Digital spaces: improving HIV prevention through social media among female sex workers in Cameroon

Introduction: Approximately 24.3% of female sex workers (FSWs) in Cameroon are living with human immunodeficiency virus (HIV). Social media platforms present new opportunities to improve HIV prevention efforts. This study examines the acceptance of Secret Facebook Groups (SFG) for HIV prevention education among FSWs in Western Cameroon and identifies barriers, facilitators, and recommendations for future interventions. Materials and methods: We conducted a qualitative study using semi-structured phone interviews with 20 FSWs aged ≥18 years during June 2022. We used purposeful convenience sampling to recruit participants from a 2021 parent study. Interview questions addressed social media platforms used for learning, challenges, and benefits of SFG for HIV prevention education, and recommendations for future interventions. We conducted thematic analysis using NVivo software with independent dual coding. Results: Five major themes emerged: (1) Facebook and WhatsApp were the most-used platforms; (2) FSWs acquired HIV prevention knowledge, including strategies and prevention tools; (3) challenges of using SFG to learn about HIV prevention included poor connectivity and infrastructure, limited data, educational level limitations, and financial support; (4) benefits included HIV prevention information, peer learning, privacy, and support; and (5) recommendations included WhatsApp as an alternative platform, improved communication, and technical support. Notably, participants consistently requested financial support, suggesting sustainability challenges for social media-based interventions in resource-limited settings. Conclusions: FSWs in this sample accepted SFG-based HIV prevention education because the intervention used a familiar platform, accommodated varying literacy levels, and provided privacy. However, better connectivity, higher education levels, and financing are needed to improve the intervention. Findings describe a digitally connected subgroup and cannot be generalized to other marginalized FSWs in Cameroon without reliable technology access. Future research should explore participatory approaches, evaluate effectiveness, and examine sustainability without external financial support.