Acceptability and Willingness to Use HIV Pre-Exposure Prophylaxis among Female Sex Workers in Lagos State, Nigeria: A Cross-Sectional Study

Acceptability and Willingness to Use HIV Pre-Exposure Prophylaxis among Female Sex Workers in Lagos State, Nigeria: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Acceptability and Willingness to Use HIV Pre-Exposure Prophylaxis among Female Sex Workers in Lagos State, Nigeria: A Cross-Sectional Study Abdulraheem Kamaldeen Sunkanmi, Ladi-Akinyemi Temitope Wumi, Babatunde Akodu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7066966/v2 This work is licensed under a CC BY 4.0 License Archived Versions: Posted Version 2 posted You are reading this latest preprint version Abstract Background Female sex workers (FSWs) in Nigeria carry a disproportionate Human Immunodeficiency Virus (HIV) burden and remain a key target group for pre-exposure prophylaxis (PrEP). Understanding PrEP acceptability and willingness to use is critical to scaling prevention in this population. This study examined factors associated with PrEP acceptability and willingness to use among PrEP-naïve FSWs in Lagos State, Nigeria. Methods A cross-sectional study was conducted between June and August 2022 among 310 FSWs recruited from 24 hotspots across four local government areas in Lagos State using a multistage sampling design. Data were collected with a semi-structured quantitative questionnaire. Analyses were restricted to 223 participants who had never used PrEP. Bivariate analyses (Wilcoxon and Kruskal–Wallis tests) identified potential predictors, which were entered into separate multivariable linear regression models for PrEP acceptability and willingness scores. Non-standardised coefficients ( b ) are reported. Results Participants had a mean age of 26.19±4.11, and most (90%) had completed secondary education. In the final multivariable model for PrEP acceptability (adjusted R² = 0.264, p < 0.001), higher PrEP knowledge (b = 0.10, p = 0.006), Islamic religion (b = 1.94, p = 0.002), non-majority ethnic group (Others: b = 1.87, p = 0.003), and higher education (b = 2.46, p = 0.009) was independently associated with greater acceptability. For willingness to use PrEP (adjusted R² = 0.228, p < 0.001), higher PrEP knowledge (b = 0.12, p = 0.019) was associated with increased willingness, while later entry into sex work (b = -0.45, p < 0.001) was associated with reduced willingness. There was a marginal trend toward reduced willingness with increasing age (b = −0.19, p = 0.055). Conclusion Among PrEP-naïve FSWs in Lagos, PrEP knowledge emerged as a key correlate of both acceptability and willingness, while education, religion, and ethnicity were primarily associated with cognitive acceptability, and age-related factors influenced willingness. Interventions that improve PrEP knowledge and incorporate age-, literacy-, and sex-work–entry considerations may strengthen both acceptability and willingness among FSWs. Pre-exposure prophylaxis (PrEP) female sex workers (FSW) HIV prevention acceptability willingness social determinants of health health equity Full Text Additional Declarations No competing interests reported. Supplementary Files 1.0appendix.pdf Supplementaryitem1.pdf Supplementaryitem2.pdf Cite Share Download PDF Archived Versions: Posted Version 2 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7066966","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[{"code":2,"date":"2026-01-26 18:29:46","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580696675,"identity":"e56e6292-fae3-11f0-907b-06cc9d20a69f","order_by":0,"name":"Abdulraheem Kamaldeen Sunkanmi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYDACdgiVAMSMD4AEDx9BLcwILcwGIC1spGhhkwCxCGrhZ2Z+/Jl3j10eP3t3WuXXHDsZNgbmh49u4NEi2cxmJs3zLLlYsufsttuy25KBDmMzNs7Bo8XgMIMZM88B5sQNN3K33ZbcxgzUwsMmjV8L++fPPAfqE/fff7utWHJbPTFaeAykeQ4cTtwgwbuN8eO2w4S1SDbzlEnOOXA8ccaZ3M3SjNuO87AxE/ALP3v75g9vDlQn9ref3fjx57Zqe3725oeP8WlBAcw8YJJY5SDA+IMU1aNgFIyCUTBiAAANp0RxfkLaBQAAAABJRU5ErkJggg==","orcid":"","institution":"Lagos University Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Abdulraheem","middleName":"Kamaldeen","lastName":"Sunkanmi","suffix":""},{"id":580696676,"identity":"ed73daec-fae3-11f0-907b-06cc9d20a69f","order_by":1,"name":"Ladi-Akinyemi Temitope Wumi","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Ladi-Akinyemi","middleName":"Temitope","lastName":"Wumi","suffix":""},{"id":580696677,"identity":"f5549800-fae3-11f0-907b-06cc9d20a69f","order_by":2,"name":"Babatunde Akodu","email":"","orcid":"","institution":"Lagos University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Babatunde","middleName":"","lastName":"Akodu","suffix":""},{"id":580696678,"identity":"022b5ea3-fae4-11f0-907b-06cc9d20a69f","order_by":3,"name":"Kofoworola Odeyemi","email":"","orcid":"","institution":"Lagos University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kofoworola","middleName":"","lastName":"Odeyemi","suffix":""}],"badges":[],"createdAt":"2025-07-07 15:23:15","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-7066966/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-7066966/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-026-26707-8","type":"published","date":"2026-02-23T15:59:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":103765655,"identity":"7286b91a-762d-4b8b-a913-8d0e8e668d93","added_by":"auto","created_at":"2026-03-02 16:06:39","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":521848,"visible":true,"origin":"","legend":"","description":"","filename":"iReRevisedAcceptabilityandWiliingness.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7066966/v2_covered_b0209633-e21f-45b3-bf3f-4bc23f949655.pdf"},{"id":101160609,"identity":"9562b6d7-df4d-4ef0-bf26-cdf3d7834888","added_by":"auto","created_at":"2026-01-26 18:30:23","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":495232,"visible":true,"origin":"","legend":"","description":"","filename":"1.0appendix.