Condom failure and pre-exposure prophylaxis use experience among female sex workers in Ethiopia: a qualitative study

• Published in: BMC public health Vol. 22; no. 1; p. 1079
• Main Authors: Amogne, Minilik Demissie, Sanders, Eduard J, Belihu, Wudinesh Belete, Sundewall, Jesper, Agardh, Anette
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.05.2022; BioMed Central; BMC
• Subjects: Alcohol; Attitudes; Clients; Condom use; Condoms; Content analysis; Data analysis; Data collection; Disease prevention; Ethiopia; Exposure; Failure; Female; Females; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; FSWs; Health aspects; Health Sciences; HIV; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Hälsovetenskap; Interviews; Medical and Health Sciences; Medicin och hälsovetenskap; Occupational exposure; Population; Pre-Exposure Prophylaxis - methods; PrEP challenge; Prophylaxis; Prostitutes; Public health; Public Health, Global Health, Social Medicine and Epidemiology; Qualitative research; Sex industry; Sex Workers; Sexual behavior; Sexually transmitted diseases; Side effect; Side effects; Social aspects; STD; Ethiopia; Addis Ababa Ethiopia; Condom use; FSWs; PrEP challenge; Ethiopia; Side effect
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-022-13468-3

Female sex workers (FSW) remain a highly exposed group for HIV/STIs due to different factors including condom failure. In Ethiopia, pre-exposure prophylaxis (PrEP) has recently been introduced as an intervention strategy to prevent new HIV infections, but knowledge about FSWs' experiences of condom failure and PrEP use remains scarce. Therefore, this study explores FSWs' experiences concerning condom failure and their attitudes towards, and experiences of, PrEP uptake. A qualitative study using in-depth interviews was conducted among FSWs in Addis Ababa. A manifest and latent content analysis method was applied to identify categories and emerging themes. Seventeen FSWs (10 who started on PrEP, 1 who discontinued, and 6 who didn't start) were interviewed. FSWs described the reasons behind condom failure, the mechanisms they used to minimize the harm, and their attitudes towards PrEP use. FSWs struggled with the continuous risk of condom failure due to factors related to clients' and their own behavior. PrEP was mentioned as one the strategies FSWs used to minimize the harm resulting from condom failure, but PrEP use was compounded with doubts that deterred FSWs from uptake. FSWs' misconceptions, their lack of confidence, and PrEP side effects were also mentioned as the main challenges to start taking PrEP and/or to maintain good adherence. The demands and behavior of the clients and FSWs' own actions and poor awareness were factors that increased the exposure of FSWs to condom failure. In addition, the challenges associated with PrEP uptake suggest the need for user-friendly strategies to counteract these barriers and facilitate PrEP uptake.