(P291) Knowledge Gaps Regarding PrEP and STI Prevention Among Sex Workers in India

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Sabrina Navarro, M.S. (she/her/hers)

Research Assistant
Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, United States

Co-author(s)

AM

Alexander Moran, Ph.D., M.S.P.H.

Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
Los Angeles, California, United States
Bijan A. Hosseini, MS (he/him/his)

Research Assistant
Department of Population and Public Health Sciences, Keck School of Medicine of USC
Los Angeles, California, United States
SK

Suchith Kumar

SK Professional Translation and Transcription Services, Mysore, Karnataka, India, United States
DM

Dipannita Mitra

Durbar Mahila Samanwaya Committee, Kolkata, West Bengal, India, United States
PR

Protim Ray, M.B.B.S.

Durbar Mahila Samanwaya Committee, Kolkata, West Bengal, India, United States
DS

Dallas Swendeman, Ph.D., MPH

Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, United States
Anne E. Fehrenbacher, Ph.D., MPH

Assistant Professor
Department of Population and Public Health Sciences, University of Southern California, United States

Background: Sex workers are disproportionately impacted by HIV in India. Compared to the general population, HIV prevalence is more than 9 times higher among female sex workers (FSW), 16 times higher among male sex workers (MSW), and 18 times higher among transgender sex workers (TGSW). Our study evaluated how PrEP acceptability and condom use preferences are affected by PrEP knowledge among sex workers.

Methods: From August 2019 to February 2020, we conducted a survey (N=233) and seven focus groups (N=45) with sex workers recruited by the Durbar Mahila Samanwaya Committee in West Bengal, India. PrEP knowledge was assessed by a sum score from a six-item scale. Associations between PrEP knowledge, acceptability, and condom use preferences were evaluated with chi-squared tests and linear regression. Focus group transcripts were inductively coded using thematic analysis.

Results: Participants had high PrEP knowledge, with higher scores among MSW (mean=5.4) versus TGSW (mean=4.8) and FSW (mean=4.7). Approximately 73% of TGSW and 68% of FSW responded incorrectly about whether PrEP protects against both HIV and STIs, compared to 12% of MSW. Despite higher PrEP knowledge, 20% of MSW reported that they would have condomless sex if they took PrEP, versus 5% of FSW and 2% of TGSW. PrEP knowledge scores were not associated with PrEP acceptability nor condom use preferences. In focus groups, MSW and TGSW provided many reasons for preferring condomless sex with PrEP use, including dual costs of PrEP and condoms, monetary incentives for condomless sex, and fear of losing clients. FSW did not express these concerns because free condoms are provided to them by targeted interventions, which have normalized condom use in brothel settings where FSW predominantly work but have had limited reach among MSW and TGSW who work in more diverse settings.

Conclusion: We identified an important PrEP knowledge gap among sex workers in India. While condoms protect against both HIV and STIs, PrEP only prevents HIV. Misconceptions regarding PrEP may increase risk of STI transmission. Understanding the structural and social factors impacting condom use preferences among sex workers is critical for maximizing the effectiveness of both PrEP promotion and STI prevention programs.