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Pre and Post-exposure Prophylaxis Awareness and Acceptability Among Sex Workers in Jamaica: A Cross-Sectional Study

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Abstract

The HIV prevention cascade is understudied among sex workers in Jamaica, where sex work and same sex practices are criminalized. We implemented a cross-sectional survey with cisgender women, transgender women, and cisgender men sex workers in Jamaica. We conducted multivariable logistic regression analyses to identify factors associated with PrEP and PEP awareness and acceptability. Participants (n = 340) included cisgender men (n = 124), transgender women (n = 101), and cisgender women (n = 115). PEP awareness was low (33.2%), yet acceptability was high (70.8%). In multivariable analyses, recent sexual violence, recent client violence, and sex work social cohesion were associated with PEP awareness and acceptability. One-third (32.7%) reported PrEP awareness, with high acceptability (80.2%). Relationship status and recent physical violence were associated with PrEP awareness and acceptability. In multivariable analyses, gender identity was not associated with differences in PEP/PrEP awareness/acceptability. Findings highlight the need to increase PEP and PrEP awareness and access among sex workers in Jamaica.

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References

  1. Worldwide, more than half of new HIV infections now among key populations and their sexual partners [Internet]. UNAIDS. 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2019/november/20191105_key-populations. Accessed 12 Dec 2019.

  2. Shannon K, Csete J. Violence, condom negotiation, and HIV/STI risk among sex workers. JAMA. 2010;304(5):573–4.

    CAS  PubMed  Google Scholar 

  3. Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner JS, Tyndall MW. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ [Internet]. 2009 Aug 11;339.

  4. Shannon K, Goldenberg SM, Deering KN, Strathdee SA. HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed. Curr Opin HIV AIDS. 2014;9(2):174–82.

    PubMed  PubMed Central  Google Scholar 

  5. Footer KHA, Park JN, Allen ST, Decker MR, Silberzahn BE, Huettner S, et al. Police-related correlates of client-perpetrated violence among female sex workers in Baltimore City, Maryland. Am J Public Health. 2019;109(2):289–95.

    PubMed  PubMed Central  Google Scholar 

  6. Baral S, Holland CE, Shannon K, Logie C, Semugoma P, Sithole B, et al. Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs. J Acquir Immune Defic Syndr. 1999;66(Suppl 3):S319–28.

    Google Scholar 

  7. Poteat T, Wirtz AL, Radix A, Borquez A, Silva-Santisteban A, Deutsch MB, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet Lond Engl. 2015;385(9964):274–86.

    Google Scholar 

  8. Logie CH, Lacombe-Duncan A, Kenny KS, Levermore K, Jones N, Baral SD, et al. Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey. Glob Health Action. 2018;11(1):1424614.

    PubMed  PubMed Central  Google Scholar 

  9. Logie CH, Wang Y, Lacombe-Duncan A, Jones N, Ahmed U, Levermore K, et al. Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. J Int AIDS Soc. 2017;20(1):21422.

    PubMed  PubMed Central  Google Scholar 

  10. UNAIDS. Jamaica [Internet]. 2017. https://www.unaids.org/en/regionscountries/countries/jamaica. Accessed 24 June 2019.

  11. Post-exposure prophylaxis to prevent HIV infection: joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection [Internet]. World Health Organization; 2007. https://apps.who.int/iris/bitstream/handle/10665/43838/9789241596374_eng.pdf;jsessionid=43B3B32292377A7C16329ECD77744C20?sequence=1.

  12. CDC morbidity and mortality weekly report [Internet]. Centers for Disease Control; 2005. http://www.cdc.gov/hiv/prevention/research.

  13. Hargreaves JR, Delany-Moretlwe S, Hallett TB, Johnson S, Kapiga S, Bhattacharjee P, et al. The HIV prevention cascade: integrating theories of epidemiological, behavioural, and social science into programme design and monitoring. Lancet HIV. 2016;3(7):e318–22.

    PubMed  Google Scholar 

  14. Horn T, Sherwood J, Remien RH, Nash D, Auerbach JD. Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model. J Int AIDS Soc. 2016;19(1):21263. 

    PubMed  PubMed Central  Google Scholar 

  15. Garnett GP, Hallett TB, Takaruza A, Hargreaves J, Rhead R, Warren M, et al. Providing a conceptual framework for HIV prevention cascades and assessing feasibility of empirical measurement with data from east Zimbabwe: a case study. Lancet HIV. 2016;3(7):e297–306.

    PubMed  PubMed Central  Google Scholar 

  16. Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer KH, Mimiaga M, Patel R, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS Lond Engl. 2017;31(5):731–4.

    Google Scholar 

  17. Duncan J, Gebre Y, Grant Y, Wedderburn M, Byfield L, Bourne D, et al. HIV prevalence and related behaviors among sex workers in Jamaica. Sex Transm Dis. 2010;37(5):306–10.

