FRAC0202 | Trends in High-risk Sexual Behavior among Young Women Engaged in Transactional Sex and initiated on HIV PrEP in Mukono, Uganda

Ezra Musingye¹, Grace Mirembe¹, Betty Mwesigwa¹, Anne Nakirijja¹, Fred Magala¹, Hannah Kibuuka¹, Eniko Akom^2|3 | ¹Makerere University Walter Reed Program, Uganda; ²U.S. Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, USA; ³Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA

Adolescent girls and young women (AGYW) engaged in transactional sex are at elevated risk of HIV and other sexually transmitted infections (STIs). HIV oral pre-exposure prophylaxis (PrEP), along with sexual behavior change counseling, is an essential prevention strategy for individuals at risk of HIV acquisition. We report the trends in sexual behavior change from baseline through the three- and six-month follow-up visits among AGYW engaged in transactional sex, aged 18-24 years, and enrolled in a PrEP demonstration study that included counseling interventions. The study was conducted in Mukono District, Uganda, from December 2017 to July 2019 to assess the feasibility of implementing oral PrEP among HIV-negative AGYW aged 18–24 who engaged in transactional sex. Eligible participants provided informed consent; received counseling on STI risk reduction at each visit, including condom use, reducing substance abuse and risky sexual behavior; and were followed up for 12 months with a structured sexual behavioral questionnaire administered at each quarterly visit. Changes in sexual behavior from baseline through the three- to six-month visits were analyzed using the Chi-squared test for trend. Data from 838 eligible enrolled participants were analyzed. The three and six-month retention rates were 63% and 47%, respectively. Changes in sexual behavior were observed over time: consistent condom use with all sexual clients increased from 56.9% at baseline to 60.1% at three months to 67.5% at six months (p=0.001); sex without a condom after alcohol or drug use decreased from 37.3% to 35.6% to 29.7% (p=0.009); sex with > 10 clients in the past three months decreased from 87.4% to 86.3% to 83.5% (p=0.085); sex with non-client casual partners decreased from 24.8% to 14.9% to 14.1% (p<0.001); sex with partners/clients >10 years older decreased from 80.5% to 76.8% to 75.4% (p=0.033); and sex with partners/clients living with HIV decreased from 13.5% to 9.4% at both the 3- and 6-month visits (p=0.038). Counseling on sexual behavior has a significant temporal effect in moderately reducing certain high-risk-taking behavior among AGYW engaged in transactional sex. Targeted counseling sessions emphasizing behavioral change should be integral to HIV/STI prevention strategies involving PrEP and other interventions.