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Page 4 of 6 Original Research

TABLE 3: Likelihood of pre-exposure prophylaxis use and perceived barriers TABLE 5: Spearman correlation coefficients for the relationship between relative
(N = 131). importance index scores of knowledge, likelihood and barriers associated with
Variable Frequency pre-exposure prophylaxis use.
n % Variables Knowledge Likelihood Barriers
Likelihood of PrEP use if provided for free Knowledge RII 1.0000 - -
Likelihood RII 0.2115 1.0000 -
Sometimes 29 22
(p = 0.0153)
Always 102 78 Barriers RII -0.0530 -0.2329 1.0000
Likelihood of PrEP use if it caused mild side-effects (p = 0.5476) (p = 0.0074)
Sometimes 50 38 RII, relative importance index.
Always 81 62
Condom use if FSWs were to start taking PrEP Discussion
Never 6 5
Sometimes 24 18 In a real-world setting, the effectiveness of PrEP will depend
Always 101 77 on its acceptability, adoption and sustained use by high-risk
Likelihood of PrEP use if it had to be paid for populations. Pre-exposure prophylaxis medication will have
Never 3 2 little impact in reducing HIV infections if these components
Sometimes 41 32 are not addressed. Findings from this study indicate that
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Always 87 66 FSWs continue to engage in risky sexual behaviours. In the
Barriers associated with PrEP uptake amongst FSWs (N = 131) last 3 months, 53 (40%) of the participants reported having
Stigma unprotected sexual intercourse with a casual partner.
Strongly disagree 128 98
Strongly agree 3 2 In our study, 54% of FSWs had heard of PrEP before
Costs
Strongly disagree 70 53 participating. In spite of having little knowledge of PrEP,
Neutral 1 1 the majority of FSWs were willing to use PrEP (median
Strongly agree 60 46 RII = 0.89; range 0.48–1) to reduce their risk of contracting
Side-effects associated with PrEP pill HIV infection. In a similar study conducted in China, only
Strongly disagree 117 89 16.5% had heard of PrEP before participation, and only 1.4%
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Neutral 2 2 had used PrEP before. Nevertheless, 69% and 95% of the
Strongly agree 12 9 respective FSW populations of China and India reported a
Poor knowledge willingness to use PrEP. 12,13 These estimates were consistent
Strongly disagree 110 84 with our findings that 89% of the participants were
Neutral 1 1 willing to use PrEP. Educating HIV-uninfected FSWs about
Strongly agree 20 15
PrEP is likely to support the uptake of PrEP and assist in
FSW, female sex worker; PrEP, pre-exposure prophylaxis. decreasing the incidence of HIV in Zimbabwe. Pre-exposure
prophylaxis programmes have been incorporated into
TABLE 4: Relationship between predictor variables and dependent variable. sexually transmitted disease clinics, reproductive health
Predictor variable Regression p Dependant
parameter variable programmes and genitourinary medicine clinics in high-
Dependents -0.0636 0.020 Knowledge income countries. 14,15,16,17
Age 0.0033 0.038 Likelihood
Unprotected sex in the last 3 months 0.0448 0.026 Likelihood Findings from this study indicated that there was a significant
association between the likelihood of PrEP use, age and
Considering the likelihood of PrEP use amongst the unprotected sexual intercourse in the preceding 3 months.
participants, there was no association noted between the Older participants were more likely to adopt PrEP as an HIV
likelihood RII score and the number of dependents, marital prevention strategy. This suggests that those who perceive
status, education, change in place of residence, income and themselves to be at a higher risk of HIV infection are more
years of practice as a sex worker (p > 0.05). Spearman’s rank likely to adopt PrEP as an HIV intervention. Elmes et al.
correlation coefficient was computed to identify and test the evaluated condom use by FSWs in Eastern Zimbabwe and
strength of the relationship between knowledge and barriers reported that older participants were less likely to request
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with the likelihood of PrEP use. Table 5 shows the Spearman condom use from partners. Older FSWs may therefore be at
correlation coefficients for the relationship between RII scores a higher risk of acquiring HIV and should be prioritised for
PrEP access.
of KLBs associated with PrEP use.
In spite of the high levels of interest in PrEP, potential barriers
Considering likelihood and knowledge RII scores, there were cited including cost, side-effects and poor knowledge of
was a positive correlation whereby more knowledge about PrEP use. Whilst PrEP had to be bought, 46% of the
PrEP moderately increased the likelihood of PrEP use (r = participants strongly agreed that lack of money would pose a
0.21, p = 0.0153). There was a negative correlation between challenge to PrEP uptake. Many participants felt that PrEP
barriers and the likelihood RII score, that is, as barriers ought to be provided free in view of the severity of the HIV
associated with PrEP use decreased, the likelihood of PrEP epidemic in Zimbabwe. The high cost of PrEP is undoubtedly
use moderately increased (r = 0.23, p = 0.0074).

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