    PubMed  Google Scholar 

  18. Barrow DG. Clinical management of HIV disease guidelines for medical practitioners. 2017;130.

  19. Hibbert K. PrEP pilot January Health ministry to roll out HIV prevention drugs [Internet]. Jamaica Observer. 2019. http://www.jamaicaobserver.com/your-health-your-wealth/prep-pilot-january_180896?profile=1373. Accessed 6 Jan 2020.

  20. Krakower DS, Jain S, Mayer KH. Antiretrovirals for primary HIV prevention: the current status of pre- and post-exposure prophylaxis. Curr HIV/AIDS Rep. 2015;12(1):127–38.

    PubMed  PubMed Central  Google Scholar 

  21. Hugo JM, Stall RD, Rebe K, Egan JE, De Swardt G, Struthers H, et al. Anti-retroviral therapy based HIV prevention among a sample of men who have sex with men in Cape Town, South Africa: use of post-exposure prophylaxis and knowledge on pre-exposure prophylaxis. AIDS Behav. 2016;20(Suppl 3):357–64.

    CAS  PubMed  Google Scholar 

  22. Tissot F, Erard V, Dang T, Cavassini M. Nonoccupational HIV post-exposure prophylaxis: a 10-year retrospective analysis. HIV Med. 2010;11(9):584–92.

    CAS  PubMed  Google Scholar 

  23. Izulla P, McKinnon LR, Munyao J, Ireri N, Nagelkerke N, Gakii G, et al. Repeat use of post-exposure prophylaxis for HIV among Nairobi-based female sex workers following sexual exposure. AIDS Behav. 2016;20(7):1549–55.

    PubMed  Google Scholar 

  24. Restar AJ, Tocco JU, Mantell JE, Lafort Y, Gichangi P, Masvawure TB, et al. Perspectives on HIV pre- and post-exposure prophylaxes (PrEP and PEP) among female and male sex workers in Mombasa, Kenya: implications for integrating biomedical prevention into sexual health services. AIDS Educ Prev. 2017;29(2):141–53.

    PubMed  PubMed Central  Google Scholar 

  25. Guidance on Pre-exposure oral prophylaxis (PrEP) for serodiscordant couples, men who have sex with men and transgender women at high risk of HIV in implementation research. World Health Organization; 2012.

  26. PrePWatch: where do you fit on the map? [Internet]. PrEPWatch. 2020. https://www.prepwatch.org/. Accessed 8 May 2020.

  27. Giguère K, Béhanzin L, Guédou FA, Talbot D, Leblond FA, Goma-Matsétsé E, et al. PrEP use among female sex workers: no evidence for risk compensation. JAIDS J Acquir Immune Defic Syndr. 2019;82(3):257.

    PubMed  Google Scholar 

  28. Eakle R, Gomez GB, Naicker N, Bothma R, Mbogua J, Cabrera Escobar MA, et al. HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: results from a prospective observational demonstration project. PLoS Med. 2017;14(11):e1002444.

    PubMed  PubMed Central  Google Scholar 

  29. Ortblad KF, Chanda MM, Musoke DK, Ngabirano T, Mwale M, Nakitende A, et al. Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials. BMC Infect Dis. 2018;18(1):503.

    PubMed  PubMed Central  Google Scholar 

  30. Eakle R, Bourne A, Mbogua J, Mutanha N, Rees H. Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa. J Int AIDS Soc. 2018;21(2):e25081.

    PubMed Central  Google Scholar 

  31. Fearon E, Phillips A, Mtetwa S, Chabata ST, Mushati P, Cambiano V, et al. How can programmes better support female sex workers to avoid HIV infection in Zimbabwe? A prevention cascade analysis. J Acquir Immune Defic Syndr 1999. 2019;81(1):24–35.

    Google Scholar 

  32. Deschamps MM, Metch B, Morgan CA, Zorrilla CD, Donastorg Y, Swann E, et al. Feasibility of identifying a female sex worker cohort at high risk of HIV infection in the Caribbean for HIV vaccine efficacy trials: longitudinal results of HVTN 907. J Acquir Immune Defic Syndr. 2016;71(1):70–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016;19(7S6):21105.

    PubMed  PubMed Central  Google Scholar 

  34. Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, et al. A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: a systematic review and meta-analysis. AIDS Behav. 2018;22(4):1063–74.

    PubMed  Google Scholar 

  35. Yi S, Tuot S, Mwai GW, Ngin C, Chhim K, Pal K, et al. Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21580.

    PubMed  PubMed Central  Google Scholar 

  36. Torres TS, Konda K, Vega-Ramirez EH, Elorreaga Reyes OA, Diaz-Sosa D, Hoagland B, et al. Awareness and factors associated with willingness to use pre-exposure prophylaxis (PrEP) in Brazil, Mexico and Peru: an online survey among men who have sex with men (MSM) (Preprint). JMIR Public Health Surveill [Internet]. 2019;5(2):e13771.

