Barriers and Enabling Factors for Taking PrEP: The Lived Perspectives of Female, Male and Transgender Sex Workers in Thailand

Despite Thailand's goal of ending AIDS by 2030, pre-exposure prophylaxis (PrEP) uptake remains very low among sex workers (SWs) as they are effectively excluded from programming. This qualitative study explores PrEP pereceptions, decision-making and long-acting injectable (LAI)-PrEP potential among 113 female, male and transgender SWs across seven high-burden provinces. Utilizing 13 focus group discussions and thematic analysis guided by the Health Belief Model, findings revealed uneven and limited PrEP awareness, with many female SWs encountering PrEP for the first time. Key barriers identified by SWs included HIV-related stigma, lack of appropriate information and issues regarding eligibility. Among transgender women sex workers, there are concerns about hormone therapy interactions. Conversely, high perceived risk and family responsibilies motivated interest in taking PrEP. Participants strongly preferred LAI-PrEP for its discretion and compatibility with irregular sex work schedules. Enhancing equitable access requires decentralized, community-led delivery that addresses structural vulnerabilities including criminalization, stigma and discrimination. While LAI-PrEP addresses adherence challenges, its success depends on intensified awareness and targeted information provision, affordability and integration with existing community-led or key population-led health services to ensure culturally appropriate, stigma-free and sustainable HIV prevention for sex workers.