Acceptability and Willingness to Use HIV Pre-Exposure Prophylaxis among Female Sex Workers in Lagos State, Nigeria: A Cross-Sectional Study

Background Pre-exposure prophylaxis (PrEP) is a crucial HIV prevention strategy for high-risk populations like female sex workers (FSWs). Understanding factors influencing PrEP acceptability and willingness to use is vital for effective implementation. This study assessed PrEP acceptability and willingness to use among FSWs in Lagos State, Nigeria. Methods We conducted a cross-sectional mixed-methods study among 310 FSWs in Lagos from June to August 2023. Quantitative data, collected using pre-tested, semi-structured questionnaires, were analysed with descriptive and inferential statistics. For the qualitative component, seven in-depth interviews (IDIs) were conducted, and data were thematically analysed. Results The mean age of respondents was 26.8 ± 4.31 years. PrEP acceptability and willingness to use were 68% and 80%, respectively. Acceptability was significantly associated with religion (p = 0.014), ethnicity (p = 0.002), age at sex work initiation (p = 0.003), number of clients per month (p = 0.007), and PrEP knowledge (p < 0.001). Specifically, lower acceptability was linked to Islamic religion, minority ethnicities (non-Igbo/Yoruba), early or late sex work initiation, and poor knowledge of PrEP. Willingness to use PrEP was also significantly associated with religion, ethnicity, and knowledge of PrEP. Poor knowledge (AOR = 0.40, CI: 0.22–0.73) and traditional religion (AOR = 0.06, CI: 0.00–0.56) significantly reduced willingness. Qualitative findings from IDIs revealed a preference for injectable PrEP, openness to accessing PrEP through health centres, and concerns about side effects. Conclusions PrEP is generally acceptable among FSWs in Lagos State, with high willingness to use. However, sociocultural and knowledge-related factors profoundly shape the uptake. Tailored, culturally sensitive education and service delivery strategies are essential to increase PrEP use among Nigeria's most vulnerable populations.