HIV postexposure prophylaxis in an urban population of female sex workers in Nairobi, Kenya

Preston Izulla, Lyle R. McKinnon, Julius Munyao, Sarah Karanja, Winnie Koima, Joshua Parmeres, Solomon Kamuti, Rosalia Kioko, Nico Nagelkerke, Gloria Gakii, Charles Wachihi, Nicholas Muraguri, Helgar Musyoki, Lawrence Gelmon, Rupert Kaul, Joshua Kimani

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)


OBJECTIVES: To assess biological and behavioral factors in HIV-uninfected female sex workers (FSWs) accessing postexposure prophylaxis (PEP) and to characterize the circumstances preceding PEP, time to access, and adherence. METHODS: Participants were HIV-uninfected FSWs enrolled in an HIV care and prevention program in Nairobi, Kenya. Those accessing PEP between 2009 and 2010 were enrolled and compared with controls. Multiple logistic regression models were used to compare PEP-related biological and behavioral parameters. RESULTS: PEP users (n = 326) had been involved in sex work for a shorter duration than nonusers [n = 2570; 3.3 vs. 5.1 yrs, AOR: 0.92, 95% confidence interval (CI): 0.89 to 0.95] and were less likely to report a regular partner (54.9% vs. 72.5%, AOR: 0.52, 0.39 to 0.68). PEP use was associated with gonorrhea infection (6.9% vs. 2.6%, AOR: 2.37, 95% CI: 1.34 to 4.21) and alcohol use (84.3% vs. 76.1%, AOR: 1.58, 95% CI: 1.09 to 2.31), but with increased condom use (85.1% vs. 68.2%, AOR 1.80, 95% CI: 1.38-2.35) and a history of prior HIV testing (89.2 vs. 76.2%, AOR: 2.22, 95% CI: 1.45 to 3.40). Reasons for PEP access centered on issues of client mistrust. The median time from exposure to PEP was 18 hours, with an estimated adherence of 49%. Precise PEP efficacy could not be calculated, but HIV incidence was 0.6% in users (2/326) compared with 2.1% (30/1417) in nonusers (Cox regression P = 0.35). CONCLUSIONS: "PEP services were accessed by 10% of FSWs during the study period and were not implicated in any incident HIV cases." Users had indicators of increased sexual risk and higher health care literacy. Increasing PEP access and compliance in FSWs may be an important HIV prevention strategy.

Original languageEnglish
Pages (from-to)220-225
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
Publication statusPublished - Feb 1 2013


  • Africa
  • HIV
  • access
  • adherence
  • female sex workers
  • postexposure prophylaxis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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