FRAC0201 | Barriers to PEP and PrEP Uptake Among Female Sex Workers in Isiolo County, Kenya: Addressing Gaps in HIV Prevention

Nancy Gakuru, Magdaline Lipesa, Peninah Mwangi, Pauline Njuguna | Bar Hostess Empowerment Support Program, Nairobi, Kenya

Female Sex Workers (FSWs) in Isiolo County, Kenya, face intersecting structural and social vulnerabilities that heighten their risk of HIV acquisition. Despite the availability of preventive tools such as Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP), uptake remains low due to stigma, limited access to health services, and legal challenges. This study, led by the Bar Hostess Empowerment and Support Program (BHESP), sought to assess HIV prevention behaviors and access to PEP and PrEP among FSWs, using a peer-led approach to build trust and deepen understanding. A cross-sectional mixed-methods study was conducted May-August 2024, targeting 150 FSWs aged 18–45 years from key hotspots in Isiolo County. Quantitative surveys assessed awareness and utilization of HIV prevention services. Qualitative data were collected through six peer-led focus group discussions (FGDs) and ten key informant interviews (KIIs) with health providers and outreach workers. Thematic analysis was performed using NVivo software. Ethical approval was obtained from a recognized national review board, and informed consent was secured from all participants. Results showed 78% of respondents had heard of PrEP, but only 40% had accurate knowledge of its preventive function. PEP awareness was slightly higher (85%), though only 25% knew the correct initiation window. Uptake was low, with 30% reporting ever using PrEP and only 18% accessing PEP after high-risk exposure. Major obstacles identified included fear of stigma at health facilities (62%), lack of FSW-friendly service points (53%), and concerns about confidentiality (47%). Legal harassment, police crackdowns, and social discrimination further discouraged access to HIV prevention tools, while peer outreach was identified as the most trusted and effective channel for information and service linkage. While awareness of HIV prevention tools among FSWs in Isiolo is moderate, actual uptake remains low due to systemic stigma, inadequate access to tailored services, and legal threats. The peerled model proved particularly effective in trust-building and information dissemination. Expanding such approaches, integrating FSW-sensitive services in public health systems, and advancing the decriminalization of sex work could significantly enhance HIV prevention outcomes. These findings underscore the urgent need to address structural and legal barriers in high-risk populations. adolescent girls and young women.