HIV Post-Exposure Prophylaxis in an Urban Population of Female Sex Workers in Nairobi, Kenya

March 2013 - Epidemiology

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Izulla, P., L.R. McKinnon, J. Munyao, et al. Journal of Acquired Immune Deficiency Syndromes (February 2013), Vol. 62 No. 2, pp. 220-225.

The authors examined efficacy of post-exposure prophylaxis (PEP) among HIV-uninfected female sex workers (FSWs) in Nairobi, Kenya, and explored determinants of PEP use, adherence, and subsequent HIV incidence. The findings showed that PEP was fairly acceptable, and no HIV infections were observed during the year after PEP initiation, although the precise efficacy was undetermined. Of 2,900 FSWs recruited from 2008-2010, 11 percent (n=326) requested PEP. In multivariate regression analysis, PEP users were less likely than non-users to have a regular partner (55 vs. 73 percent); were more likely to report consistent condom use (85 vs. 68 percent); had a history of HIV testing (89 vs. 76 percent); used alcohol (84 vs. 76 percent); had higher gonorrhea rates (6.9 vs. 2.6 percent); and reported a previous abortion (average 0.74 vs. 0.62).  Requests for PEP were mostly from FSWs with “first-time” clients; and 85 percent of women reported condom breakage as the reason for seeking PEP. Delayed timing was an issue; 25 percent initiated PEP 36 hours post-exposure, suggesting an opportunity to improve risk reduction counseling. Fifty-six percent of users adhered for at least 10 days. The authors concluded that PEP may be useful as HIV prevention for FSWs; but research should further assess reasons associated with PEP use. PEP guidelines for FSWs in sub-Saharan Africa are needed.

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