Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Targeted structural interventions have led to a decline in HIV prevalence among female sex workers (FSWs) in India; however, prevalence remains well above the national average. The challenge lies in further reducing HIV incidence among FSWs. One possible approach to reducing HIV incidence among FSWs may be pre-exposure prophylaxis (PrEP), a new HIV prevention technology that involves the use of antiretroviral medications to reduce the risk of HIV infection. People who do not have HIV take a daily pill to keep the virus from establishing a permanent infection. PrEP is not intended to replace existing HIV prevention technologies and strategies. Rather it is intended to be used in combination with them. Although much is known about the efficacy of PrEP, a crucial gap remains surrounding its scale up. The World Health Organization (WHO) is encouraging countries to undertake PrEP demonstration projects to ascertain its real-world effectiveness. Building on a feasibility study that assessed the acceptance of PrEP among FSWs, the WHO and Gates Foundation have agreed to jointly-fund a 16-month project in partnership with two renowned sex worker-led organizations in India: Ashodaya Samithi in Mysore and Sonagachi Project in Kolkata. I propose an ethnographic study to explore how messaging practices influence uptake and retention over the life course of the project. Through extensive participant observation and field note composition in both study sites, as well as focus group discussions and qualitative in-depth interviews with health care professionals and community members, the proposed study will document the experiences of FSWs during the 16-month PrEP trial. The knowledge generated from this study is expected to reveal how informal and formal messaging surrounding PrEP supports (or inhibits) uptake and retention to inform the scale up of PrEP among FSW communities across India and beyond.