Validation of a Brief Internalized Sex-work Stigma Scale among Female Sex Workers in Kenya

ABSTRACT

Female sex workers (FSW) often face severe stigma and discrimination and are extremely vulnerable to HIV and other sexually transmitted infections. In the fields of HIV and mental health, internalized stigma is associated with poor health care engagement. Due to the lack of valid, standardized measures for internalized sex work-related stigma, its dimensions and role are not well-understood. This study aimed to validate the six-item Internalized AIDS-Related Stigma Scale adapted to capture internalized sex work-related stigma by examining the scale’s psychometric properties and performance among a cross-sectional, snowball sample of FSW (N = 497) in Kenya. While the original pre-hypothesized six-item model yielded acceptable CFI and SRMR values (CFI = 0.978 and SRMR = 0.038), the RMSEA was higher than desirable (RMSEA = 0.145). Our final four-item model demonstrated improved goodness of fit indices (RMSEA = 0.053; CFI = 0.999; and SRMR = 0.005). Both the pre-hypothesized six-item and reduced final four-item model demonstrated good internal consistency (Cronbach’s alphas of 0.8162 and 0.8754, respectively). Higher levels of internalized stigma were associated with depression, riskier sexual behavior, and reduced condom use. This very brief measure will allow for reliable assessment of internalized stigma among FSW. Further investigation of internalized stigma among male sex workers, particularly the intersection of sex work-related and same-sex behavior-related stigmas, is needed.

KEYWORDS:

• Sex work
• Internalized stigma
• Validation
• sub-Saharan Africa

This article is referred to by:

A Novel Method for Studying the Effect of Older Brothers on Sexual Orientation and Its Robustness to Stopping Rule Distortions

Disclosure Statement

The content of this manuscript is the sole responsibility of the authors and does not necessarily reflect the views or policies of U.S. Agency for International Development or the U.S. 385 President’s Emergency Plan for AIDS Relief (PEPFAR), and does not imply endorsement by the U.S. Government.

Supplementary Material

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Additional information

Funding

The study was funded by the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through funding to the Health Policy Project [agreement number AID-OAA-A-10-00067]. MAS was supported by National Institute of Mental Health [T32MH096724].