Sex workers views on pre-exposure prophylaxis in South Africa - The influence of trust and stigma

Abstract

In South Africa, sex work is criminalized, exposing sex workers to stigmatization and discrimination. Stigmatization is found to impede access to healthcare, making sex workers particularly vulnerable to HIV infection. Sex workers are a high risk group for HIV: 60 to 70% of sex workers is estimated to be HIV positive. Recently, Pre-exposure Prophylaxis (PrEP) has been introduced in South Africa as a new HIV prevention method and made available for sex workers. Taking PrEP consistently can decrease the risk of getting HIV by more than 90%. Since PrEP is relatively new and is not broadly distributed in South Africa, not everyone knows about it yet. Important factors in the acceptance of PrEP are knowledge about it, positive promotion, trust in the healthcare system and its workers, and faith that a medication will benefit you. So far, PrEP has not been generally accepted by sex workers,. This qualitative researched focuses on social factors that influence sex workers views on PrEP, specifically on the role of stigma and trust. To uncover the dynamics between stigmatization, trust in healthcare and views on PrEP, key stakeholders were asked about their opinions and experience with sex workers and PrEP. Seventeen semi-structured interviews were conducted with health professionals and peer educators, either over the phone or by Skype. Thematic analysis revealed four relevant themes by which the results were structured: (1) awareness of PrEP and health knowledge are key in acceptance, (2) structural stigmatization of sex workers impedes on access to care, (3) trust in healthcare and healthcare workers is shaped by experiences of stigmatization and discrimination and (4) the position of sex workers in society impedes the potential benefit of PrEP. It can be concluded that education for both the sex worker and non-sex worker population, sensitization of healthcare professionals and the decriminalization of sex work could increase PrEP acceptance among sex workers.