Values and preferences of female sex workers in Zimbabwe for long-acting injectable pre-exposure prophylaxis and the dapivirine vaginal ring

Results of a mixed-methods research study

Bibliographic Data

ID21881665
AuthorsFortunate Machingura (0000-0003-4623-8180, Liverpool School of Tropical Medicine), Marc d'Elbée (Université de Bordeaux), Tatenda Kujeke (Centre for Sexual Health and HIV AIDS Research), Jasper Maguma (Centre for Sexual Health and HIV AIDS Research), Michelle Rodolph (World Health Organization), Rachel Baggaley (0000-0001-6320-3444, World Health Organization), Sungai T Chabata (0000-0001-7629-1543, Liverpool School of Tropical Medicine), Frances M Cowan (0000-0003-3087-4422, Liverpool School of Tropical Medicine)
Year2026
Volume11
Issue3
Pagese021333
Publication date2026-03-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2025-021333
PMID41771664
OpenAlexW7133298218
LanguageEN
References cited31

INTRODUCTION: Female sex workers (FSWs) in sub-Saharan Africa are at high risk of HIV acquisition. Here we explore the values and preferences of Zimbabwean FSW for long-acting pre-exposure prophylaxis (PrEP). METHODS: We employed mixed methods; focus group discussions (FGD) (n=15), a respondent-driven sampling (RDS) survey (n=4444) from 22 sites across Zimbabwe and a nested discrete choice experiment (DCE) (n=435) conducted in 4/22 sites in 2021. Purposively selected FSWs aged 18 or over who reported being HIV negative were eligible for inclusion in FGDs. Analysis of self-reported HIV negative survey participants was RDS-II weighted. DCE analysis estimated relative preferences. Qualitative and quantitative data were triangulated. RESULTS: Median age of survey participants was 28 years with IQR of 23-34 years. There was strong concordance across methods by product, provider, service and individual characteristics. Most FSWs indicated that they preferred long-acting injectable (LAI) PrEP to either oral PrEP or dapivirine vaginal ring (DVR). Most were interested in using LAI PrEP (74.1%; n=1835/2392), a few the DVR (10.9%, n=230/2392), and 2.4% (59/2392) and 13.5% (268/2392) either or neither of the two options, respectively. There was little trust in public sector healthcare providers, with most FSWs opting to access PrEP through programmes designed for sex workers (and stating they would miss a prescription refill/repeat injection if the public sector was the only available option). Injectable PrEP addressed privacy and adherence concerns to some extent, although FSWs felt that 6-monthly would be preferable to less frequent injections. Issues of privacy (related to PrEP and being a FSW), confidentiality and respect emerged as key qualitative themes. CONCLUSIONS: FSW had a strong preference for LAI PrEP, but ensuring product choice and user privacy was key. FSW in Eastern and Southern Africa should therefore be prioritised for PrEP choices, with ongoing monitoring and evaluation of services to make sure they are acceptable, effective and evolve as products and delivery options become available

Female sex · Health services · Preference · Sex work · Sex workers · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Sex work and related issues

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