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Try out PMC Labs and tell us what you think. Learn More. This paper focuses on aspects of Pr EP acceptability as a new intervention within the context of a larger service delivery programme including the simultaneous rollout of early ART. Sex worker peer educators recruited participants from varying sex work locales. Facilitation was in English with adaptation by facilitators into local languages as needed. Transcripts were translated and transcribed into English. Thematic analysis was used to analyse the data.

Demographics were largely similar across the sites. Overall, there was strong acceptability of Pr EP among participants and positive anticipation for the imminent delivery of Pr EP in the local sex worker clinics. Participant discussions and recommendations highlighted the importance of developing clear education and messaging to accurately convey the concept of Pr EPand intervention integration into supportive and tailored services. Through the course of these FGD s, Pr EP became a positive and highly anticipated prevention option among the FSW s participants who endorsed implementation in their communities.

Effective integration of Pr EP into existing services will include comprehensive health programming where ART is also available, appropriate messaging, and support. As a result, these two interventions have become part of the standard of care set out by the World Health Organization WHO in 5.

Local sex free by texting

PrEP trials including only women struggled with maintaining adherence levels required to confer protection 678. Dimensions of acceptability contributing to successful uptake and use can include personal preferences around ease of use and product attributes including actual and perceived efficacy ; social Local sex free by texting including stigma from partners, family, and friends, and social norms; interactions with medical facilities and service delivery mechanisms; the policy and regulatory landscape; and the context of the HIV epidemic itself 12 The relative value of these dimensions is often mediated by interactions with the other dimensions as well as an individual's perception of HIV risk Some of these elements were explored in PrEP and vaginal microbicide efficacy trials, though they more often focused on product attributes Lenses into PrEP acceptability among sex workers have been made available through research with people who use drugs, such as one Canadian study which found that engaging in sex work was in itself a motivation to take up PrEP While limited in scope, findings from these studies, have pointed to values and perspectives around PrEP particular to FSWs' work and roles as women.

In addition, service providers' experience with rolling out ART programmes, and the delivery of contraception to prevent unwanted pregnancies, could provide a basis for understanding PrEP where services would be similar, but motivations to take the medication would differ in prevention versus treatment.

The findings presented here focus solely on dimensions of PrEP acceptability, where at the time of data collection, the role and potential of PrEP had not yet been normalized by government guidelines and national regulatory approval. This paper considers PrEP as a new intervention within the context of impending provisions within a larger service delivery programme including the simultaneous rollout of early ART.

The aim of this paper is to specifically explore PrEP acceptability among the FGD participants as future potential users. The two clinics were part of the larger Wits RHI Sex Worker Programme which provides comprehensive primary care services to female, male and transgender sex workers in a variety of settings.

The clinics, services and programme are described in further detail in several other publications, including a detailed of the formative research conducted during the de of the TAPS project 25262728 Only cis gendered women were recruited as the eventual demonstration project did not include any other populations. Discussions were facilitated primarily in English with adaptation by facilitators and staff note takers into local languages as needed. An introduction was provided at the beginning of each FGD session to orient participants as to the purpose of the discussions and the topics to be discussed.

This is included in Annex 1. Background information on PrEP and early ART was provided within the context of each group dynamic and as the topic arose, which varied depending on participant's knowledge. FGDs lasted between one and a half and two hours. No other compensation was given for this research. Analysis followed principles of Braun and Clarke's thematic analysis 33 beginning with a set of questions building from themes derived from the discussion guide based on the MSEM but we remained open to new lines of enquiry as they emerged from the data in an inductive manner.

The coding framework was devised by Local sex free by texting primary author with support from two other researchers, and all transcripts were coded in duplicate by two researchers. All participants provided their informed consent and pseudonyms to protect identities, indicated in this paper as colours. Key demographic characteristics are displayed in Table 1. Participants were not asked to disclose their HIV status, however most participants did so of their own volition during the discussions. While there was relative diversity among the FGD participants, themes arising from the discussions did not differ across the groups.

Most of the discussion centred on male and female condoms, however some women acknowledged male circumcision and prevention of mother to child transmission PMTCTand some had heard of, or participated in, studies involving the vaginal gel and ring. Considering PrEP within the context of other ly known options, or lack thereof, allowed women to recognize and interpret PrEP as a potential choice for prevention. Initial understanding of PrEP was usually reached by equating it with contraception.

She has to take care for herself ….

Local sex free by texting

The only method that we know so far is to use a condom, and…. These sentiments laid the groundwork for seemingly universal approval and anticipation of PrEP, which FGD facilitators indicated would be imminently offered in the clinics in their locality:.

Local sex free by texting

People are dying outside of HIV. And HIV is spreading so fast …. At least people who are still negative will have a chance to stay negative…. So the spreading of HIV will get limited. Then as time goes by the HIV rate will go down …. I don't want my daughter to go through what I am going through now. Brown, JHB 1. All of the women immediately saw the benefit of having PrEP in the body, especially given that condoms often burst or were removed. As sex workers, participants reported how they frequently found themselves in vulnerable positions with clients, which could be hard to anticipate or plan for.

In such circumstances, PrEP could be invaluable in protecting women from HIV where they would have personal control over one method of protection.

