HIV- and sex work-related stigmas and quality of life of female sex workers living with HIV in South Africa: a cross-sectional study

BMC Infectious Diseases

Research

Claire Chen¹  Carly A. Comins¹  Stefan Baral¹  Sheree R. Schwartz¹  Linwei Wang²  Sharmistha Mishra³  Vijay Guddera⁴  Harry Hausler⁴  Katherine Young⁴  Mfezi Mcingana⁴  Ntambue Mulumba⁴  Deliwe Rene Phetlhu⁵ 

[1] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, W3503, 21205, Baltimore, MD, USA;MAP-Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada;MAP-Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada;Department of Medicine, Division of Infectious Disease, University of Toronto, Toronto, ON, Canada;Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada;TB HIV Care Association, Cape Town, South Africa;TB HIV Care Association, Cape Town, South Africa;University of Western Cape, Cape Town, South Africa;

关键词: Female sex workers;    Stigma;    Quality of life;    South Africa;    HIV;    Environmental domain;   

DOI  :  10.1186/s12879-022-07892-4

 received in 2022-08-05, accepted in 2022-11-23,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEnvironmental quality of life (QoL) assesses individually perceived factors such as physical safety and security, accessibility, quality of healthcare, and physical environment. These factors are particularly relevant in the context of sex work and HIV, where stigma has been identified as an important barrier across several prevention and treatment domains. This study aims to examine the association between different types of HIV- and sex work-related stigmas and environmental QoL among female sex workers (FSW) living with HIV in Durban, South Africa.MethodsWe conducted cross-sectional analyses using baseline data from the Siyaphambili randomized controlled trial. FSW who reported sex work as their primary source of income and had been diagnosed with HIV for ≥ 6 months were enrolled from June 2018–March 2020, in eThekwini, South Africa. We evaluated the association between environmental QoL, dichotomizing the environmental domain score collected by the WHO Quality of Life HIV Brief (WHOQOL-HIV BREF) questionnaire at the median, and stigma using modified robust Poisson regression models. Five stigma subscales were assessed: sex work-related (anticipated, enacted, or internalized stigma) and HIV-related (anticipated or enacted stigma).ResultsAmong 1373 FSW, the median environmental QoL was 10.5 out of 20 [IQR: 9.0–12.5; range 4.0–19.0], while the median overall QoL was 3 out of 5 [IQR: 2–4; range 1–5]. One-third of FSW (n = 456) fell above the median environmental QoL score, while 67% were above the median overall QoL (n = 917). Reporting anticipated sex work stigma was associated with lower environmental QoL (adjusted prevalence ratio [aPR] 0.74 [95% CI 0.61, 0.90]), as was severe internalized sex work stigma (aPR: 0.64, 95% CI 0.48, 0.86). Reporting enacted HIV stigma versus none was similarly associated with lower environmental QoL (aPR: 0.65, 95% CI 0.49, 0.87). Enacted sex work stigma and anticipated HIV stigma were not statistically associated with environmental QoL.ConclusionsThis study highlights the need to consider the impact of multiple stigmas on FSW’s non-HIV related clinical outcomes, including safety and physical well-being. Moreover, these results suggest that addressing underlying structural risks may support the impact of more proximal HIV prevention and treatment interventions.Trial registration NCT03500172 (April 17, 2018)

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 2