Table 2 Overview of the themes, categories and sub-categories concerning FSWs’ experience of condom failure and PrEP use

Struggling with the continuous risk of condom failure

Difficulties associated with clients’ behavior/demand

Deliberate condom breakage/ slippage and piercing

Men’s focusing only on sexual satisfaction leading to struggle (rough sex) and taking a long time

Drunk clients

Poor quality of condom brought by clients

Size of penis

Dealing with their own inadequacies

FSWs getting drunk

Getting involved (FSWs) in the sex (level of absorption)

Letting a client have sex in different positions/ allowing clients to take control over the position

Not having proper condom use knowledge/skill

Negligent FSWs face frequent breakage/slippage

Minimizing harm due to condom failure

Changing condoms

Getting rid of harmful fluids

Taking PrEP

Doubting the feasibility of PrEP as a protection strategy

Misconceptions and barriers towards taking PrEP

Perceiving PrEP as an alternative, and not supplement, to condom use

Perceiving no difference between taking PrEP daily and taking ART after being positive

Not liking to take PrEP everyday

Doubting effectiveness of PrEP for HIV protection

Lacking confidence in self-efficacy

Fear of being negligent regarding condom use with client

Fear of forgetting to take the pill while drunk as a reason not to start taking PrEP

Fear of not being able to manage the side effects

Being challenged by the negative aspects associated with PrEP use

Having to deal with adverse side effects

Having nausea and nightmares; gastritis and back pain; bloating, and sometime diarrhea

Facing risk of stigma

Being seen as HIV positive when taking PrEP

The PrEP container is similar to ART

Feeling challenged by adherence needs

Worrying that drinking and using khat might interfere with PrEP adherence

Forget to take PrEP in the morning due to sleeping