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Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil

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Abstract

Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.

Resumen

Mujeres trabajadoras sexuales (MTS) se ven afectadas de manera desproporcionada por la violencia sexual (VS) y el VIH. Las barreras sociales y estructurales limitan su acceso a la profilaxis posexposición (PEP). Encuesta de muestreo dirigida por encuestados en 12 ciudades brasileñas con 4188 MTS para estimar la prevalencia de VS y los factores asociados al uso de PEP entre MTS que experimentaron VS. La prevalencia de VS fue del 26.3% (1199). De essas, el 7.5% buscó atención médica y usó PEP, el 19% buscó atención médica pero no usó PEP y el 73.5% no buscó atención después del SV. Factores asociados con el uso de PEP: conciencia de PEP; participación en talleres educativos y divulgación del trabajo en los servicios de salud. Aunque Brasil tiene un programa de PEP gratuito, no es de fácil acceso. Es urgente el desarrollo de estrategias efectivas para vincular las MTS con servicios de prevención.

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Acknowledgements

The authors would like to express their gratitude to the participants of the study, to the local teams that carried out the fieldwork in the 12 cities, and all collaborating NGOs. We are also grateful for the support of STI/HIV/AIDS and Viral Hepatitis Department of the Brazilian Minister of Health. Additionally, we appreciate the CAPES support for the Master´s fellowship granted to AP.

The Brazilian FSW Group was composed of: Celia Landmann Szwarcwald, Paulo Roberto Borges de Souza Júnior, Orlando C. Ferreira Jr., Giseli Nogueira Damacena, Neide Gravato da Silva, Rita Bacuri, Helena Brigido, Hermelinda Maia Macena, Ana Brito, Inês Dourado, Mark Drew Crosland Guimarães, Wanessa da Silva de Almeida, Alexandre Grangeiro, Carla Luppi, Karin Regina Luhm, Isete Maria Stella, Adriana Varela Espinola, Tânia Varela, Francisca Sueli da Silva.

Funding

Funding for this study was provided by Brazilian Ministry of Health, through its Secretariat for Health Surveillance and its Department of Prevention, Surveillance and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis through a Grant Number: LN7901-BR.

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Authors and Affiliations

  1. Institute of Collective Health, Federal University of Bahia, Av. Basílio da Gama, s/n, Canela Campus do Canela, Salvador, Bahia, CEP: 40110-040, Brazil

    Acácia Mayra Pereira de Lima, Laio Magno, Elis Passos Santana & Inês Dourado

  2. Department of Life Sciences, State University of Bahia, Campus 1, Salvador, Bahia, Brazil

    Laio Magno

  3. Department of Preventive Medicine, Federal University of São Paulo, Botucatu, São Paulo, Brazil

    Carla Gianna Luppi

  4. Institute of Scientific Communication and Information in Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

    Célia Landmann Szwarcwald

  5. Department of Preventive Medicine, Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil

    Alexandre Grangeiro

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  1. Acácia Mayra Pereira de Lima
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The Brazilian FSW Group

  • Paulo Roberto Borges de Souza Júnior
  • , Orlando C. Ferreira Jr.
  • , Giseli Nogueira Damacena
  • , Neide Gravato da Silva
  • , Rita Bacuri
  • , Helena Brigido
  • , Hermelinda Maia Macena
  • , Ana Brito
  • , Mark Drew Crosland Guimarães
  • , Wanessa da Silva de Almeida
  • , Karin Regina Luhm
  • , Isete Maria Stella
  • , Adriana Varela Espinola
  • , Tânia Varela
  •  & Francisca Sueli da Silva

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Correspondence to Acácia Mayra Pereira de Lima.

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de Lima, A.M.P., Magno, L., Luppi, C.G. et al. Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil. AIDS Behav 26, 4082–4092 (2022). https://doi.org/10.1007/s10461-022-03734-1

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