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 the 223 participants who had never used PrEP. Bivariate analyses using the Wilcoxon rank-sum test and Kruskal-Wallis test were conducted to identify factors associated with 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 = 0.102, p = 0.006), Islamic religion (b = 1.937, p = 0.002), non-majority ethnic group (Others: b = 1.872, p = 0.003), and higher education (b = 2.455, p = 0.009) were 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 = -0.15, p = 0.055). CONCLUSION: Among PrEP-naïve FSWs in Lagos, PrEP knowledge emerged as a key correlate of both PrEP 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 incorporating age-, literacy-, and sex-work-entry considerations may strengthen both PrEP acceptability and willingness among FSWs.