Women who engage in sex work in Zambia experiencing chronic discrimination are 65% more likely to discontinue HIV prevention medication within three months, according to research published in BMJ Global Health. The study of 262 participants in Lusaka reveals how stigma creates barriers to sustaining pre-exposure prophylaxis (PrEP), with sex workers facing a 21-fold higher risk of HIV acquisition than the general population according to the BMJ Global Health study.
Stigma prevalence among women sex workers in Lusaka
Multiple forms of discrimination affect PrEP adherence, 2023 study data
Source: BMJ Global Health, 2024 | Georgian Medical Journal News
Discrimination drives medication discontinuation
The prospective cohort study, conducted between July and October 2023, found that women experiencing chronic discrimination had an adjusted prevalence ratio of 1.65 for early PrEP discontinuation compared to those without such experiences, according to the BMJ Global Health study. The research tracked 296 participants who initiated oral PrEP at community health hubs.
Among the 262 women with complete electronic medical records, 32.2% of early discontinuers reported high chronic discrimination compared to 27.1% of those who maintained regular refill visits, according to the study findings. The discrimination was primarily attributed to being identified as a sex worker, according to the study findings.
Multiple stigma types affect adherence
The BMJ Global Health research identified three distinct forms of stigma affecting PrEP persistence. Beyond chronic discrimination at 28.2%, PrEP-specific stigma affected 22.5% of participants, while HIV-related stigma impacted 20.2%.
Study participants had a median age of 24 years, with 88.5% having no employment outside sex work and 7.6% living in extreme poverty, according to the BMJ Global Health study. The research was conducted through partnership between community-based organizations and Zambia’s Ministry of Health, reflecting collaborative approaches to addressing key population health needs.
Intervention strategies needed urgently
The findings highlight critical gaps in current PrEP delivery models for marginalized populations. The study’s community-based participatory research approach, involving both transgender and cisgender women, provides insights into how stigma operates across different experiences of sex work.
Chronic discrimination was significantly associated with early PrEP discontinuation, with an adjusted prevalence ratio of 1.65 (95% CI 1.07 to 2.54)
— BMJ Global Health study, 2024
Key takeaways
- Nearly one-third of women sex workers in Lusaka experience high levels of chronic discrimination (BMJ Global Health study)
- Discrimination increases early PrEP discontinuation risk by 65% within three months (BMJ Global Health study)
- Multiple overlapping stigmas affect HIV prevention adherence in key populations (BMJ Global Health study)
Frequently asked questions
Why do women sex workers have higher HIV risks?
Women who engage in sex work face a 21-fold greater risk of HIV acquisition than the general population according to the BMJ Global Health study, due to multiple factors including biological vulnerability, structural inequities, and limited access to prevention services.
What is PrEP and how effective is it?
Pre-exposure prophylaxis (PrEP) involves taking antiretroviral medication daily to prevent HIV infection. The BMJ Global Health study examined oral PrEP discontinuation patterns among women sex workers in Zambia.
This research underscores the need for stigma-reduction interventions integrated into PrEP delivery programs, according to the study authors. The BMJ Global Health study demonstrates how social determinants drive discontinuation among marginalized populations.
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
