8. Information on PrEP and PEP for all sex workers and simplified access

HIV-PrEP and HIV-PEP can be important tools for health and safety in sex work. However, in order to realize this potential, structural measures are required in terms of education and access:

  1. All sex workers should know that PrEP exists. This does not mean generalized recommendation for sex workers to take PrEP. The aim should be that they receive enough factual information to consider this protection option if necessary and to make an informed decision. Sex workers should also be informed about PEP. Simply knowing about PEP can provide sex workers with psychological relief and is a prerequisite for sex workers to be able to use this emergency measure following a risk of contracting HIV. Many sex workers inform themselves about sexual health in Public Health Departments. They therefore need information about PrEP and PEP (both in the offer according to §10 ProstSchG and in the offer according to §19 Infection Protection Act). Also specialist advice centers in the areas of sex work and drugs are recommended to systematically offer PrEP and PEP education, for example in the form of workshops. Note: The Deutsche Aidshilfe is working on a brochure on PrEP and PEP that aims to raise awareness among various groups of people, including sex workers (expected publication in 2024).
  2. Education about PrEP must not lead to increased pressure on sex workers to offer sex without a condom. To prevent this, the association “PrEP = sex without a condom” must be countered. PrEP should not be presented as an alternative to condoms, but as an additional protective measure.
  3. Access to PrEP must be made much easier for sex workers:
    • Many sex workers in need of PrEP do not have health insurance. Some obtain PrEP medication via informal channels (such as the internet or the informal market). This type of supply harbors risks: Without medical care and HIV tests before starting and during use, they run the risk of making an undetected HIV infection worse. There is also the risk that the medication is not continuously available – and stopping PrEP can lead to HIV infections. In some health authorities (for example in Berlin and Hamburg), people without health insurance are already being offered PrEP treatment: They receive the necessary testing free of charge and a private prescription with which they can buy the medication in the pharmacy for around 50 euros per month. Such offers are to be expanded and made available in more health authorities. For people with low incomes the costs of the medication should be covered.
    • Sex workers with health insurance who need PrEP should be offered low-threshold prescriptions. Since the majority of sex workers do not go to an HIV specialist practice, they are dependent on more general practitioners and gynecologists to prescribe PrEP on a health insurance prescription.