Facilitators and barriers to adherence to pre-exposure prophylaxis among young female sex workers
DOI:
https://doi.org/10.26694/repis.v11i1.7029Keywords:
Medication adherence, Pre-exposure prophylaxis, HIV, Young female sex workersAbstract
Introduction: The Mozambican Ministry of Health offers free pre-exposure prophylaxis (PrEP) to people at substantial risk of human immunodeficiency virus (HIV) infection, including HIV-negative young female sex workers (FSWs). However, studies indicate low adherence to this prophylaxis in Mozambique, for reasons still unknown. Objective: To analyze the factors associated with PrEP adherence among young female sex workers in Maputo city. Method: A cross-sectional, quantitative study was conducted in Maputo city, Mozambique, between June and September 2024. The sample consisted of 272 FSWs (18–24 years old), selected by stratified probability sampling from five health centers offering PrEP. Data were collected through a structured questionnaire administered in person. The data were digitized in Open Data Kit (ODK), analyzed in Stata version 17, using descriptive statistics, Pearson's chi-square test and multinomial logistic regression (p<0.05) to estimate odds ratios (OR) of PrEP adherence and refusal. Results: Of the 272 respondents, 43.4% refused PrEP. Psychosocial and family support was positively associated with adherence (OR = 5.7; p = 0.002; 95% confidence interval (CI): 2.022–9.380), while social stigma associated with taking prophylaxis (OR = 1.7; p = 0.025; 95% CI: 0.22–3.32) and medication shortages at health centers (OR = 2.95; p = 0.001; 95% CI: 1.13–4.76) increased the likelihood of refusal. Implications: The study results indicate that although prophylaxis is free, not all eligible FSWs adhere to it due to medication shortages and the social stigma associated with taking them. Promoting awareness campaigns on PrEP use among FSWs and in the community, and improvements in the regular supply of medication at health centers can increase adherence to prophylaxis.
References
UNAIDS. Estatísticas de HIV/SIDA em Moçambique [Internet]. 2024 [cited 2025 Feb 8]. p. 1–5. Available from: https://www.unaids.org/en/regionscountries/countries/mozambique
UNAIDS. Estatística globais sobre HIV/SIDA [Internet]. 2024 [cited 2025 Feb 8]. p. 1–7. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://unaids.org.br/wp-content/uploads/2024/07/20240722_UNAIDS_Global_HIV_Factsheet_PTBR.pdf
Navarro RM, Salimo ZM, Lemos SM. Factores envolvidos nas dificuldades de negociação do uso de preservativo com parceiro fixo por parte de mulheres profissionais de sexo. Revista Ibero-Americana de Humanidades, Ciências e Educação. 2024 Aug 29;10(8):4013–55. Available from: https://doi.org/10.51891/rease.v10i8.15448
Celum CL, Delany‐Moretlwe S, McConnell M, van Rooyen H, Bekker L, Kurth A, et al. Rethinking HIV prevention to prepare for oral PrEP implementation for young African women. J Int AIDS Soc. 2015 Jul 20;18(4S3). Available from: https://doi.org/10.7448/IAS.18.4.20227
Hosek S, Celum C, Wilson CM, Kapogiannis B, Delany‐Moretlwe S, Bekker L. Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa. J Int AIDS Soc. 2016 Oct 18;19(7S6). Available from: https://doi.org/10.7448/IAS.19.7.21107
Suca A, Salimo ZM, Inguane HCE, Chissaque AH, Silva WP, Cuinhane CE. “Tenho medo de apanhar HIV”: Percepções do risco e adesão à PREP entre mulheres jovens trabalhadoras do sexo na cidade de Maputo, Moçambique. Revista Ibero-Americana de Humanidades, Ciências e Educação. 2025 Sep 8;11(9):959–87. Available from: https://doi.org/10.51891/rease.v11i9.20919
Arnold T, Brinkley-Rubinstein L, Chan PA, Perez-Brumer A, Bologna ES, Beauchamps L, et al. Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi. PLoS One. 2017 Feb 21;12(2):e0172354. Available from: https://doi.org/10.1371/journal.pone.0172354
Nieto O, Brooks RA, Landrian A, Cabral A, Fehrenbacher AE. PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services. PLoS One. 2020 Nov 5;15(11):e0241340. Available from: https://doi.org/10.1371/journal.pone.0241340
Jackson-Gibson M, Ezema AU, Orero W, Were I, Ohiomoba RO, Mbullo PO, et al. Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya. BMC Public Health. 2021 Dec 1;21(1):1284. Available from: https://doi.org/10.1186/s12889-021-11335-1
Camp C, Saberi P. Facilitators and barriers of 2-1-1 HIV pre-exposure prophylaxis. PLoS One. 2021 May 20;16(5):e0251917. Available from: https://doi.org/10.1371/journal.pone.0251917
Pillay D, Stankevitz K, Lanham M, Ridgeway K, Murire M, Briedenhann E, et al. Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa. PLoS One. 2020 Apr 30;15(4):e0228620. Available from: https://doi.org/10.1371/journal.pone.0228620
Velloza J, Donnell D, Hosek S, Anderson PL, Chirenje ZM, Mgodi N, et al. Alignment of PrEP adherence with periods of HIV risk among adolescent girls and young women in South Africa and Zimbabwe: a secondary analysis of the HPTN 082 randomised controlled trial. Lancet HIV. 2022 Oct;9(10):e680–9. Available from: https://doi.org/10.1016/S2352-3018(22)00195-3
MISAU. Circular da PrEP: Actualização 2023 Orientação para Expansão Nacional da Profilaxia Pré-exposição ao HIV em Moçambique; 2023.
