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a major barrier to its uptake worldwide, particularly in The Zimbabwean MoHCC has considered addressing the
high-income countries where only branded TDF/FTC is knowledge gap about PrEP in the general population through
available. In low-income countries that have established different channels whilst at the same time raising awareness
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PrEP programmes, cost is not identified as a barrier to access to increase risk perception, especially amongst adolescent
because the medicines are free. In the Kenyan setting, FSWs girls and young women. These considerations have been
were more concerned about the stigma of being tested for made as part of an implementation plan for PrEP in
HIV and the barrier posed by the test with regard to the Zimbabwe between 2018 and 2020 (inclusive). Our study
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success of the intervention. In our study, stigma was not provides guidance on the progress made on addressing the
identified as a possible barrier to taking PrEP. This contrasted knowledge gap about PrEP.
with the Kenyan setting and is a distinct finding for the
Zimbabwean FSWs. With a reduced fear of stigmatisation, Conclusion
there is scope for improved acceptability of PrEP in FSWs.
We set out to evaluate the knowledge levels of PrEP and the
Our results indicate that participants were generally willing likelihood of its use amongst FSWs. Whilst the knowledge
to accept PrEP and adopt it as soon as it was made available. level was low, the majority of FSWs would be willing to
Information emerging from trial projects and open-label use PrEP for the purpose of HIV/AIDS prevention.
extensions where PrEP has been offered free of charge by Non-governmental organisations are playing a major role
knowledgeable providers suggests that uptake may be high in sensitising FSWs about PrEP. The local clinics need
in settings where cost and provider-related barriers had been to increase their visibility as information dissemination
removed. 15,16,21 institutions for PrEP. The clinics are strategically positioned
to enlighten key populations about PrEP and to prescribe
Our results showed that participants were willing to take medication to those who might need it. Successful
PrEP even when reminded of potential side-effects. dissemination of information can be achieved if PrEP
Participants cited that the side-effects of PrEP could have an programmes are incorporated into other programmes
impact on one’s quality of life but that would not hinder within the clinics.
taking PrEP. Only 9% of the FSWs strongly expressed that
side-effects would affect their lifestyle and possibly prevent Acknowledgements
PrEP use. Sex workers in Mombasa, Kenya, voiced concerns The authors thank all the team members, field officers and
about the potential negative side-effects of PrEP. In this FSWs who participated in the study.
qualitative study, a minority of participants were deterred
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from using PrEP because of the side-effects. Women from
six US cities where female HIV infection is highly prevalent Competing interests
viewed PrEP as an important prevention option, provided The authors have declared that no competing interests exist.
that side-effects and cost to the consumer were minimal. 23
Authors’ contributions
The feasibility of oral PrEP implementation in Zimbabwe
has been proven in ongoing and completed demonstration T.M., A.D., C.C.M. and B.C. provided leadership for the
projects and clinical trials. By the end of 2017, a total of project. T.M., A.D. and B.C. were responsible for
3073 clients were initiated on PrEP in Zimbabwe. Ninety conceptualisation of the study. A.D., B.N. and B.C. were
per cent of the clients initiated on PrEP were women, with responsible for data collection. T.M., C.C.M., B.N., T.G.M.-P.
the majority of them in the 25–49 years age group. The and A.D. were responsible for data analysis. G.D.M.,
majority (52%) of the clients initiated on PrEP were FSWs. T.G.M.-P. and C.C.M. provided technical expertise. T.M. and
The accessibility of PrEP outside of demonstration projects B.C. provided clinical expertise for the project. All authors
has been limited. 9 contributed to the writing of the manuscript and approved
the final version for publication.
Whilst the sample size recruited for participation in this
study was small, the information generated provides a Funding information
foundation in the development of further programming for This research was made possible through core services and
PrEP implementation in FSWs. The information was also support from the University of Rochester Center for AIDS
generated from peri-urban, high-density areas in Harare (the Research, a programme (P30 AI078498) funded by the
capital city of Zimbabwe). Perceptions and knowledge levels National Institutes of Health (NIH). The content is solely the
might differ across other diverse geographical locations in responsibility of the authors and does not necessarily
Zimbabwe, and more studies need to be conducted. Because represent the official views of the NIH.
of the legal status of sex work in Zimbabwe, we used a
snowball sampling technique in order to reach FSWs who
might otherwise have been unwilling to participate in the Data availability statement
study for fear of litigation. This sampling technique has the Data sets are available from the corresponding author upon
potential to introduce selection bias. request.

http://www.sajhivmed.org.za 129 Open Access