
Peer Education and the Uptake of Pre-Exposure Prophylaxis among Female Sex Workers in South Africa
Issue: Vol.6 No.11 Article 5 pp. 2781 – 2792
DOI: https://doi.org/10.38159/ehass.20256115 | Published online 28th October, 2025
© 2025 The Author(s). This is an open access article under the CCBY license (http://creativecommons.org/licenses/by/4.0/).
The distribution of oral pre-exposure prophylaxis (PrEP) in South Africa was instituted in 2016. Female sex workers (FSWs) were targeted as a priority group to curb the rise in new HIV infections. Certain organizations working with FSWs were tasked to distribute PrEP. Some used a peer-education approach to initiate FSWs on PrEP. This study aimed to understand the role of peer support in encouraging the uptake of PrEP among FSWs. Key informant interviews were conducted with thirteen (13) participants, eleven (11) peer educators, and two (2) healthcare workers from a research and sex work organization. Consent was obtained from all participants. Data were thematically analyzed. During the outreach, peer educators gave information on PrEP to FSWs; however, most felt that more efforts are needed to create greater awareness and knowledge dissemination of PrEP. FSWs willing to test for HIV were tested on-site in a mobile facility. Once PrEP was initiated, support was provided through telephone calls, and reminders for treatment top-ups were sent via text messages. Medication was delivered to those who missed their site visit. Each peer provided FSWs with practical suggestions for managing side effects. FSWs traveling periodically were given an extra supply of PrEP or linked to another distribution site. Some FSWs suggested the need for long-acting PrEP to foster retention. Reaching FSWs with PrEP through peers has ensured ongoing use of PrEP, which is further sustained through follow-ups and efficient side-effect management.
Keywords: Oral Pre-Exposure Prophylaxis, Peer Educators, Female Sex Workers
Agha, Sohail, and Ronan Van Rossem. “Impact of a School-Based Peer Sexual Health Intervention on Normative Beliefs, Risk Perceptions, and Sexual Behavior of Zambian Adolescents.” Journal of Adolescent Health 34, no. 5 (May 2004): 441–52. https://doi.org/10.1016/j.jadohealth.2003.07.016.
Basu, Ishika, Smarajit Jana, Mary Jane Rotheram-Borus, Dallas Swendeman, Sung-Jae Lee, Peter Newman, and Robert Weiss. “HIV Prevention Among Sex Workers in India.” JAIDS Journal of Acquired Immune Deficiency Syndromes 36, no. 3 (July 2004): 845–52. https://doi.org/10.1097/00126334-200407010-00012.
Braun, Virginia, and Victoria Clarke. “Using Thematic Analysis in Psychology.” Qualitative Research in Psychology 3, no. 2 (January 21, 2006): 77–101. https://doi.org/10.1191/1478088706qp063oa.
Cornish, Flora, and Catherine Campbell. “The Social Conditions for Successful Peer Education: A Comparison of Two HIV Prevention Programs Run by Sex Workers in India and South Africa.” American Journal of Community Psychology 44, no. 1–2 (September 12, 2009): 123–35. https://doi.org/10.1007/s10464-009-9254-8.
Creswell, John. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. SAGE, Ca; Ofprnia. California: Sage Publications, 2013.
Eakle, Robyn, Rutendo Bothma, Adam Bourne, Sanele Gumede, Keneilwe Motsosi, and Helen Rees. “‘I Am Still Negative’: Female Sex Workers’ Perspectives on Uptake and Use of Daily Pre-Exposure Prophylaxis for HIV Prevention in South Africa.” PLOS ONE 14, no. 4 (April 9, 2019): e0212271. https://doi.org/10.1371/journal.pone.0212271.
Ford, K, D N Wirawan, W Suastina, B D Reed, and P Muliawan. “Evaluation of a Peer Education Programme for Female Sex Workers in Bali, Indonesia.” International Journal of STD & AIDS 11, no. 11 (November 1, 2000): 731–33. https://doi.org/10.1258/0956462001915156.
Grasso, Michael A, Albert E Manyuchi, Maria Sibanyoni, Alex Marr, Tom Osmand, Zachary Isdahl, Helen Struthers, et al. “Estimating the Population Size of Female Sex Workers in Three South African Cities: Results and Recommendations From the 2013-2014 South Africa Health Monitoring Survey and Stakeholder Consensus.” JMIR Public Health and Surveillance 4, no. 3 (August 7, 2018): e10188. https://doi.org/10.2196/10188.
He, Jiayu, Ying Wang, Zhicheng Du, Jing Liao, Na He, and Yuantao Hao. “Peer Education for HIV Prevention among High-Risk Groups: A Systematic Review and Meta-Analysis.” BMC Infectious Diseases 20, no. 1 (2020): 338.
Krishnamurthy, Parthasarathy, Sam K. Hui, Narayanan Shivkumar, Chandrasekhar Gowda, and R. Pushpalatha. “Assessing the Impact of Peer Educator Outreach on the Likelihood and Acceleration of Clinic Utilization among Sex Workers.” PLOS ONE 11, no. 7 (July 28, 2016): e0159656. https://doi.org/10.1371/journal.pone.0159656.
Leonard, Lori, Ibrahima Ndiaye, Asha Kapadia, and Geoff Eisen. “HIV Prevention among Male Clients of Female Sex Workers in Kaolack, Senegal: Results of a Peer Education Program.” AIDS Education and Prevention 12, no. 1 (2000): 21.
