Understanding early uptake of PrEP by female sex workers in Zimbabwe

ABSTRACT

Female sex workers (FSW) are prioritised for increased access to pre-exposure prophylaxis (PrEP), although rates of uptake remain sub-optimal, particularly across Southern Africa. In the first two years of its availability in Zimbabwe, 37.1% of FSW in trial sites initiated PrEP and received at least one re-supply. We conducted a qualitative study on perceptions of PrEP among 19 early users selected from sites with varying rates of PrEP initiation. Narrative interviews examined the pathways taken by FSW from hearing about PrEP, through their decision to start taking it, and early experiences. FSW appreciated PrEP’s introduction within familiar and trusted “friendly” services tailored for sex workers and valued positive encouragement from clinic staff and peers over negative influence from family members. They also found PrEP difficult to understand at first, and feared side effects and rare adverse complications described in information leaflets. While FSW identified individual strategies for remembering to take their medication, they also relied on structured peer adherence support, leading some FSW to actively promote the method to other FSW as “PrEP champions”. Information on how early users experience a new prevention technology such as PrEP can inform design of interventions that leverage existing support structures and target key barriers.

KEYWORDS:

• PrEP
• female sex workers
• Zimbabwe
• qualitative

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The SAPPH-Ire trial was funded by United Nations Population Fund via Zimbabwe's Integrated Support Fund, which receives funds from DfID, Irish Aid and Swedish SIDA. A small amount of funding for survey work came from GIZ. USAID supported the cost of PSI Zimbabwe to provide ART and PrEP to sex workers as part of the trial. We received a donation of Truvada for PrEP use for the trial from Gilead.