Behavioral Risk Compensation Ensuing HIV Oral Pre-Exposure Prophylaxis Use Among Female Sex Workers In Nairobi, Kenya

Abstract

Background Oral Human Immunodeficiency Virus (HIV) Pre Exposure Prophylaxis (PrEP) is a chemoprophylaxis involving use of antiretroviral medicines taken orally to prevent HIV. Oral PrEP can reduce the risk of HIV infection by more than 95%. In 2010, World Health Organization (WHO) recommends PrEP use among persons at substantial risk of HIV and since, over 300,000 people have used PrEP. However, risk compensation among Female Sex Workers (FSWs) using PrEP, raises concerns on increased risk of sexually transmitted Infections (STIs). Materials and Methods A retrospective cohort study was conducted among FSWs comprising of both HIV oral PrEP users and non-PrEP users accessing services at selected Drop-in Centers (DICEs) in Nairobi County. Multi stage sampling was used to select sites and participants. Sample size of 168 PrEP users and 168 nonPrEP users was used. A structured data abstraction tool was used to collect the desired data on condom use and average sexual acts. This data was abstracted from the participant records as documented during monthly routine data collection. Data was analyzed using STATA.This study investigated the effects of HIV oral PrEP on risky sexual behaviors among female sex workers in Nairobi. Specifically, the study determined the rate of condom use, and compared the number of sexual acts Female Sex Workers have per day, between FSWs taking HIV oral PrEP and non-PrEP user FSW in Nairobi. Results PrEP did not determine condom use among PrEP users (P=0.221, 95%CI). Average number of sexual acts per day was higher among HIV oral PrEP users than non-PrEP users (P=0.005, 95%CI). PrEP use did not significantly decrease the rate of condom use, while the average number of sexual acts per day significantly increased over time among HIV oral PrEP users. Conclusion This study has ascertained that HIV oral PrEP use does not increase condom use but may result into increased average number of sexual acts per day among female sex workers. Prevention counseling should be emphasized during PrEP initiation and throughout PrEP follow up visits