Background Pre-exposure prophylaxis is the use of antiretroviral medications by HIV-negative individuals to prevent infection before exposure. Ethiopia has made progress in reducing new HIV infections, but the burden remains high with ongoing challenges in prevention uptake. This study examined the utilization and factors associated with preexposure prophylaxis among female sex workers. Methods A community-based cross-sectional study design was conducted in Bahir Dar city administration among female sexual workers in 2022. The results were collected using a pre-tested and structured questionnaire. Epi data for data entry and social package for social science for analysis were used. Result Overall, 15.9% (CI: 12.0-21.1) of female sexual workers received pre-exposure prophylaxis. Parents’ living condition (only father alive [AOR = 0.23, 95% CI, 0.02–0.64], only mother alive [AOR = 0.31, 95% CI, 0.02–0.74]), marital status being single (AOR = 0.27, 95% CI, 0.06–0.94), having history of STI (AOR = 2.82, 95% CI, 1.60–4.77) were associated with pre-exposure prophylaxis uptake. Conclusion This study showed low pre-exposure prophylaxis uptake. The study identified a history of sexually transmitted infections, marital status, and parent living conditions as significant factors. To increase pre-exposure prophylaxis uptake and reduce HIV incidence, an awareness campaign, tailored support, targeted interventions, and addressing concerns of high-risk groups are needed.
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