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Quantifying intersectional stigma in HIV prevention contexts: adaptation and validation of a scale among female sex
Kaitlyn Atkins1, H T Saleem2, A L Stangl2
1Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21215, USA. kait.atkins@jhu.edu.
Background:
Key populations disproportionately affected by HIV face stigma and discrimination related to their multiple, converging marginalized identities. Engaging these populations in HIV prevention services requires understanding intersectional stigma and its effects and addressing it through targeted programs. New approaches are needed to quantify intersectional stigma as a determinant of HIV and HIV prevention engagement among key populations, particularly in sub-Saharan Africa, where this is understudied. We applied an intersectional approach in adapting existing stigma measures with female sex workers (FSW) in Namibia, with the goal of refining measures to more comprehensively assesses how stigmas related to FSW's converging identities shape HIV-related outcomes.
Methods:
Using survey data collected from 214 FSW in Namibia, we measured sex work-related stigma, PrEP-related stigma, and non-attributed stigma (i.e., stigma that was not attributed to any one condition, behavior, or identity). We evaluated the psychometric properties of these scales and combined them, using exploratory factor analysis to refine an intersectional stigma measure. We assessed construct validity by testing for correlations with healthcare provider trust, racial discrimination, depressive symptoms, and social cohesion.
Results:
We identified three dimensions of intersectional stigma among this sample of FSW: experienced intersectional stigma (α = 0.88), anticipated intersectional stigma (α = 0.84), and PrEP-related stigma (α = 0.45). Subscales were positively correlated with racial discrimination, depressive symptoms, and healthcare provider distrust.
Conclusions:
Our adapted measure is novel in relying on pre-existing measures, providing a proof of concept that researchers and programs can use existing validated tools to study stigma and its impacts through an intersectional lens. Our approach can be replicated to inform HIV prevention programs with key populations in other contexts. Further, our adapted tool demonstrated preliminary evidence of validity and reliability, and can be used by programs with FSW to consider how different dimensions of stigma may impact engagement with HIV prevention providers and programs.