    PubMed  PubMed Central  Google Scholar 

  37. Edeza A, Galárraga O, Santamaria EK, Sosa-Rubí S, Operario D, Biello KB. “I Do Try To Use Condoms, But…”: knowledge and interest in PrEP among male sex workers in Mexico City. Arch Sex Behav. 2019;49(1):355–63.

    PubMed  PubMed Central  Google Scholar 

  38. Underhill K, Morrow KM, Colleran CM, Holcomb R, Operario D, Calabrese SK, et al. Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US. PLoS ONE. 2014;9(11):e112425.

    PubMed  PubMed Central  Google Scholar 

  39. Underhill K, Morrow KM, Colleran C, Holcomb R, Calabrese SK, Operario D, et al. A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by U.S. male sex workers and other men who have sex with men: implications for biomedical HIV prevention. J Urban Health Bull N Y Acad Med. 2015;92(4):667–86.

    Google Scholar 

  40. Sevelius JM, Keatley J, Calma N, Arnold E. “I am not a man”: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7–8):1060–75.

    PubMed  Google Scholar 

  41. Escudero DJ, Kerr T, Operario D, Socías ME, Sued O, Marshall BDL. Inclusion of trans women in pre-exposure prophylaxis trials: a review. AIDS Care. 2015;27(5):637–41.

    PubMed  Google Scholar 

  42. Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city. AIDS Care. 2018;30(1):9–17.

    PubMed  Google Scholar 

  43. Poteat T, Wirtz A, Malik M, Cooney E, Cannon C, Hardy WD, et al. A Gap Between Willingness and Uptake: Findings from Mixed Methods Research on HIV Prevention among Black and Latina Transgender Women. JAIDS J Acquir Immune Defic Syndr [Internet]. 2019;82(2):131–40.

    PubMed  Google Scholar 

  44. Restar AJ, Kuhns L, Reisner SL, Ogunbajo A, Garofalo R, Mimiaga MJ. Acceptability of antiretroviral pre-exposure prophylaxis from a cohort of sexually experienced young transgender women in two U.S. cities. AIDS Behav. 2018;22(11):3649–57.

    PubMed  PubMed Central  Google Scholar 

  45. Jalil EM, Grinsztejn B, Velasque L, Ramos Makkeda A, Luz PM, Moreira RI, et al. Awareness, willingness, and PrEP eligibility among transgender women in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr 1999. 2018;79(4):445–52.

    Google Scholar 

  46. Zalazar V, Arístegui I, Kerr T, Marshall BDL, Romero M, Sued O, et al. High willingness to use HIV pre-exposure prophylaxis among transgender women in Argentina. Transgender Health. 2016;1(1):266–73.

    PubMed  PubMed Central  Google Scholar 

  47. Oldenburg CE, Le B, Toan T, Thien DD, Huyen HT, Friedman MR, et al. HIV pre-exposure prophylaxis indication and readiness among HIV-uninfected transgender women in Ho Chi Minh City, Vietnam. AIDS Behav. 2016;20(Suppl 3):365–70.

    PubMed  PubMed Central  Google Scholar 

  48. Wang Z, Lau JTF, Yang X, Cai Y, Gross DL, Ma T, et al. Acceptability of daily use of free oral pre-exposure prophylaxis (PrEP) among transgender women sex workers in Shenyang, China. AIDS Behav. 2017;21(12):3287–98.

    PubMed  Google Scholar 

  49. Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P, et al. A systematic review of the correlates of violence against sex workers. Am J Public Health. 2014;104(5):e42–54.

    PubMed  PubMed Central  Google Scholar 

  50. Leddy AM, Weiss E, Yam E, Pulerwitz J. Gender-based violence and engagement in biomedical HIV prevention, care and treatment: a scoping review. BMC Public Health. 2019;19(1):897.

    PubMed  PubMed Central  Google Scholar 

  51. Ayala G, Makofane K, Santos G-M, Beck J, Do TD, Hebert P, et al. Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention [Internet]. Journal of Sexually Transmitted Diseases. 2013. https://www.hindawi.com/journals/jstd/2013/953123/. Accessed 6 Jan 2020.

  52. Roberts ST, Haberer J, Celum C, Mugo N, Ware NC, Cohen CR, et al. Intimate partner violence and adherence to HIV pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: a prospective cohort study. J Acquir Immune Defic Syndr. 2016;73(3):313–22.

    PubMed  PubMed Central  Google Scholar 

  53. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.

