PrEP Acceptability, Access and Predicted User Behaviors in US Male Sex Workers: Implications for Effectiveness
METHODS: We conducted in-depth interviews with n=31 male sex workers in Providence, RI. Men were adults of self-reported uninfected/unknown HIV status, reporting recent sex work and unprotected anal sex with a man of infected/unknown HIV status. Interviews discussed PrEP acceptability, healthcare access, adherence, and risk compensation.
RESULTS: Few men had heard of PrEP; none had used PrEP or PEP. Most were interested in PrEP, but lacked health insurance and were uncomfortable disclosing risk behavior to clinicians. Most were unemployed or disabled, making PrEP unaffordable. Predicted adherence was high depending on perceived HIV risk and PrEP benefit, but obstacles included inconsistent routines, need for covert use, alternating low-risk and high-risk periods due to drug use, and side effects. Some men predicted increased personal risk-taking, more clients, and income related to PrEP use; others predicted reduced risk-taking due to empowerment associated with PrEP. Some predicted no behavior change.
CONCLUSIONS: Male sex workers are interested in PrEP and could benefit from implementation. But effectiveness will depend on outreach, access to cost assistance, improved access to health care in settings where they are comfortable disclosing MSM behavior, addressing adherence obstacles, and population-specific behavioral counseling.
Learning Areas:Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences
Describe knowledge of biomedical HIV prevention methods, especially PrEP and PEP, among male sex workers in the US. Identify potential access barriers for male sex workers who wish to use PrEP, including access to clinical providers and HIV testing services. Analyze willingness to use PrEP, predicted PrEP adherence, and predicted adjustments in sexual risk behavior (i.e., risk compensation behavior) among male sex workers who wish to use PrEP.
Keyword(s): HIV/AIDS, Sex Workers
Qualified on the content I am responsible for because: I served as a member of the study team including collection, analysis, and write up of data.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.