Assessment of healthcare access and knowledge of HIV pre-exposure prophylaxis in women engaging in sex work: An exploratory study in Lille, Northern France

In the context of the extension of HIV pre-exposure prophylaxis (PrEP) prescription to all physicians in France, we conducted an exploratory study investigating care access and PrEP knowledge in women engaging in sex work (WSW) in Lille, Northern France. A cross-sectional quantitative study was conducted from May to September 2024 through a questionnaire administered to all WSW who attended the meetings of "Le Mouvement du Nid," a nonprofit association supporting WSW. Sociodemographic characteristics, healthcare uptake, sexual practices, PrEP knowledge, and use were assessed according to self-reported data via a structured questionnaire. Forty-five WSW were included: 42 cisgender WSW, 3 transgender WSW. The median age was 36 years. All WSW but 2 were migrants, mainly from sub-Saharan Africa (87%). Vulnerability factors were frequent, especially difficulties with access to social rights (58%) or housing (67%). WSW were often victims of violence (67%). The majority of WSW (76%) reported having a family doctor, and 42% consulting 1 within a year. Only 22% had disclosed engaging in sex work to their family doctor. Screening for sexually transmitted infections has been done by 64% of WSW in the last year, rarely with their family doctor (18%). Four (9%) WSW reported a history of postexposure prophylaxis, all were cisgender WSW. Four (9%) WSW knew about PrEP, including 1 cisgender WSW. No WSW was using PrEP. After receiving education about PrEP, 51% of WSW were interested with PrEP. Knowledge of HIV prevention tools was poor among WSW. Enhancement of sexual healthcare of WSW among family doctors may help PrEP implementation.