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Sex workers and PrEP

The Global Fund Sex Work Programme aims to prevent new HIV infections among sex workers in South Africa. Between 2019 and 2022, the programme was managed by NACOSA working with implementing organisations in thirteen districts. One of the key components of the programme was to provide pre-exposure prophylaxis (PrEP), an HIV prevention method newly introduced in South Africa, to HIV negative sex workers to reduce new HIV infections.

A process evaluation was conducted by Impact Consulting for NACOSA to assesses the processes that the programme used to support initiation, uptake, cycling and prevention- effective adherence with regards to PrEP, and makes recommendations about providing PrEP to sex workers in the future. The evaluation found that, on the whole, sex workers were aware of their risk, informed about PrEP as a prevention method, and able to access PrEP initiation and refill services easily and without facing stigma if they chose to.

“The nurse here and our peer educator have been pillars of support in making us take PrEP and also making us stay on PrEP. Even when I wanted to give up, they would send you a reminder and when you complain of side effects, they counsel you and tell you nicely that the side effects will go down at some point.”

Key barriers for uptake and retention on PrEP for sex workers was experiencing or being afraid of side effects, and feeling pressure to initiate without enough space to think about their own decision.

“People’s lies and judgemental minds about people who are taking PrEP: I was afraid I will be associated with AIDS.”

Recommendations for future programming included systematic use of sex workers already on PrEP to motivate their peers to get on PrEP and changing the packaging so that it looks less like antiretrovirals (ARVs). An injectable form of PrEP was highly supported.