Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda

Background Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda.Methods In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP.Results Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR = 1.19, 95% CI = 1.07-1.32, P = 0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR = 1.17, 95% CI = 1.05-1.31, P = 0.032, P = 0.003) and being On PrEP for the past 1-2 years (aPR = 1.18, 95% CI = 1.00-1.38, P = 0.032) was significantly associated with HIV-related worry (aPR = 1.17, 95% CI = 1.05-1.31, P = 0.032, P = 0.003)Conclusions We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions. There is more to pre-exposure prophylaxis (PrEP) other than the health benefits. Usually, the important social benefits are less considered yet they could reveal much more. As interest intensifies, the social benefits should be incorporated more to tell us what we are missing about PrEP, that could be important globally in the use of this drug. Being less worried about a drug and enjoying sex without worry means 'confidence' about a drug that could be vital for future uptake.