MISAU. Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA); 2018.
Miller WMJMF. Mapeamento Programático e Prevalência de HIV entre Populações Chave em 5 Províncias de Moçambique; 2018.
CNCS. Plano Estratégico Nacional de Resposta ao HIV e SIDA 2023–2028. Maputo: Conselho Nacional de Combate ao SIDA; 2023.
MISAU. Guião de Oferta da Profilaxia Pré-Exposição ao HIV; 2021.
Salimo ZM, Manhiça LE, Biquiza AS, Ribeiro R V., Gotine AREM, Mazalo J V., et al. Update on Typhoid Fever: An ongoing threat to public health. Revista Ibero-Americana de Humanidades, Ciências e Educação. 2024 Jun 1;10(6):1–18. Available from: https://doi.org/10.51891/rease.v10i6.13911
Instituto Nacional de Estatística. IV recenseamento geral da população e habitação. Censo 2017. Resultados preliminares. Maputo; 2017.
Município de Maputo. Cidade de Maputo; 2022.
Hosmer DW, Lemes D, Sturdivant RX. Applied Logistic regression. 3rd ed. New York; 2013.
OMS. Diretrizes consolidadas sobre o uso de medicamentos antirretrovirais no tratamento e prevenção da infecção pelo HIV e Recomendações para uma abordagem de saúde pública; 2016.
Salimo ZM, Avelino-Silva VI, Silva EF da, Chaves YO, Kadri MR de A El, Nogueira PA, et al. Factors related to loss to follow-up among people living with HIV: a systematic review. Rev Inst Med Trop Sao Paulo. 2025;67. Available from: https://doi.org/10.1590/S1678-9946202567053
Gois DAB, Almeida GO de, Mendes MP, Carvalho RM, Gonçalves AS. Adesão a Profilaxia Pré-exposição por mulheres profissionais do sexo: revisão integrativa da literatura. Revista ft. 2024 Sep 11;20–1. Available from: https://doi.org/10.69849/revistaft/ra10202409111520
Zucchi EM, Grangeiro A, Ferraz D, Pinheiro TF, Alencar T, Ferguson L, et al. Da evidência à ação: desafios do Sistema Único de Saúde para ofertar a profilaxia pré-exposição sexual (PrEP) ao HIV às pessoas em maior vulnerabilidade. Cad Saude Publica. 2018 Jul 23;34(7). Available from: https://doi.org/10.1590/0102-311X00206617
Ulrich Beck. Sociedade de risco: Rumo a uma outra modernidade. 1st ed. Vol. 1. São Paulo, Brasil: 34 Ltda; 2010. 1–56 p.
Beck U, Giddens A. Modernização reflexiva: Política, tradição e estética na ordem social moderna. 2nd ed. Vol. 1. São Paulo: Editora UNESP; 2001. 1–133 p.
Atukunda EC, Owembabazi M, Pratt MC, Psaros C, Muyindike W, Chitneni P, et al. A qualitative exploration to understand barriers and facilitators to daily oral PrEP uptake and sustained adherence among HIV‐negative women planning for or with pregnancy in rural Southwestern Uganda. J Int AIDS Soc. 2022 Mar 24;25(3). Available from: https://doi.org/10.1002/jia2.25894
De Souza GB, De Souza GC, Cariello NW, Paiva N da SF, Vannier RC, De Azevedo RP, et al. Adesão, efetividade e impacto da PrEP: explorarndo evidências na prevenção do HIV no Municipio de Teresópolio, RJ. Revista da Jopic. 2025;1(13):25–35. Available from: https://doi.org/10.29327/2430932.1.13-3
Stoner MCD, Rucinski KB, Giovenco D, Gill K, Morton JF, Bekker LG, et al. Trajectories of PrEP Adherence Among Young Women Aged 16 to 25 in Cape Town, South Africa. AIDS Behav. 2021 Jul 2;25(7):2046–53. Available from: https://doi.org/10.1007/s10461-020-03134-3
Admassu M, Nöstlinger C, Hensen B. Barriers to PrEP use and adherence among adolescent girls and young women in Eastern, Southern, and Western Africa: a scoping review. BMC Womens Health. 2024 Dec 26;24(1):665. Available from: https://doi.org/10.1186/s12905-024-03516-y
Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. New England Journal of Medicine. 2015 Dec 3;373(23):2237–46. Available from: https://doi.org/10.1056/NEJMoa1506273
Sagaon-Teyssier L, Suzan-Monti M, Demoulin B, Capitant C, Lorente N, Préau M, et al. Uptake of PrEP and condom and sexual risk behavior among MSM during the ANRS IPERGAY trial. AIDS Care. 2016 Mar 24;28(sup1):48–55. Available from: https://doi.org/10.1080/09540121.2016.1146653
Eakle R, Venter F, Rees H. Profilaxia pré-exposição (PrEP) em uma era de prevenção do HIV estagnada: ela pode mudar o jogo? Retrovirology. 2018;15(1):1–10. Available from: https://doi.org/10.3390/pathogens12070924
Sun CJ, Anderson KM, Bangsberg D, Toevs K, Morrison D, Wells C, et al. Access to HIV Pre-exposure Prophylaxis in Practice Settings: a Qualitative Study of Sexual and Gender Minority Adults’ Perspectives. J Gen Intern Med. 2019 Apr 4;34(4):535–43. Available from: https://doi.org/10.1007/s11606-019-04850-w
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Amade Suca, Zeca Manuel Salimo, Humberto Cláudio Inguane, Assucênio Hortêncio Chissaque, Wilson Pereira Silva, Carlos Eduardo Cuinhane
This work is licensed under a Creative Commons Attribution 4.0 International License.
