Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda

Lydia Jacenta Nakiganda; Benjamin R. Bavinton; Isobel Mary Poynten; David Serwadda; Jeremiah Mulamba Bazaale; Andrew E. Grulich

doi:10.1071/SH23056

RESEARCH ARTICLE (Open Access)

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Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda

Lydia Jacenta Nakiganda

^A ^* , Benjamin R. Bavinton

^A , Isobel Mary Poynten ^A , David Serwadda ^B ^C , Jeremiah Mulamba Bazaale ^B and Andrew E. Grulich ^A

+ Author Affiliations

- Author Affiliations

^A Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia.

^B Rakai Health Sciences Program, Kalisizo, Uganda.

^C Makerere University School of Public Health, Kampala, Uganda.

^* Correspondence to: lnakiganda@kirby.unsw.edu.au

Handling Editor: Nittaya Phanuphak

Sexual Health 21, SH23056 https://doi.org/10.1071/SH23056

Submitted: 20 March 2023 Accepted: 7 January 2024 Published: 25 January 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda.

Methods

In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP.

Results

Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR = 1.19, 95% CI = 1.07–1.32, P = 0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR = 1.17, 95% CI = 1.05–1.31, P = 0.032, P = 0.003) and being On PrEP for the past 1–2 years (aPR = 1.18, 95% CI = 1.00–1.38, P = 0.032) was significantly associated with HIV-related worry (aPR = 1.17, 95% CI = 1.05–1.31, P = 0.032, P = 0.003)

Conclusions

We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions.

Keywords: attitudes, female sex workers, HIV/AIDS, HIV-related worry, PrEP, sexual health, sexual pleasure, sexual satisfaction, Uganda.

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