ACCEPTABILTY OF HIV PRE- EXPOSURE PROPHYLAXIS, ASSOCIATED FACTORS, AND EXPERIENCES AMONG HIV NEGATIVE FEMALE SEX WORKERS IN GULU CITY, NORTHERN UGANDA: A MIXED-METHOD STUDY

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dc.contributor.authorAlwedo Immaculate
dc.date.accessioned2026-11-02T07:09:08Z
dc.date.available2026-11-02T07:09:08Z
dc.date.issued2026
dc.description.abstractBackground: Female sex workers (FSWs) are at heightened risk of HIV infection due to their structural, economical and socio-cultural vulnerabilities. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool however; its acceptability varies across settings. This study aimed to assess the acceptability and identify factors associated with PrEP among HIV-negative FSWs in Gulu City, Northern Uganda. Methods: A concurrent mixed-method study was conducted among 301 HIV-negative FSWs aged 18 years and above in Gulu City, Northern Uganda. Participants were purposively sampled and interviewed using a structured questionnaire. Quantitative data were analyzed using multivariable logistic regression to determine Adjusted Odds Ratios (AORs), 95% confidence intervals (CIs), and statistical significance at P < 0.05. Additionally, in-depth qualitative interviews were conducted with a purposive sub-sample of nine participants to explore attitudes, beliefs, and experiences regarding PrEP use. Thematic analysis was used to interpret qualitative data, complementing quantitative findings. Results: Of 301 participants, most were predominantly aged 25–34 years 48.2 %( n=145) with primary 47.5% (n=143) or secondary education 40.5% (n=122) and 66.5% (n=200) reporting no employment outside sex work. Condom use was inconsistent, with 63.8% (n=192) sometimes using condoms and 18.3% (n=55) never using them. Majority 81.4% (n=245) accepted to use PrEP when availed to them. Higher education (primary: AOR=3.63, 95% CI: 1.29–10.19; secondary: AOR=8.23, 95% CI: 2.64–25.69; tertiary: AOR=6.43, 95% CI: 1.03–40.06), monthly income UGX 100,001–500,000 (AOR=2.42, 95% CI: 1.26–4.65), and sometimes using condoms (AOR=2.37, 95% CI: 1.00–5.59) remained independently associated with PrEP acceptability while age, marital status, living arrangement, and never using condoms were not. Awareness of PrEP was also a key determinant, with 96.3% (n=236) of acceptors aware of it compared to 3.7% (n=9) among non-acceptors. Qualitative findings highlighted that perceived HIV risk, peer influence, convenience, and cultural beliefs shaped attitudes toward PrEP use. Conclusion: PrEP acceptability among HIV negative FSWs in Gulu City is high and strongly influenced by education, income, and sexual risk behaviors. To improve PrEP acceptability; programs should expand PrEP modality options and interventions targeting lower-educated FSWs, address economic and behavioral barriers, and leverage peer networks to enhance PrEP uptake. These findings underscore the need for integrated and responsive HIV prevention interventions targeting FSWs in urban Uganda.
dc.identifier.urihttp://hdl.handle.net/20.500.14270/1096
dc.language.isoen
dc.publisherGulu University
dc.subjectHIV PrEP
dc.subjectAcceptability
dc.subjectFSWs
dc.subjectHIV Prevention
dc.subjectGulu City
dc.titleACCEPTABILTY OF HIV PRE- EXPOSURE PROPHYLAXIS, ASSOCIATED FACTORS, AND EXPERIENCES AMONG HIV NEGATIVE FEMALE SEX WORKERS IN GULU CITY, NORTHERN UGANDA: A MIXED-METHOD STUDY

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