Abstract
Sex workers need HIV-prevention methods they can control and incorporate easily in their work. We studied the acceptability of three methods: HIV self-test use with clients, oral pre-exposure prophylaxis (PrEP), and rectal microbicide gel. Four male and eight transgender female (TGF) sex workers in Puerto Rico completed a baseline survey with a quantitative measure of likelihood of use. From them, one male and four TGF also completed a 12-week study of rectal microbicide placebo gel use prior to receptive anal intercourse with male clients and evaluated via qualitative in-depth interviews and follow-up quantitative assessments how each method could be incorporated into their work. Most were interested in a rectal microbicide gel and able to use it covertly with clients. Challenges to using the HIV self-test with clients included the potential for both breach of confidentiality and confronting violent situations. Participants also expressed interest in oral PrEP, but raised concerns about side effects.
Resumen
Los trabajadores sexuales necesitan métodos de prevención del VIH que pueden controlar e incorporar fácilmente en su trabajo. Estudiamos la aceptabilidad de tres métodos de prevención: el uso de la autoprueba del VIH con clientes, de la profilaxis oral pre-exposición (PrEP) y de un gel microbicida rectal. Cuatro hombres y ocho mujeres transgénero (MTG) que eran trabajadores sexuales en Puerto Rico respondieron a una encuesta inicial sobre la probabilidad del uso de cada método. De ellos, un hombre y cuatro MTG también completaron un estudio de 12 semanas usando un gel microbicida rectal placebo antes de tener relaciones sexuales anal receptivas con clientes varones. Los participantes evaluaron mediante entrevistas cualitativas en profundidad y cuantitativas de seguimiento cómo incorporar cada método en su trabajo. La mayoría mostró interés en un gel microbicida rectal y pudo usarlo encubiertamente con clientes. Los desafíos al uso de la autoprueba del VIH con clientes incluyeron la posibilidad tanto de pérdida de confidencialidad como de confrontar situaciones violentas. Los participantes expresaron interés en PrEP oral pero manifestaron preocupación por los efectos secundarios.
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Acknowledgments
We would like to thank the study staff for their hard work, especially Hazel Ayala Flores, Ericka Jeanxelle Florenciani, and Juan Antonio Buch Barzaga, and the study participants for giving us their time and sharing their experiences with us. We also thank Marina Mabragaña, MD for her contributions to qualitative data coding and summaries and Alan Sheinfil for his contribution to the literature search. This research was sponsored by the US National Institutes of Health (NIH), including NICHD and NIMH, under R01 HD59533 (Carballo-Diéguez and McGowan, Co-PIs) and co-sponsored by CONRAD. Additional support came from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Robert Remien). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Giguere, R., Frasca, T., Dolezal, C. et al. Acceptability of Three Novel HIV Prevention Methods Among Young Male and Transgender Female Sex Workers in Puerto Rico. AIDS Behav 20, 2192–2202 (2016). https://doi.org/10.1007/s10461-016-1387-9
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DOI: https://doi.org/10.1007/s10461-016-1387-9