BACKGROUND:
Female sex workers (FSWs) in Nairobi experience a disproportionate burden of HIV, with prevalence estimates approaching 29%, driven by structural vulnerability, stigma, and barriers to consistent HIV prevention services.¹-⁴ Understanding how FSWs negotiate sexual and reproductive health (SRH) during client interactions is critical to strengthening HIV prevention strategies among key populations.¹,²

METHODS:
A mixed-methods community-based study was conducted among FSWs in Nairobi. Quantitative data were collected using structured questionnaires to assess sociodemographic characteristics, condom use, sexual health history, and HIV prevention practices. Qualitative data were gathered through facilitated discussions exploring SRH negotiation strategies, risk environments, and access to prevention technologies. Descriptive statistics were used to summarize quantitative findings, while thematic analysis was applied to qualitative data.

RESULTS:
Most participants reported consistent condom carriage and use, including both male and female condoms, reflecting high awareness of HIV prevention tools. Uptake of biomedical prevention strategies such as PrEP, PEP, HIV self-testing, and vaginal rings was commonly reported, though negotiation with clients remained challenging due to financial pressure, fear of violence, and misinformation. Experiences of sexually transmitted infections were frequent, and qualitative findings highlighted how peer networks, hotspot-based negotiation, and strategic communication enabled women to mitigate HIV risk despite unsafe working conditions.

CONCLUSIONS:
This study demonstrates that HIV prevention among FSWs extends beyond individual knowledge to include social, economic, and structural factors that shape risk negotiation. Strengthening peer-led interventions, expanding access to combination prevention technologies, and addressing stigma and violence are essential to sustaining HIV prevention gains among FSWs in Nairobi.