Proyecto PrEParado

PrEP Preparedness Study among Female Sex Workers in the Mexico-US Border Region

PI: Heather Pines
Funding Source: University of California, San Diego Center for AIDS Research (CFAR)

Female sex workers (FSWs) are at substantial risk of HIV infection in low- and middle-income countries (LMIC), including those in the Mexico-United States (US) border region. FSWs’ vulnerability to HIV infection is attributed to a number of biological and behavioral factors; however, structural factors (i.e., gender inequality, violence, poverty, migration, social marginalization, and sex work criminalization) often heighten their risk by limiting their ability to negotiate condom use with clients. As such, female-controlled antiretroviral (ARV) pre-exposure prophylaxis (PrEP), which can be taken orally or applied vaginally to prevent HIV infection, shows great promise for reducing HIV incidence among FSWs. However, inconsistent findings with respect to the efficacy of PrEP among women underscore the importance of adherence for PrEP’s real-world effectiveness and need for enhanced PrEP product acceptability data from potential user populations to inform development and population-specific implementation strategies. High rates of intravaginal cleansing practices among FSWs worldwide suggest vaginal PrEP formulated as a douche may be acceptable to this vulnerable population. Yet, data on the acceptability of and preferences between PrEP product formulations (i.e., pill, douche, gel, or ring) among FSWs are limited.

The overall goal of Proyecto PrEParado (Project PrEPared) is to advance the development and implementation of a PrEP product that is acceptable to FSWs in the Mexico-US border region and other similar LMIC. Proyecto PrEParado is a University of California, San Diego CFAR and Johns Hopkins University CFAR collaboration embedded in an ongoing study evaluating the efficacy of a behavioral HIV prevention intervention among FSWs in two Mexico-US border cities – Tijuana and Ciudad Juarez – (R01DA039071; PI: Patterson).

Proyecto PrEParado will enroll 300 FSWs in the Mexico-US border region to:
  1. Characterize vaginal douching and lubrication practices, as well as motivators and barriers to vaginal douche and lubricant use.
  2. Assess PrEP product acceptability and the influence of individual product characteristics on overall product acceptability.
  3. Examine the influence of individual, behavioral, and socio-contextual factors on willingness to use PrEP and whether the influence of these factors differs by product formulation.