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7066966/v2/420256a423ef892dcf06125e.pdf"},{"id":101160611,"identity":"de9bbb2a-43cb-4ba2-aacb-9a69c5b39961","added_by":"auto","created_at":"2026-01-26 18:30:24","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":198264,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryitem1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7066966/v2/73fc8f86842090b8b6eca3d5.pdf"},{"id":101205853,"identity":"2ac27143-3886-4a4b-81f2-554e6cea3712","added_by":"auto","created_at":"2026-01-27 09:50:25","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":130623,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryitem2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7066966/v2/ea232e9367bbd2f91a5b813a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Acceptability and Willingness to Use HIV Pre-Exposure Prophylaxis among Female Sex Workers in Lagos State, Nigeria: A Cross-Sectional Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pre-exposure prophylaxis (PrEP), female sex workers (FSW), HIV prevention, acceptability, willingness, social determinants of health, health equity","lastPublishedDoi":"10.21203/rs.3.rs-7066966/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7066966/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003cbr\u003e\n \u003c/strong\u003eFemale sex workers (FSWs) in Nigeria carry a disproportionate Human Immunodeficiency Virus (HIV) burden and remain a key target group for pre-exposure prophylaxis (PrEP). Understanding PrEP acceptability and willingness to use is critical to scaling prevention in this population. This study examined factors associated with PrEP acceptability and willingness to use among PrEP-naïve FSWs in Lagos State, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003cbr\u003e\n \u003c/strong\u003eA cross-sectional study was conducted between June and August 2022 among 310 FSWs recruited from 24 hotspots across four local government areas in Lagos State using a multistage sampling design. Data were collected with a semi-structured quantitative questionnaire. Analyses were restricted to 223 participants who had never used PrEP. Bivariate analyses (Wilcoxon and Kruskal–Wallis tests) identified potential predictors, which were entered into separate multivariable linear regression models for PrEP acceptability and willingness scores. Non-standardised coefficients (\u003cem\u003eb\u003c/em\u003e) are reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003cbr\u003e\n \u003c/strong\u003eParticipants had a mean age of 26.19±4.11, and most (90%) had completed secondary education. In the final multivariable model for PrEP acceptability (adjusted R² = 0.264, p \u0026lt; 0.001), higher PrEP knowledge (b = 0.10, p = 0.006), Islamic religion (b = 1.94, p = 0.002), non-majority ethnic group (Others: b = 1.87, p = 0.003), and higher education (b = 2.46, p = 0.009) was independently associated with greater acceptability. For willingness to use PrEP (adjusted R² = 0.228, p \u0026lt; 0.001), higher PrEP knowledge (b = 0.12, p = 0.019) was associated with increased willingness, while later entry into sex work (b = -0.45, p \u0026lt; 0.001) was associated with reduced willingness. There was a marginal trend toward reduced willingness with increasing age (b = −0.19, p = 0.055).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003cbr\u003e\n \u003c/strong\u003eAmong PrEP-naïve FSWs in Lagos, PrEP knowledge emerged as a key correlate of both acceptability and willingness, while education, religion, and ethnicity were primarily associated with cognitive acceptability, and age-related factors influenced willingness. Interventions that improve PrEP knowledge and incorporate age-, literacy-, and sex-work–entry considerations may strengthen both acceptability and willingness among FSWs.\u003c/p\u003e","manuscriptTitle":"Acceptability and Willingness to Use HIV Pre-Exposure Prophylaxis among Female Sex Workers in Lagos State, Nigeria: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 07:30:29","doi":"10.21203/rs.3.rs-7066966/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-17T04:29:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T11:46:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228422999213002361135128153092281905888","date":"2025-10-07T18:25:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130831905888997200144450539159679852159","date":"2025-10-07T08:14:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135884171570880440159287503246184365817","date":"2025-10-06T09:05:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T10:20:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194627262144488276765832140115409364271","date":"2025-09-04T12:44:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36536068204212177053545927785273374484","date":"2025-09-02T12:47:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262464511623974308058466512014351297705","date":"2025-07-21T14:37:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-14T08:16:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-14T08:13:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-14T05:45:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-12T00:25:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-07-12T00:22:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fb0c5aa-7d3d-4369-bc50-27c53503a0ae","owner":[],"postedDate":"January 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:03:17+00:00","versionOfRecord":{"articleIdentity":"rs-7066966","link":"https://doi.org/10.1186/s12889-026-26707-8","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-02-23 15:59:33","publishedOnDateReadable":"February 23rd, 2026"},"versionCreatedAt":"2026-01-26 18:29:46","video":"","vorDoi":"10.1186/s12889-026-26707-8","vorDoiUrl":"https://doi.org/10.1186/s12889-026-26707-8","workflowStages":[]},"version":"v2","identity":"rs-7066966","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7066966","identity":"rs-7066966","version":["v2"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}