Raising PrEP Awareness Could Improve Use Among Female Sex Workers in China

HIV pre-exposure prophylaxis (PrEP) has not reached its peak potential in China, according to a recent study that suggests a lack of HIV awareness and misconceptions about PrEP may be barriers to implementing prevention programs there.

The study, published in the journal AIDS Care, examined 1466 female sex workers (FSW) in China to better understand levels of awareness and willingness to use PrEP, along with factors influencing those outcomes.

“HIV pre-exposure prophylaxis has potential for use among female sex workers as a self-initiated approach to help prevent HIV in addition to traditional prevention methods such as condom use,” study author Adrienne N. Poon, MD, MPH assistant professor of medicine at the George Washington University School of Medicine & Health Sciences, told Contagion^®. “We found that there was a general lack of awareness of low willingness to use PrEP among FSW in China. This is likely due to the overall low levels of HIV knowledge and awareness.”

Only 10.2% of participants reported having heard of PrEP, and 35.5% reported a willingness to use the treatment. Willingness increased to 36.9% if the treatment were free, 44.2% if there were no side effects, and 49.1% among those who were knowledgeable about HIV.

“HIV education is an important component for prevention,” Poon said. “We found that those that exhibited greater HIV testing behaviors and who were more engaged in decisions for condom use were more likely to be willing to use PrEP.”

Surprisingly, the study noted that willingness to use PrEP was lower among those who had heard of it, suggesting that misconceptions about PrEP were likely and highlighting a need for accurate information about the treatment. Poon said further research is needed to understand how awareness and health barriers affect willingness to use PrEP.

The study noted that the majority of participants came from disadvantaged upbringings and had middle school or lower education levels. Those who were older when they first began commercial sex had a greater willingness to use PrEP. Regional variations in willingness also suggested that differences in exposure to HIV information may be a factor. About 55.7% of female sex workers in Shandong, which is among China’s most developed provinces, reported willingness to use PrEP compared with 15.3% in the more rural and less-developed Guizhou, the study noted. In Guangdong, which is an industrial center, 34.4% of participants reported a willingness to use PrEP.

“Further research is needed to study of how improved HIV knowledge and awareness may be related to awareness and willingness of PrEP,” Poon told Contagion^®. “PrEP is currently recommended by WHO for key populations at relatively high risk of incident HIV infection. Subgroups of FSW in China, such as those using opioids or amphetamines may be at higher risk. Further research is also needed to assess if these specific subgroups of FSW may benefit from PrEP.”

At-risk women have been shown to be lagging in taking PrEP, and a recent study at Emory University’s Rollins School of Public Health demonstrated that informational training for health care providers in safety-net family planning clinics increases the likelihood that these women will learn about and embrace the treatment.

Understanding the barriers to taking PrEP and what motivates patients to continue the treatment is important to helping improve adherence, a recent study that examined young men and transgender women of color who have sex with men noted.

“Raising awareness of PrEP among potential users and training health care providers in providing culturally sensitive education for those woman at highest risk of HIV infection will be critical for any successful study,” the study in China concluded.