al.  Factors Associated with Retention in HIV Prevention and Treatment Clinical Services Among Female Sex Workers Enrolled in a Sex Workers’ Outreach Program (SWOP) in Nairobi, Kenya , 2021, AIDS and Behavior.

[15]  E. Merchán-Hamann,et al.  Factors associated with knowledge and use of hiv prevention strategies among female sex workers in 12 brazilian cities. , 2021, Ciencia & saude coletiva.

[16]  R. Kaul,et al.  Intimate partner and client‐perpetrated violence are associated with reduced HIV pre‐exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross‐sectional study of female sex workers from Nairobi, Kenya , 2021, Journal of the International AIDS Society.

[17]  Vincent Muturi-Kioi,et al.  Low awareness of oral and injectable PrEP among high-risk adolescent girls and young women in Kampala, Uganda , 2021, BMC Infectious Diseases.

[18]  W. Mcfarland,et al.  Awareness and Willingness to use HIV Pre-exposure Prophylaxis (PrEP) Among Trans Women in China: A Community-Based Survey , 2020, AIDS and Behavior.

[19]  Tara S. Beattie,et al.  Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis , 2020, PLoS medicine.

[20]  R. Ndejjo,et al.  Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study , 2020, BMC Public Health.

[21]  R. Gray,et al.  Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda , 2020, Journal of the International AIDS Society.

[22]  C. Logie,et al.  Pre and Post-exposure Prophylaxis Awareness and Acceptability Among Sex Workers in Jamaica: A Cross-Sectional Study , 2020, AIDS and Behavior.

[23]  T. Patterson,et al.  Perceived barriers to pre-exposure prophylaxis use and the role of syndemic factors among female sex workers in the Mexico-United States border region: a latent class analysis , 2020, AIDS care.

[24]  M. McConnell,et al.  Willingness to use PrEP among female university students in Lesotho , 2020, PloS one.

[25]  K. Mayer,et al.  Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review , 2020, Advances in Therapy.

[26]  A. Ario,et al.  Preference and uptake of different community-based HIV testing service delivery models among female sex workers along Malaba-Kampala highway, Uganda, 2017 , 2019, BMC Health Services Research.

[27]  M. Petersen,et al.  Pre-exposure Prophylaxis (PrEP) Uptake Among Older Individuals in Rural Western Kenya , 2019, Journal of acquired immune deficiency syndromes.

[28]  S. Baral,et al.  Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review , 2019, BMC Public Health.

[29]  I. Bogoch,et al.  HIV post-exposure prophylaxis (PEP) , 2018, British Medical Journal.

[30]  H. Rees,et al.  Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa , 2018, Journal of the International AIDS Society.

[31]  G. Musinguzi,et al.  “When they know that you are a sex worker, you will be the last person to be treated”: Perceptions and experiences of female sex workers in accessing HIV services in Uganda , 2017, BMC International Health and Human Rights.

[32]  T. Sandfort,et al.  Perspectives on HIV Pre- and Post-Exposure Prophylaxes (PrEP and PEP) Among Female and Male Sex Workers in Mombasa, Kenya: Implications for Integrating Biomedical Prevention into Sexual Health Services. , 2017, AIDS education and prevention : official publication of the International Society for AIDS Education.

[33]  H. Zou,et al.  Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study , 2016, BioMed research international.

[34]  K. Mayer,et al.  Antiretrovirals for Primary HIV Prevention: the Current Status of Pre- and Post-exposure Prophylaxis , 2015, Current HIV/AIDS Reports.

[35]  M. Boily,et al.  Global epidemiology of HIV among female sex workers: influence of structural determinants , 2015, The Lancet.

[36]  J. Dai,et al.  Willingness to use pre-exposure prophylaxis for HIV prevention among female sex workers: a cross-sectional study in China , 2012, HIV/AIDS.

[37]  Erik von Elm,et al.  Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. , 2007, International journal of surgery.

[38]  B. Löwe,et al.  Detecting and monitoring depression with a two-item questionnaire (PHQ-2). , 2005, Journal of psychosomatic research.

[39]  Kosuke Imai,et al.  Survey Sampling , 1998, Nov/Dec 2017.

[40]  G. Watts,et al.  Journals , 1881, The Lancet.

[41]  S. McCormack,et al.  Pre-Exposure Prophylaxis for HIV Infection as a Public Health Tool , 2022, Journal of Law, Medicine & Ethics.

[42]  N. Michael,et al.  Joint United Nations Programme on HIV/AIDS. , 2004, Military medicine.