title: Prioritizing Risk in Preparation for a Demonstration Project: A Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) among Female Sex Workers in South India.
abstract: BACKGROUND
  HIV prevalence among female sex workers (FSWs) in India remains well above the national average. Pre-exposure prophylaxis (PrEP), a new HIV prevention technology, may help to reduce HIV incidence, but there is a dearth of research that can inform the potential scale-up of PrEP in India. In partnership with Ashodaya Samithi, a local sex worker collective, we conducted a feasibility study to assess acceptance of a planned PrEP demonstration project, willingness to use PrEP, and recommendations for project roll-out among FSWs in southern Karnataka.
  
  
  METHODS
  From January-April 2015, 6 focus group discussions, 47 in-depth interviews, and 427 interviewer-administered questionnaires were completed by female sex workers. All participants were 18 years of age or older and practiced sex work. Qualitative data were coded for key themes and emergent categories. Univariate descriptive analysis was employed to summarise the quantitative data.
  
  
  RESULTS
  Qualitative. PrEP was described as an exciting new prevention technology that places control in the hands of FSWs and provides a "double safety" in combination with condom use. Participants expressed agreement that women who may experience more HIV risk in their occupational environments should be prioritized for enrollment into a demonstration project. Quantitative. 406 participants (95%) expressed interest in PrEP. Participants prioritized the inclusion of FSWs under the age of 25 (79%), those who do not use condoms when clients offer more money (58%), who do not consistently use condoms with regular partners (57%), who drink alcohol regularly (49%), and who do not use condoms consistently with clients (48%).
  
  
  CONCLUSIONS
  This feasibility study indicated strong interest in PrEP and a desire to move forward with the demonstration project. Participants expressed their responses in terms of public health discourses surrounding risk, pointing to the importance of situating PrEP scale up within the trusted spaces of community-based organizations as a means of supporting PrEP uptake and adherence.
authors.affiliation: Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Sushena
authors.initials: S
authors.lastname: Reza-Paul
authors.affiliation: Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lazarus
authors.affiliation: Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Monika
authors.initials: M
authors.lastname: Doshi
authors.affiliation: Ashodaya Samithi, Mysore, India.
authors.forename: Syed
authors.initials: S
authors.lastname: Hafeez Ur Rahman
authors.affiliation: Ashodaya Samithi, Mysore, India.
authors.forename: Manjula
authors.initials: M
authors.lastname: Ramaiah
authors.affiliation: Ashodaya Samithi, Mysore, India.
authors.forename: Raviprakash
authors.initials: R
authors.lastname: Maiya
authors.affiliation: Ashodaya Samithi, Mysore, India.
authors.forename: Venugopal
authors.initials: V
authors.lastname: Ms
authors.affiliation: Ashodaya Samithi, Mysore, India.
authors.forename: K T
authors.initials: KT
authors.lastname: Venukumar
authors.affiliation: Independent Consultant, Chennai, India.
authors.forename: Sundar
authors.initials: S
authors.lastname: Sundararaman
authors.affiliation: Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Marissa
authors.initials: M
authors.lastname: Becker
authors.affiliation: Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Lorway
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D060386:Sex Workers