Introduction <p>HIV prevalence among cis and trans women sex workers (WSW) is higher than among other women of the same age. It is even higher among migrant women sex workers (MWSW). PrEP is a useful tool for reducing HIV transmission in high-risk populations. The objective of this study was to assess the barriers and action levers to facilitate access to PrEP among MWSW.</p> Methods <p>A qualitative study was conducted, combining semi-structured interviews, informal interviews, and participant observations. In a multi-level approach, our aim was to interview in parallel both MWSW and medical and social workers who frequently interact with them.</p> Results <p>We observed a significant lack of awareness about PrEP among MWSW. However, some of them showed interest when it was explained by the researchers, and wanted to be more involved in HIV prevention in general. Strong institutional resistance was observed among medical and social workers, mainly justified by a lack of time to address sexual health issues with increasingly precarious sex workers and an inability to provide them with long term follow-up. However, involvement of peer workers in sexual health prevention was considered an option by some medical and social workers.</p> Conclusions <p>This study highlights individual and institutional barriers to PrEP access for MWSW, along with key facilitators like peer involvement and integrated healthcare approaches. Improving uptake requires culturally and linguistically tailored interventions co-developed with MWSW and better training for healthcare providers to ensure an inclusive approach. Structural changes, including policy reforms and sustainable peer-led funding, are essential to bridge gaps in access and enhance sexual health outcomes for this vulnerable population.</p> Social Policy Implications <p>Strategies designed to enhance PrEP accessibility for MWSW should be grounded in community empowerment methodologies, leveraging peer-based interventions.</p>