A Review of Pre-Exposure Prophylaxis Adherence among Female Sex Workers

Abstract

Globally and in Africa specifically, female sex workers (FSWs) are at an extraordinarily high risk of contracting human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) has emerged as an effective and ethical method with which to prevent HIV infection among FSWs. PrEP efficacy is, however, closely linked to adherence, and adherence to PrEP among FSWs is a complex and interrelated process that has been shown to be of importance to public health policies and HIV control and intervention programs. This comprehensive review categorizes barriers to and facilitators of adherence to HIV PrEP for FSWs, and describes five strategies for promoting PrEP adherence among FSWs. These strategies encompass 1) a long-term educational effort to decrease the stigma associated with sex work and PrEP use, 2) education on how PrEP works, 3) lifestyle modification, 4) research on next-generation PrEP products to address the inconvenience of taking daily pills, and 5) integration of PrEP into existing services, such as social services and routine primary care visits, to reduce the economic burden of seeking the medication. Our review is expected to be useful for the design of future PrEP intervention programs. Multidisciplinary intervention should be considered to promote PrEP adherence among FSWs in order to help control the HIV epidemic.

Keywords: Human immunodeficiency virus infection and acquired immune deficiency syndrome prevention; drug adherence; female sex workers; pre-exposure prophylaxis.

Fig. 1. Global number of AIDS-related deaths, new HIV infections, and people living with HIV (1990–2017). HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome. Data used in this Figure from https://www.unaids.org/en/resources/fact-sheet.

Fig. 2. Summary of barriers to PrEP adherence among female sex workers and ways to overcome them. PrEP, pre-exposure prophylaxis.