Awareness and Barriers to Pre-Exposure Prophylaxis (PrEP) among Commercial Female Sex Workers in Mekelle City, Tigray, Ethiopia: A Cross – Sectional Study, 2025

Background: Nationally, Ethiopia's HIV epidemic is concentrated among key populations, with female sex workers showing a disproportionately high prevalence of HIV, averaging 18.7% across urban centers. In Mekelle, recent data indicate a rising HIV prevalence of 8.5% among CSWs, underscoring the urgent need for accessible and effective prevention strategies. However, barriers including low PrEP awareness, misinformation, stigma, and limited healthcare access significantly hinder PrEP utilization. Methodology: a cross sectional study was done. Result:The study surveyed 335 female sex workers, with a mean age of 30.25 years, most of whom were divorced, Orthodox Christians, and had at least secondary education. Nearly 88% had heard of PrEP, but only 27.2% correctly identified it as an HIV prevention method, with health workers being the main information source. Most participants (79.4%) had used PrEP, and 89.9% were currently taking it daily, mainly from government facilities. Counseling before starting PrEP was rare, and over 74% reported experiencing side effects. While 13.6% had discontinued PrEP at some point, the majority expressed willingness to resume its use. Conclusion:This study expressed that female sex workers in Mekelle had high awareness and usage of PrEP, though consistent condom use was low and misconceptions about PrEP were common. Despite strong uptake, most users lacked proper counseling and many experienced side effects, which could hinder adherence. Strengthening education, counseling, and support services is essential to improve the effectiveness of HIV prevention among this high-risk group.