ArticleBMJ global health2026
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.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionFemale 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).
methodsWe 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.
resultsMedian 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.
conclusionsFSW 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.
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