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. Author manuscript; available in PMC: 2023 Nov 1.
Published in final edited form as: AIDS Care. 2022 Apr 26;34(11):1443–1451. doi: 10.1080/09540121.2022.2067317

Table 4.

Factors that may affect PrEP implementation among young MSM and TGW who sell or trade sex and supporting quotations

Topic Relevant quotations
Structural-level stigmatization of HIV and HIV-related services “The good side of cancer is that it occurs inside. You die without being seen. It is like you are so unfortunate to die from cancer. But with AIDS, people say you die from AIDS because you deserve it, you sleep around.” [Participant #9, MSM, Bangkok].

“I am afraid [of knowing my HIV status]. Tell you frankly that I am afraid. Now I am afraid. If I know that I have [HIV], I’d better die…I don’t have the heart… if I don’t take care of myself, it is my own fault [for getting HIV]” [Participant #20, TGW, Bangkok].


Interviewer: What makes them (the participant’s friends) not want to come [to the HIV clinic]?
Participant: Everybody would say the same thing, that they are shy and embarrassed. They are afraid of being seen by other people. In fact, the Drop In Center is at the end of the soi (street), there are very few chances that people would see them. But they still feel awkward and afraid that other people would know [they are using HIV-related services]. [Participant #11, TGW, Bangkok]


“I had been wanting to get tested [for HIV] … but I didn’t dare to go to the hospital. It felt like there were too many people, and they don’t take care of me either” [Participant #19, MSM, Bangkok].


“I took [PrEP] 7 days before they (client) came [on vacation] and one every other day while they were there. I was afraid they would know... They would think that I have AIDS because I took the pills, so I had to hide” [Participant #5, TGW, Bangkok].
Network-level role of venue management in HIV prevention Interviewer: How did you know you should use condom? Who taught you to use condom when having sex?
Participant: Masseurs in the shop. They told me I would have to use condom if I had sex with customers. [Participant #11, TGW, Bangkok]


“Interviewer: What about when you were freelance? Who do you consult [about your health]?
Participant: None. I searched from the internet” [Participant #6, MSM, Pattaya].


We will distribute condoms.... we could never know whether they would put it on while they are in the room. We will stress about safety because if you get infected, your life would never be the same as normal people. Even you can live long today but the feelings in your mind will be changed. [Participant #3, MSM Venue Manager, Bangkok]


We have to care for our masseurs who work with us and make them happy. It’ll make them willing to stay with us. You can’t force your masseurs much, by saying, for example, “You have to go for a blood test with me.” I’d rather tell them, “Would you like to go with me for a blood test because I am going to fetch some condoms. But it’s okay if you are not free. [Participant #10, MSM Venue Owner, Bangkok]


“I tell them to check their blood (HIV test). ‘Go check with me, will you?’ It’s a way of supporting my boys (employees) too” [Participant #10, MSM Venue Owner, Bangkok].
Individual-level knowledge regarding PrEP and perceived risk of HIV acquisition Interviewer: Have you ever heard of a drug which can be taken before having sex?
Participant: I have never heard of a drug to be taken before having sex. I only used to take PEP (post-exposure prophylaxis). [Participant #4, MSM Venue Manager, Bangkok].


“Interviewer: Have you ever talked to university students about PrEP? Participant: Yes, I have. They would ask ‘Really? Could it be preventable?’ They still wondered. They were not confident” [Participant #11, TGW, Bangkok].


Interviewer: But you wouldn’t let your boyfriends use condoms with you [during sex]. Why?
Participant: I don’t know. It was like I loved them (sexual partner) so much and I trusted them [to not use a condom during sex]. [Participant #11, TGW, Bangkok].
Individual-level interest in health and wellbeing as an avenue of HIV prevention “Interviewer: But you always use condoms [during sex], right?
Participant: Usually for regular customers, I give oral sex without a condom” [Participant #8, TGW, Bangkok].


As sex workers, you could really take care of yourself because you have to look fit and eat good stuff and it will come out right. I was very careful with this job. You had to take it seriously. You are dead if you risk it. If you get HIV infected then you are just waiting to die. [Participant #5, TGW, Bangkok]


Interviewer: But for (sexual) intercourse, [the client] has to put on condom, right?
Participant: Yes, for intercourse [the client] must put on condom. Even those who propose 30,000 [baht] for [sex with] no condom, [I say] no. Even if you give me 100,000 [baht], I will not give (engage in sex). Yes, there were a lot [of clients who asked for sex without a condom]. [Participant #7, TGW, Bangkok]