OBJECTIVES:HIV and AIDS remain a major public health and economic burden to Kenya. The prevalence among the general population has been decreasing, however, it remains very high at an average of 30% among female sex workers (FSWs). The sex trade is unlawful in Kenya and FSWs operate illegally without business protection increasing risk of sexual exploitation and abuse. The Government of Kenya offers FSWs Oral Pre-exposure prophylaxis (PrEP) free of charge to reduce the risk of HIV infection. Socioeconomic inequalities contribute to disparities in the uptake of health services, with the rich accessing more care than the poor given ill health. The objective of this study was to estimate socioeconomic inequality in PrEP use among FSWs in rural Kenya.

METHODS:Using a structured questionnaire, 479 HIV negative FSWs were sampled and data on their socioeconomic and demographic status collected. Average marginal effects was used to estimate the determinants of PrEP use by FSWs. Concentration curves and Erreygers CI were used to estimate inequality in PreP use among FSWs in rural Kenya.

RESULTS:Of the 479 HIV Negative FSWs (median age 26y), 297 (62%) reported ever using PrEP. PrEP uptake was highest amongst those aged over 24 years (66%), formerly and currently married (54%), with less than 2 children (85%), unemployed (54%), above secondary education (61%), town residence (88%) among others. The concentration index showed that PrEP uptake was concentrated among the wealthy FSWs (CI=0.224; p<0.05).

CONCLUSIONS:The findings shows socioeconomic inequality in oral PrEP uptake, hence the need to target poor and vulnerable FSWs in the distribution of PrEP. Secondly, the government needs to consider linking social protection interventions and PrEP use to improve its uptake