Awareness and Interest in HIV Pre-Exposure Prophylaxis among Street-Based Female Sex Workers

Results from a US Context

Catherine Tomko, Ju Nyeong Park, Sean Travis Allen, Jennifer Glick, Noya Galai, Michele R Decker, Katherine Footer, Susan Sherman

Research output: Contribution to journalArticle

Abstract

Pre-exposure prophylaxis (PrEP) has the potential to be an empowering HIV prevention tool among female sex workers (FSW), yet little is known about PrEP awareness and interest in this population. Sex workers and Police Promoting Health in Risky Environments (SAPPHIRE) is a prospective cohort study of street-based FSW in Baltimore, MD. A cross-sectional analysis explored awareness and interest in PrEP among HIV-negative FSW. Multivariable Poisson regressions modeled associations between individual, interpersonal, and structural variables and PrEP awareness and interest. Of n = 232 FSW, 66% were white, half were less than 35 years old, 59% injected drugs daily, and 66% sold sex daily. Only 21% of FSW were aware of PrEP, though 74% were interested. PrEP awareness was associated with experiencing client condom coercion [adjusted incidence rate ratio (aIRR) = 0.50, 95% CI: 0.28-0.90] and condomless sex with an intimate partner (aIRR = 0.54, 95% CI: 0.30-0.98). PrEP interest was associated with perceiving PrEP as "very easy" to take (aIRR = 1.91, 95% CI: 1.49-2.45) and moving to an unfamiliar geographic area to sell sex (aIRR = 1.20, 95% CI: 1.04-1.39). Women who had a current gonorrhea or chlamydia infection were less likely to be interested in PrEP (aIRR = 0.75, 95% CI: 0.59-0.95). Though PrEP awareness among FSW is low, there are FSW who are significantly more likely to express interest in PrEP and outreach efforts should target these women. Results suggest that women-controlled HIV prevention methods may be important for reducing incidence among FSW.

Original languageEnglish (US)
Pages (from-to)49-57
Number of pages9
JournalAIDS Patient Care and STDs
Volume33
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Sex Workers
HIV
Incidence
Pre-Exposure Prophylaxis
Coercion
Baltimore
Chlamydia Infections
Gonorrhea
Condoms
Police
Cohort Studies
Cross-Sectional Studies
Prospective Studies

Keywords

  • awareness
  • HIV
  • pre-exposure prophylaxis
  • prevention
  • sex work

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{93f4f1f2fac5489ca0e9eae64832448b,
title = "Awareness and Interest in HIV Pre-Exposure Prophylaxis among Street-Based Female Sex Workers: Results from a US Context",
abstract = "Pre-exposure prophylaxis (PrEP) has the potential to be an empowering HIV prevention tool among female sex workers (FSW), yet little is known about PrEP awareness and interest in this population. Sex workers and Police Promoting Health in Risky Environments (SAPPHIRE) is a prospective cohort study of street-based FSW in Baltimore, MD. A cross-sectional analysis explored awareness and interest in PrEP among HIV-negative FSW. Multivariable Poisson regressions modeled associations between individual, interpersonal, and structural variables and PrEP awareness and interest. Of n = 232 FSW, 66{\%} were white, half were less than 35 years old, 59{\%} injected drugs daily, and 66{\%} sold sex daily. Only 21{\%} of FSW were aware of PrEP, though 74{\%} were interested. PrEP awareness was associated with experiencing client condom coercion [adjusted incidence rate ratio (aIRR) = 0.50, 95{\%} CI: 0.28-0.90] and condomless sex with an intimate partner (aIRR = 0.54, 95{\%} CI: 0.30-0.98). PrEP interest was associated with perceiving PrEP as {"}very easy{"} to take (aIRR = 1.91, 95{\%} CI: 1.49-2.45) and moving to an unfamiliar geographic area to sell sex (aIRR = 1.20, 95{\%} CI: 1.04-1.39). Women who had a current gonorrhea or chlamydia infection were less likely to be interested in PrEP (aIRR = 0.75, 95{\%} CI: 0.59-0.95). Though PrEP awareness among FSW is low, there are FSW who are significantly more likely to express interest in PrEP and outreach efforts should target these women. Results suggest that women-controlled HIV prevention methods may be important for reducing incidence among FSW.",
keywords = "awareness, HIV, pre-exposure prophylaxis, prevention, sex work",
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