    Google Scholar 

  54. Lippman SA, Donini A, Díaz J, Chinaglia M, Reingold A, Kerrigan D. Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil. Am J Public Health. 2010;100(Suppl 1):S216–23.

    PubMed  PubMed Central  Google Scholar 

  55. Decker MR, Tomko C, Wingo E, Sawyer A, Peitzmeier S, Glass N, et al. A brief, trauma-informed intervention increases safety behavior and reduces HIV risk for drug-involved women who trade sex. BMC Public Health. 2017;18(1):75.

    PubMed  PubMed Central  Google Scholar 

  56. Langer A, Stewart F, Smedts K, Demarest L. Conceptualising and measuring social cohesion in Africa: towards a perceptions-based index. Soc Indic Res. 2017;131(1):321–43.

    Google Scholar 

  57. Chuang Y-C, Chuang K-Y, Yang T-H. Social cohesion matters in health. Int J Equity Health. 2013;12:87.

    PubMed  PubMed Central  Google Scholar 

  58. Cowan FM, Davey C, Fearon E, Mushati P, Dirawo J, Chabata S, et al. Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): a cluster-randomised trial. Lancet HIV. 2018;5(8):e417–26.

    PubMed  Google Scholar 

  59. Argento E, Duff P, Bingham B, Chapman J, Nguyen P, Strathdee SA, et al. Social cohesion among sex workers and client condom refusal in a Canadian setting: implications for structural and community-led interventions. AIDS Behav N Y. 2016;20(6):1275–83.

    Google Scholar 

  60. Nnko S, Kuringe E, Nyato D, Drake M, Casalini C, Shao A, et al. Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review. BMC Public Health. 2019;19(1):15.

    PubMed  PubMed Central  Google Scholar 

  61. Blanchard AK, Mohan HL, Shahmanesh M, Prakash R, Isac S, Ramesh BM, et al. Community mobilization, empowerment and HIV prevention among female sex workers in south India. BMC Public Health. 2013;13(1):234.

    PubMed  PubMed Central  Google Scholar 

  62. Fonner VA, Kerrigan D, Mnisi Z, Ketende S, Kennedy CE, Baral S. Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland. PLoS ONE. 2014;9(1):e87527.

    PubMed  PubMed Central  Google Scholar 

  63. Ransome Y, Zarwell M, Robinson WT. Participation in community groups increases the likelihood of PrEP awareness: New Orleans NHBS-MSM Cycle, 2014. PLoS ONE. 2019;14(3):e0213022.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Oldenburg CE, Biello KB, Colby D, Closson EF, Nguyen T, Trang NNN, et al. Engagement with peer health educators is associated with willingness to use pre-exposure prophylaxis among male sex workers in Ho Chi Minh City, Vietnam. AIDS Patient Care STDs. 2014;28(3):109–12.

    PubMed  PubMed Central  Google Scholar 

  65. Logie CH, Abramovich A, Schott N, Levermore K, Jones N. Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica. Reprod Health Matters. 2018;26(54):72–83.

    PubMed  Google Scholar 

  66. Logie CH, Lee-Foon N, Jones N, Mena K, Levermore K, Newman PA, et al. Exploring lived experiences of violence and coping among Lesbian, Gay, bisexual and transgender youth in Kingston, Jamaica. Int J Sex Health. 2016;28(4):343–53.

    Google Scholar 

  67. Oldenburg CE, Bärnighausen T, Harling G, Mimiaga MJ, Mayer KH. Adherence to post-exposure prophylaxis for non-forcible sexual exposure to HIV: a systematic review and meta-analysis. AIDS Behav. 2014;18(2):217–25.

    PubMed  PubMed Central  Google Scholar 

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Funding

This research was funded by the Canadian Institutes of Health Research (CIHR) Operating Grant 0000303157; Fund: 495419, Competition 201209. Dr. Logie’s efforts were in part supported by an Ontario Ministry of Research and Innovation Early Researcher Award, a Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations, and the Canada Foundation for Innovation.

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Authors and Affiliations

  1. Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada

    Carmen H. Logie & Ying Wang

  2. Women’s College Research Institute, Women’s College Hospital, Toronto, Canada

    Carmen H. Logie

  3. Jamaica AIDS Support for Life, Kingston, Jamaica

    Patrick Lalor, Davina Williams & Kandasi Levermore

  4. Sex Work Association of Jamaica, Kingston, Jamaica

    Patrick Lalor

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  1. Carmen H. Logie
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Correspondence to Carmen H. Logie.

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Logie, C.H., Wang, Y., Lalor, P. et al. Pre and Post-exposure Prophylaxis Awareness and Acceptability Among Sex Workers in Jamaica: A Cross-Sectional Study. AIDS Behav 25, 330–343 (2021). https://doi.org/10.1007/s10461-020-02972-5

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