"The Drug Will Help Protect My Tomorrow": Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi

AIDS Educ Prev. 2019 Oct;31(5):421-432. doi: 10.1521/aeap.2019.31.5.421.


Female sex workers (FSW) are disproportionately at risk for HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet approaches for incorporating PrEP within prevention strategies used by FSW are lacking. Semistructured focus group discussions were conducted with 44 HIV-negative FSW in Lilongwe, Malawi to explore perceptions of PrEP: acceptability, integration within HIV prevention behaviors, and barriers to use. Acceptability of PrEP was high. Motivation to use PrEP was rooted in love for one's life, anticipated negative economic effects associated with HIV acquisition. PrEP was viewed as complementary to existing norms for engaging in healthy sexual behaviors. Many felt PrEP may provide extra protection from HIV, along with condoms and frequent STI testing. Unpredictable daily lives, stigma, and side effects were barriers that could affect PrEP use. Leveraging existing HIV prevention strategies and social norms surrounding HIV prevention behaviors may positively impact PrEP uptake among FSW in Malawi and sub-Saharan Africa.

Keywords: HIV/AIDS; female sex workers; pre-exposure prophylaxis; prevention; sub-Saharan Africa.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Condoms / statistics & numerical data*
  • Female
  • Focus Groups
  • HIV Infections / prevention & control*
  • Humans
  • Malawi
  • Male
  • Motivation*
  • Perception
  • Pre-Exposure Prophylaxis*
  • Qualitative Research
  • Risk Reduction Behavior*
  • Safe Sex
  • Sex Workers / psychology*
  • Sexual Behavior
  • Social Stigma
  • Young Adult


  • Anti-HIV Agents