Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Sia Emmanuel Msuya, Kilimanjaro Christian Medical University College, Tanzania
- Second opponent: Associate Professor Anna Kågesten, Karolinska Institutet, Sweden
- Third member and chair of the evaluation committee: Professor Jan Frich, University of Oslo
Chair of the Defence
Professor Nanna Lien, University of Oslo
Principal Supervisor
Associate Professor Elia John Mmbaga, University of Oslo
Summary
Sex-workers in low-and middle income countries, including in Tanzania, are at increased risk of HIV. Pre-exposure prophylaxis (PrEP) taken as a daily oral drug is efficacious in preventing HIV. However, studies have shown suboptimal engagement with services providing PrEP.
This thesis aimed to provide some of the first evidence on PrEP usage among female sex workers in Tanzania, including perceptions and experiences with PrEP and estimate disengagement with services and potential influencing factors, including harmful alcohol use.
A total of 470 HIV negative female sex workers (≥18 years) living in Dar es Salaam were recruited through respondent-driven sampling. They were surveyed at baseline when initiating PrEP and their attendance was registered at first clinical follow-up (month 1). Qualitative interviews were also conducted with 40 female sex workers who were former or current PrEP users or who intended to start PrEP.
Almost three quarters (74.6%) of the women did not attend the first follow-up appointment, and this was independently associated with mental distress. Older age and having more clients were protective factors for disengagement with PrEP services. Harmful alcohol use was prevalent (37.3%) and independently associated with experiences of arrest, gender-based violence and mobility. Harmful alcohol use was not associated with disengagement.
PrEP had multiple and diverse effects, referred to as the “effectosphere” of PrEP. Despite high disengagement, PrEP could lead to empowerment and human flourishing by enabling a sense of freedom and confidence which could promote health, economic opportunities and social relations. However, PrEP could also expose sensitive information leading to stigma, arguments, create fear of harms and medicalize aspects of life.
The findings indicate that PrEP is relevant for female sex workers, but PrEP needs to be integrated into holistic HIV prevention strategies that takes into account their complex social circumstances.
Additional information
Contact the research support staff.