Local sex free by texting

Experiences of sexual violence were frequently reported unprompted within groups, and were seen as particularly motivating for PrEP uptake and use. Maybe they even, some of us we have even been ganged raped. Finally, in their own recognition that the primary HIV risk for FSWs came from their main partners rather than clients, many participants reflected on the utility of PrEP in protecting them in the likely event that their partner was also having sex with other women:.

Even if she says, that boyfriend, she loves him, there are many hotels. He doesn't have her only. The other hotels there are many he's got another girlfriend, the other hotel, he's got another. And he's been sleeping with them without that condom Red, JHB1. While at the time of the FGDs many of the women did not report having a current main partner, most of the women recounted experiences with main partners which they felt primarily contributed to their risk and often led to the end of those partnerships. Such sentiment informed a belief expressed by many that PrEP should be made available to all women, rather than just FSWs.

While the potential to reduce HIV transmission was keenly recognized and appreciated, women were also acutely aware of a range of other risks in their sexual, social and personal environments that might influence their willingness to use PrEP. These would, they felt, require careful consideration and management. A primary concern related to the potential discontinuation of condom use in the context of PrEP, and the implications of this for acquisition of other sexually transmitted infections STIs or unwanted pregnancies:.

But what I think, neh, if they are going to use these PrEP pills they have to teach people well, that they must use condoms. Make them to be aware of Local sex free by texting is going to happen because of, if they say ok you can keep on drinking these pills they will start forgetting to use condoms and start to sleep around without.

All of the women agreed that PrEP could not take the place of condoms, and that the two should go together in order to prevent other STIs and unwanted pregnancies, especially since most of the women acknowledged not using other modes of contraception. This perception reflected a general sense that Local sex free by texting would serve as useful backup when condoms failed, rather than being seen as the primary prevention strategy. Many participants felt that some women may not be sufficiently motivated to take a pill every day, especially when they were not feeling unwell.

It's difficult to support somebody who's not sick and say she must take medication especially every day. At the clinic they will always check and tell you that your viral load is high, but you will tell yourself that there is no need to take that medication, rather take drugs and you will be ok Brown, PTA 3.

Additional worries around adherence included substance use alcohol and illicit drugs and the potential for forgetting to take a daily pill. Importantly, the discussion of substance use raised questions about whether PrEP could be taken even when someone knew they would be drinking or using other substances during the course of the day. Explaining that using alcohol or other drugs would not diminish the preventive effects of PrEP was met with approval from the participants.

The perception of potential side effects, especially given knowledge of ART side effects from existing drugs on the market, was seen as a likely major barrier to uptake:. Interestingly, as a result, participants felt it would be important to ensure clear messaging around potential side effects and their duration was central to in the promotion of PrEP.

Perhaps less common were concerns that focused more on logistical and social aspects outside of the women's control, such as the pills being stolen outside clinics:. They know that this one has come to fetch her pills, they steal them from you, you get hurt. They know that they are going to use the pills as drugs. You know that you will be mugged, they hold you up they stab you, what do you do? Including PrEP as part of this type of service delivery environment was considered paramount to successful implementation.

If you get somebody who supports you in what you are doing it's much more easier for you to continue than when they don't have anybody next to you. Like a person like my sister is my biggest supporter. Immediately when I found out I am positive that's the first person I told.

Purple, JHB 1. Finally, flexibility in service delivery was underscored as critical for a successful PrEP intervention. This stemmed from not having much time to go to the clinic due to having to work long hours to pay rent, as well as having become habituated to mobile services in the case of the Johannesburg groups:. I don't pay rent.

I do business to feed myself. The other's on the streets they are staying in flats. So we are different in that, you who is staying in a hotel, you don't have time to come to clinic, you are waiting for a mobile clinic to come, you understand?

Green, JHB 1. Our findings indicate strong acceptability of PrEP among FSWs in the two communities and positive anticipation for the imminent delivery of PrEP in the local sex worker clinics. Indeed, women were so positive at the end of each session that they independently asked to create waiting lists to be informed as soon as the TAPS project was launched so they could be the first to enrol. These centred on developing clear education and messaging to accurately convey the concept of PrEP and the need to ensure continued condom use, as well as intervention integration into supportive and tailored services.

Fitting PrEP within existing knowledge of ART and PEP, while equating it with contraception as a prevention modality, was an effective and naturally developed education strategy among participants, which has also been true among researchers Discussions concerning condom use usually focused on the reliability of condoms with clients where clients could not be trusted not to remove or damage condoms, or condoms themselves could not be trusted Local sex free by texting to burstand use with main partners with whom condom use was seen as untrusting or unloving.

This translated into one of the key motivations for use of having an additional layer of protection and personal control, to safeguard against the unpredictable such as sexual violence at work or lack of condom use with main partners with an unknown HIV status. This notion of additional protection and the relevant reasons are fairly different than what has been articulated by MSM who have been more concerned with lack of accurate risk perception and stigma within their social circles 36suggesting the need to carefully consider differences in population perspectives when planning to rollout PrEP.

Local sex free by texting

Interestingly, changes in condom use over time were primarily seen in the efficacy and implementation studies with MSM, as opposed to the studies with heterosexual men and women 2 which may correlate with the different needs and desires of the populations. It should also be noted that many of the women in these FGDs declared not currently using contraception other than condoms.

Local sex free by texting

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