PrEP Use Willingness and Perceptions Among Young Female Sex Workers in Kisumu, Kenya: Implications for HIV Prevention

Abstract Female sex workers (FSW) are disproportionately burdened with HIV. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission, yet determinants of willingness to use PrEP among young FSW is less understood. We assessed factors associated with willingness to use PrEP, using data from a cross-sectional study on PrEP adherence strategies, among HIV-negative FSW aged 18–24 years living in Kisumu City, Kenya. We characterized differences in demographics and sexual history by awareness of PrEP using Pearson’s chi-square test. Among FSW aware of PrEP, we further assessed factors associated with willingness to use PrEP. We enrolled 200 FSW, of whom 83% reported being aware of PrEP. Among those aware of PrEP, 16% had previously taken PrEP. On average, for each additional day or night spent away from the neighborhood in the past month, FSW had 12% decreased odds (AOR = 0.88, 95%CI: 0.77, 0.99) of willingness to use PrEP. While most FSW in Kisumu City were aware of PrEP and perceived it positively, uptake was hindered by stigma, discomfort with health services, and lifestyle factors like mobility. To close the gap between awareness and actual use of PrEP, there is need for flexible and mobile PrEP delivery models tailored to the unique lifestyles of FSW, such as community-based outreach, peer delivery, or digital health interventions that support care continuity despite mobility.