Socioeconomic Inequality in Hiv Prevention Amongst Female Sex Workers: an Analysis of Pre-exposure Prophylaxis Use

Abstract

Introduction: Globally, HIV and AIDS still remains a major health and economic burden with disproportionate burden in SSA. The global trend of the disease is on a decline, however, SSA has witnessed slower decline in her indicators. The Key population are reported as major drivers of the epidemic, accounting for 47% of the new infection globally, with a prevalence rate of 30% in Kenya. Socioeconomic inequalities amongst FSWs do exist in regards to access and coverage of health, trade at the sex market and negotiation of safe sex compounded by the illegality of the trade despite roll out of PrEP, a biomedical intervention drug, with reported 92% effectiveness. It is of private benefit and confers public health externality to the sex network and the general population. Objectives: There exist paucity of studies on determinants of demand for PrEP, socioeconomic inequalities in PrEP use and economic studies of FSWs in Kenya, a gap my study hopes to bridge. This study sought to understand the socioeconomic determinants of PrEP use; decipher the role of socioeconomic inequalities in PrEP use among the FSW and further utilize the results to inform policy change. Methodology: Using a structured questionnaire 479 HIV negative FSWs in Kisii County were sampled to a point of saturation. Data was entered and analyzed using STATA version 14. Probit regression model was conducted to determine associations between the variables and concentration index was employed to determine the socioeconomic inequality. This study contributed to the existing literature on PrEP uptake, helped in designing FSW-specific interventions and strategies to distribute PrEP as well as to inform policy debates related to universal coverage and utilization of health services, a consideration in assessing the global performance of health systems. Results: Of the 479 FSWs, 62% reported ever using PrEP. PrEP uptake was highest amongst these groups of FSWs; aged over 24 years, formerly and currently married, Catholics, have less than 2 children, unemployed, above secondary education, town residence, smaller households of less than 5 and belonged to the richer wealth quantile. The number of children, index scores of risk, service provision and wealth were found to be statistically significant. Concentration index showed that PrEP uptake was concentrated among the FSWs from a wealthy class. Conclusion: Based on the findings, we observed that peer led approaches has demonstrated favorable outcomes in advocating for PrEP use amongst the FSWs and a structured roll out and implementation of the same would boost uptake. Policies and strategies aimed at enhancing PrEP uptake among the FSW may assist reduce the gap between the highest and lowest SES groups in Kisii.