dc.date.accessioned | 2024-07-12T12:52:47Z | |
dc.date.available | 2024-07-12T12:52:47Z | |
dc.date.issued | 2024 | |
dc.identifier.isbn | 978-82-348-0456-4 | |
dc.identifier.uri | http://hdl.handle.net/10852/111477 | |
dc.description.abstract | Sex-workers in low-and middle income countries, including in Tanzania, are at increased risk of HIV. Pre-exposure prophylaxis (PrEP) taken as a daily oral drug is efficacious in preventing HIV. However, studies have shown suboptimal engagement with services providing PrEP.
This thesis aimed to provide some of the first evidence on PrEP usage among female sex workers in Tanzania, including perceptions and experiences with PrEP and estimate disengagement with services and potential influencing factors, including harmful alcohol use.
A total of 470 HIV negative female sex workers (≥18 years) living in Dar es Salaam were recruited through respondent-driven sampling. They were surveyed at baseline when initiating PrEP and their attendance was registered at first clinical follow-up (month 1). Qualitative interviews were also conducted with 40 female sex workers who were former or current PrEP users or who intended to start PrEP.
Almost three quarters (74.6%) of the women did not attend the first follow-up appointment, and this was independently associated with mental distress. Older age and having more clients were protective factors for disengagement with PrEP services. Harmful alcohol use was prevalent (37.3%) and independently associated with experiences of arrest, gender-based violence and mobility. Harmful alcohol use was not associated with disengagement.
PrEP had multiple and diverse effects, referred to as the “effectosphere” of PrEP. Despite high disengagement, PrEP could lead to empowerment and human flourishing by enabling a sense of freedom and confidence which could promote health, economic opportunities and social relations. However, PrEP could also expose sensitive information leading to stigma, arguments, create fear of harms and medicalize aspects of life.
The findings indicate that PrEP is relevant for female sex workers, but PrEP needs to be integrated into holistic HIV prevention strategies that takes into account their complex social circumstances. | en_US |
dc.language.iso | en | en_US |
dc.relation.haspart | Paper I. Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. Lichtwarck HO, Kazaura MR, Moen K, Mmbaga EJ. International Journal of Environmental Research and Public Health. 2022 Dec 30;20(1):698. DOI: 10.3390/ijerph20010698. The article is included in the thesis. Also available at: https://doi.org/10.3390/ijerph20010698 | |
dc.relation.haspart | Paper II. Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach. Lichtwarck HO, Mbotwa CH, Kazaura MR, Moen K, Mmbaga EJ. BMJ Global Health. 2023 Dec 28;8(12):e013662. DOI: 10.1136/bmjgh-2023-013662. The article is included in the thesis. Also available at: https://doi.org/10.1136/bmjgh-2023-013662 | |
dc.relation.haspart | Paper III. What can PrEP do for female sex workers? Unpacking the “effectosphere” of biomedical HIV prevention in Dar es Salaam. Lichtwarck HO, Massawe PM, Mmbaga EJ, Moen K. Submit to Social Science & Medicine Feb 2024. To be published. The paper is not available in DUO awaiting publishing. | |
dc.relation.uri | https://doi.org/10.3390/ijerph20010698 | |
dc.relation.uri | https://doi.org/10.1136/bmjgh-2023-013662 | |
dc.title | Pre-Exposure Prophylaxis Use among Female Sex Workers in Dar es Salaam, Tanzania: a Mixed-Methods Study | en_US |
dc.type | Doctoral thesis | en_US |
dc.creator.author | Lichtwarck, Hanne Ochieng | |
dc.type.document | Doktoravhandling | en_US |