Patient Preference and Adherence (Apr 2024)

Exploring Attitudes Toward Pre-Exposure Prophylaxis for HIV Prevention Prior to Implementation Among Female Sex Workers in Malaysia: Results from a Qualitative Study

  • Foley S,
  • Keene DE,
  • Shrestha R,
  • Brown SE,
  • Gautam K,
  • Sutherland RA,
  • Maviglia F,
  • Saifi R,
  • Wickersham JA

Journal volume & issue
Vol. Volume 18
pp. 797 – 807

Abstract

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Shaylen Foley,1 Danya E Keene,1 Roman Shrestha,2– 4 Shan-Estelle Brown,5 Kamal Gautam,2 Ryan A Sutherland,3 Francesca Maviglia,3 Rumana Saifi,4 Jeffrey A Wickersham3,4 1Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA; 2Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA; 3Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; 4Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 5Department of Anthropology, Rollins College, Winter Park, FL, USACorrespondence: Shaylen Foley, 135 College Street, Suite 323, New Haven, CT, 06510, USA, Tel +419 343-4606, Email [email protected]: Pre-exposure prophylaxis (PrEP) is an effective method for prevention of HIV transmission. Female sex workers (FSW) in Malaysia are at substantially increased risk of acquiring HIV compared to the general female population, yet little is known about this population’s current HIV prevention practices or acceptance of PrEP. This study aims to inform the culturally relevant implementation of PrEP through the qualitative exploration of (1) the potential need for PrEP in this population and (2) the factors that determine FSW willingness to use oral PrEP.Methods: In-depth, semi-structured interviews (n = 30) were conducted with FSW in English, Malay, or Tamil. Transcribed and translated interviews were analyzed using a grounded theory approach.Results: FSW express positive interest in PrEP but prefer it as a supplement to condoms, not a replacement. Perceived challenges to PrEP use include cost, adherence, and side effects.Conclusion: The findings suggest that in combination with condom use, PrEP may be an acceptable method of HIV prevention. Effective PrEP rollout may also include condom promotion using a peer-driven model, cost subsidies, and sex work harm reduction and empowerment components.Keywords: sex work, HIV, pre-exposure prophylaxis, Malaysia

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