Comparing the impact of increasing condom use or HIV pre-exposure prophylaxis (PrEP) use among female sex workers

Zindoga Mukandavire, Kate M Mitchell, Peter Vickerman

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)
25 Downloads (Pure)


In many settings, interventions targeting female sex workers (FSWs) could significantly reduce the overall transmission of HIV. To understand the role HIV pre-exposure prophylaxis (PrEP) could play in controlling HIV transmission amongst FSWs, it is important to understand how its impact compares with scaling-up condom use-one of the proven HIV prevention strategies for FSWs. It is important to remember that condoms also have other benefits such as reducing the incidence of sexually transmitted infections and preventing pregnancy. A dynamic deterministic model of HIV transmission amongst FSWs, their clients and other male partners (termed 'pimps') was used to compare the protection provided by PrEP for HIV-negative FSWs with FSWs increasing their condom use with clients and/or pimps. For different HIV prevalence scenarios, levels of pimp interaction, and baseline condom use, we estimated the coverage of PrEP that gives the same reduction in endemic FSW HIV prevalence or HIV infections averted as different increases in condom use. To achieve the same impact on FSW HIV prevalence as increasing condom use by 1%, the coverage of PrEP has to increase by >2%. The relative impact of PrEP increases for scenarios where pimps contribute to HIV transmission, but not greatly, and decreases with higher baseline condom use. In terms of HIV infections averted over 10 years, the relative impact of PrEP compared to condoms was reduced, with a >3% increase in PrEP coverage achieving the same impact as a 1% increase in condom use. Condom promotion interventions should remain the mainstay HIV prevention strategy for FSWs, with PrEP only being implemented once condom interventions have been maximised or to fill prevention gaps where condoms cannot be used.

Original languageEnglish
Pages (from-to)62-70
Number of pages9
Early online date12 Nov 2015
Publication statusPublished - Mar 2016
Externally publishedYes

Bibliographical note

© 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.


  • Condoms
  • Female
  • HIV Infections
  • Humans
  • Pre-Exposure Prophylaxis
  • Program Evaluation
  • Sex Workers
  • Comparative Study
  • Journal Article
  • Research Support, Non-U.S. Gov't


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