# Associations with HIV preexposure prophylaxis use by cisgender female sex workers in two Ugandan cities

## TL;DR

This study examines factors influencing HIV pre-exposure prophylaxis (PrEP) use among female sex workers in two Ugandan cities, finding low usage linked to location and education.

## Contribution

The study identifies geographic and educational disparities in PrEP awareness and use among female sex workers in Uganda.

## Key findings

- Only 9.7% of participants self-reported current oral PrEP use.
- FSWs in Mbarara were twice as likely to be aware of or use PrEP compared to those in Mbale.
- Higher education levels were associated with increased PrEP use.

## Abstract

Sex workers of all genders have a high risk of HIV acquisition and are a priority population for HIV pre-exposure prophylaxis (PrEP). We aimed to assess current oral PrEP use and associated factors among cisgender female sex workers (FSW) in two Ugandan cities.

We administered a survey questionnaire to 236 HIV-negative FSW in the cities of Mbale and Mbarara from January to March 2020. The survey was nested in a quasi-experimental study to assess the effect of peer education and text message reminders on the uptake of regular sexually transmitted infection (STI) and HIV testing. Using interviewer-administered questionnaires, we obtained data on current self-reported tenofovir-based oral PrEP use. We used modified Poisson regression with robust standard errors to evaluate the factors associated with current oral PrEP usage.

Nearly 70% of FSWs reported taking an HIV test during the past three months. Among the respondents, 33% (33/100) in Mbale and 67% (91/136) in Mbarara reported having ever heard of PrEP. However, only 9.7% (23/236) self-reported currently taking oral-PrEP. In Mbarara, FSWs were twice as likely to be aware of or use oral PrEP than those in Mbale (adjusted prevalence ratio [aPR] 2.33; 95% confidence interval (CI) 1.19–3.97; p = 0.01). Additionally, current use was positively associated with attainment of secondary (aPR 2.50; 95% CI: 1.14–5.45; p = 0.02) or tertiary education (aPR 3.12; 95% CI: 1.09–8.96; p = 0.03).

PrEP use in this cohort of FSWs was low and was associated with location and level of education. To increase PrEP uptake among FSWs, targeted educational campaigns and implementation studies are needed, particularly for those with lower levels of education.