Ethiopia has made significant efforts to reduce the impact of HIV, leading to substantial progress in reducing the number of new HIV infections. However, despite achievements, the burden of HIV remains high, and there is an ongoing challenge in the uptake of HIV preventive measures. This study tried to find the uptake of PrEP and its associated factors among FSWs.

According to the study, only 15.9% (CI: 12.0-21.1) of FSW had received PrEP. The result is in agreement with previous studies of Atlanta (11.9%) [13] and Kenya Kenya (21.7%) [14], but lower compared to studies carried out in South Africa (36.6%) [12], Brazil (60.9%) [15], and Uganda (92.2%) [16]. The difference in PrEP uptake among FSWs could be due to various reasons. These include the local epidemic intensity, specific demographic and behavioral factors, awareness of PrEP, availability and accessibility of PrEP medication, attitude of healthcare providers and facilities, and general attitude towards PrEP within the population. Factors such as stigma, misconception, and cultural beliefs can also influence whether FSWs are willing to use PrEP.

In this study, lack of information was the main barrier to accessing PrEP services, while studies in Kenya and Uganda identified side effects and stigma [14, 16]. Possible reasons for this difference could include variations in program implementation and promotion. There may be shortcomings in public health campaigns or healthcare provider communication regarding PrEP benefits and safety. In Kenya and Uganda, side effects and stigma were highlighted, indicating better awareness about PrE. Cultural factors and resource availability may also differ among countries, contributing to variations in perceived barriers.

The study found that PrEP uptake was significantly associated with a history of STIs, marital status, and parent living conditions among FSWs. Those with a history of STIs had higher odds of PrEP uptake and might be more aware of PrEP as a prevention measure. This finding was consistent with a previous study [17, 18]. This could be due to frequent interaction with healthcare providers or HIV/STI prevention services. FSWs with STIs might also have established connections with healthcare services, making it easier to access PrEP and receive education and counseling about HIV prevention methods. Those with a history of STIs may also perceive themselves at higher risk of HIV and be motivated to seek out PrEP.

This study found that single FSWs were less likely to receive PrEP than those in committed relationships (“Baluka”) which is supported by previous study [18]. This might be because single FSWs lack social support to access PrEP, while those in committed relationships may be encouraged by their partners. Additionally, FSWs may face financial constraints and perceive a higher risk of contracting HIV, making PrEP a necessary preventive measure for both partners and FSWs.

In the current study, parents’ living conditions contributed to the uptake of PrEP. FSWs with only one living parent are less likely to use PrEP than those with both parents alive and in a marital relationship. This could be due to additional psychological stressors or challenges faced by those who have experienced the loss of a parent. Additionally, individuals with a stable family support system, including emotional, financial, and healthcare support, may be more encouraged and facilitated to use preventive measures like PrEP.