Concerns for Sex Workers as PrEP Risks Replacing Condoms in HIV Prevention

4 February 2016

Policy makers and HIV agencies urgently need to ensure that PrEP complements existing prevention programmes and does not undermine condom use to protect the health of sex workers, says the Institute of Development Studies.

While many including UNAIDS are heralding the new HIV prevention drug as the new first line of defense for HIV negative people, IDS highlights that sex workers and NGOs who work with them are worried that PrEP could be pushed on them and drive demand for condomless sex.

PrEP must be used with condoms to protect sex workers against unwanted pregnancies and other sexually transmitted diseases. Unlike condoms that are fairly self-explanatory and easy to buy, PrEP has to be dispensed from a qualified professional, requires regular medical follow-up and a strict routine of regular HIV testing (as it is harmful to people who are HIV positive), which the briefing argues could be unworkable for sex workers in low-income settings. Others fear the testing will become mandatory and that they will lack the rights and power needed to make informed sexual health decisions.

The new briefing by Cheryl Overs, a visiting research fellow at IDS highlights that the lack of trials and evidence about the use of PrEP with sex workers raises urgent ethical questions and underlines the need for better insights into the potential impacts.

Cheryl Overs, visiting research fellow at IDS and founder of the Global Network of Sex Work Projects, said:

“There is much optimism around the introduction of PrEP and rightly so but sex workers have been placed in a wide bracket of people at risk of HIV, with a lack of trials or evidence of how PrEP will specifically impact them in the long-term. 

PrEP should not be seen as the magic bullet. Reconfiguring sex industries to make sex workplaces and sex workers’ lives safer remains the priority everywhere”.

There are also concerns that HIV prevention funding will be concentrated on PrEP leaving little resources left for the regular health monitoring and testing required alongside it, not to mention the condom promotion, advocacy, counselling, education and social support needed.

The briefing makes several recommendations including establishing a new monitoring and evaluation toolkit to assess long term impacts of prep on sex workers, local rules and procedures to protect sex workers from coercive testing or treatment and clear messaging for sex workers, clients and sex worker employers that medications are not alternatives to condoms.

Download the briefing in full: ‘Examining the Implications of PrEP as HIV Prevention for Sex Workers’

Ends

For interview requests please note that Cheryl Overs is based in Australia. For more information, contact Sophie Robinson, IDS, on +44 (0)1273 915763, s.s.robinson@ids.ac.uk or out of hours, contact Hannah Corbett, IDS, +44 (0)7701286978, h.corbett@ids.ac.uk

Notes to Editors

  1. Anti-retroviral (ARV) medication can prevent HIV as well as treat it when taken regularly by a HIV-negative person before exposure to the virus. This is pre-exposure prophylaxis, known as PrEP. It must be prescribed after a HIV test and monitored for side effects and it does not protect against other STIs and is not contraceptive.
  2. The Institute of Development Studies (IDS) is a leading global institution for development research, teaching and learning, and impact and communications, based at the University of Sussex. Our vision is a world in which poverty does not exist, social justice prevails and economic growth is focused on improving human wellbeing. We believe that research knowledge can drive the change that must happen in order for this vision to be realised. Visit www.ids.ac.uk