Marcus, Julia L., Timothy Buisker, Hacsi Horvath, Rivet Amico, Jonathan Fuchs, SP Buchbinder, R M Grant, and Ay Liu. “Helping Our Patients Take HIV Pre‐exposure Prophylaxis PrEP: A Systematic Review of Adherence Interventions.” HIV Medicine 15, no. 7 (August 24, 2014): 385–95. https://doi.org/10.1111/hiv.12132.
Nsanzimana, Sabin, and Jamie I Forrest. “Many Pathways to Ending AIDS by 2030.” The Lancet HIV 5, no. 8 (August 2018): e407–8. https://doi.org/10.1016/S2352-3018(18)30131-0.
Oldenburg, Catherine E., Katie B. Biello, Donn Colby, Elizabeth F. Closson, Thi Nguyen, Nguyen N.N. Trang, Hang X. Lan, Kenneth H. Mayer, and Matthew J. Mimiaga. “Engagement with Peer Health Educators Is Associated with Willingness to Use Pre-Exposure Prophylaxis Among Male Sex Workers in Ho Chi Minh City, Vietnam.” AIDS Patient Care and STDs 28, no. 3 (March 2014): 109–12. https://doi.org/10.1089/apc.2013.0372.
Ortblad, Katrina F., and Catherine E. Oldenburg. “Tailoring combination HIV prevention for female sex workers.” The Lancet HIV 5, no. 8 (2018): e406-e407.
Rangasami J, T. Konstant, and M. Stacey. “Evaluation of Peer Education in the Global Fund Sex Work Programme April 2016 to March 2019.,” 2019.
Rao, Amrita, Hlengiwe Mhlophe, Anje Pretorius, Mfezi Mcingana, Jennifer Mcloughlin, Lillian Shipp, Stefan Baral, Harry Hausler, Sheree Schwartz, and Catherine Lesko. “Effect of Implementation Strategies on Pre-Exposure Prophylaxis Persistence among Female Sex Workers in South Africa: An Interrupted Time Series Study.” The Lancet HIV 10, no. 12 (December 2023): e807–15. https://doi.org/10.1016/S2352-3018(23)00262-X.
Republic of South Africa. South Africa’s National Sex Worker HIV, TB and STI Plan 2019–2022. Edited by South African National AIDS Council. Pretoria: South Africa, 2021.
Richter, Marlise. “Sex Work, Reform Initiatives and HIV/AIDS in Inner-City Johannesburg.” African Journal of AIDS Research 7, no. 3 (November 2008): 323–33. https://doi.org/10.2989/AJAR.2008.7.3.9.656.
Sarafian, Isabelle. “Process Assessment of a Peer Education Programme for HIV Prevention among Sex Workers in Dhaka, Bangladesh : A Social Support Framework.” Social Science & Medicine 75, no. 4 (August 2012): 668–75. https://doi.org/10.1016/j.socscimed.2011.09.003.
Scheibe, Andrew, Marlise Richter, and Jo Vearey. “Sex Work and South Africa’s Health System: Addressing the Needs of the Underserved.” South African Health Review 2016, no. 1 (2016): 165–78.
Simoni, Jane M, Kimberly M Nelson, Julie C Franks, Samantha S Yard, and Keren Lehavot. “Are Peer Interventions for HIV Efficacious? A Systematic Review.” AIDS and Behavior 15, no. 8 (2011): 1589–95.
Solomon, Sunil S, Suniti Solomon, Allison M McFall, Aylur K Srikrishnan, Santhanam Anand, Vinita Verma, Canjeevaram K Vasudevan, et al. “Integrated HIV Testing, Prevention, and Treatment Intervention for Key Populations in India: A Cluster-Randomised Trial.” The Lancet HIV 6, no. 5 (May 2019): e283–96. https://doi.org/10.1016/S2352-3018(19)30034-7.
Tolli, Marina V. “Effectiveness of Peer Education Interventions for HIV Prevention, Adolescent Pregnancy Prevention and Sexual Health Promotion for Young People: A Systematic Review of European Studies.” Health Education Research 27, no. 5 (2012): 904–13.
UN AIDS. “UNAIDS DATA ,” 2018. https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf.
Webel, Allison R. “Testing a Peer-Based Symptom Management Intervention for Women Living with HIV/AIDS.” AIDS Care 22, no. 9 (September 8, 2010): 1029–40. https://doi.org/10.1080/09540120903214389.
Webel, Allison R., Jennifer Okonsky, Joyce Trompeta, and William L. Holzemer. “A Systematic Review of the Effectiveness of Peer-Based Interventions on Health-Related Behaviors in Adults.” American Journal of Public Health 100, no. 2 (February 2010): 247–53. https://doi.org/10.2105/AJPH.2008.149419.
World Health Organization. “Policy Brief: Pre-Exposure Prophylaxis (PrEP): WHO Expands Recommendation on Oral Pre-Exposure Prophylaxis of HIV Infection (PrEP).” World Health Organization, Geneva, Switzerland, 2015. https://iris.who.int/bitstream/handle/10665/197906/WHO_HIV_2015.48_eng.pdf.
Nosipho Faith Makhakhe is a Senior Lecturer at the Centre for General Education at Durban University of Technology South Africa.
Nosipho Faith Makhakhe. “Peer Education and the Uptake of Pre-Exposure Prophylaxis among Female Sex Workers in South Africa.” E-Journal of Humanities, Arts and Social Sciences 6, no. 11 (2025): 2781 – 2792, https://doi.org/10.38159/ehass.20256115
© 2025 The Author(s). Published and Maintained by Noyam Journals. This is an open access article under the CCBY license (http://creativecommons.org/licenses/by/4.0/).









