Peer Education and the Uptake of Pre-Exposure Prophylaxis among Female Sex Workers in South Africa

The distribution of oral pre-exposure prophylaxis (PrEP) in South Africa was instituted in 2016. Female sex workers (FSWs) were targeted as a priority group to curb the rise in new HIV infections. Certain organizations working with FSWs were tasked to distribute PrEP. Some used a peer-education approach to initiate FSWs on PrEP. This study aimed to understand the role of peer support in encouraging the uptake of PrEP among FSWs. Key informant interviews were conducted with thirteen (13) participants, eleven (11) peer educators, and two (2) healthcare workers from a research and sex work organization. Consent was obtained from all participants. Data were thematically analyzed. During the outreach, peer educators gave information on PrEP to FSWs; however, most felt that more efforts are needed to create greater awareness and knowledge dissemination of PrEP. FSWs willing to test for HIV were tested on-site in a mobile facility. Once PrEP was initiated, support was provided through telephone calls, and reminders for treatment top-ups were sent via text messages. Medication was delivered to those who missed their site visit. Each peer provided FSWs with practical suggestions for managing side effects. FSWs traveling periodically were given an extra supply of PrEP or linked to another distribution site. Some FSWs suggested the need for long-acting PrEP to foster retention. Reaching FSWs with PrEP through peers has ensured ongoing use of PrEP, which is further sustained through follow-ups and efficient side-effect management. Keywords: Oral Pre-Exposure Prophylaxis, Peer Educators, Female Sex Workers