Combined HIV prevention in female cis and trans sex workers: Clinical experience with PrEP, PEP and a comprehensive approach in an STI clinic.

INTRODUCTION: Implementing PrEP and PEP among cis and trans female sex workers remains a challenge, representing an underrepresented population in prevention programs in Spain. METHODS: Retrospective descriptive study of HIV-negative cis and trans female sex workers managed at a Madrid clinic (December 2024-August 2025; n = 34). RESULTS: Most (85.3%) were cis women (median age: 28 years); 85.3% were of Latin American origin and 88.2% had an irregular administrative status. Baseline STI prevalence was 32.4%, with low prior screening (20.6%). PEP was received by 16 patients (47.1%), and 9 transitioned to PrEP. PrEP was initiated by 17 patients (50.0%); 6 (35.3%) discontinued, primarily due to gastrointestinal intolerance within the first weeks. Vaccination reached 70.6% (24 patients). CONCLUSIONS: PEP was associated with significant PrEP uptake. High early discontinuation rates highlight the need to optimize follow-up and suggest long-acting injectable formulations as a strategic alternative for this vulnerable population.