Validating a measure of anticipated sex work-related stigma among male and female sex workers in Kenya

ABSTRACT

Sex workers face different types of sex work-related stigma, which may include anticipated, perceived, experienced, or internalized stigma. Sex work stigma can discourage health care seeking and hamper STI and HIV prevention and treatment efforts. There is a paucity of validated sex work-related stigma measures, and this limits the ability to study the stigma associated with sex work. A cross-sectional survey was conducted that measured anticipated sex work-related stigma among male and female sex workers in Kenya (N = 729). We examined the construct validity and reliability of the anticipated stigma items to establish a conceptually and statistically valid scale. Our analysis supported a 15-item scale measuring five anticipated sex work stigma domains: gossip and verbal abuse from family; gossip and verbal abuse from healthcare workers; gossip and verbal abuse from friends and community; physical abuse; and exclusion. The scale demonstrated good face, content, and construct validity. Reliability was good for all subscales and the overall scale. The scale demonstrated good model fit statistics and good standardized factor loadings. The availability of valid and reliable stigma measures will enhance efforts to characterize and address stigma among sex workers and ultimately support the protection, health and well-being of this vulnerable population.

KEYWORDS:

• Sex work-related stigma
• anticipated stigma
• validation
• sex workers
• sub-Saharan Africa

Acknowledgments

We would like to express our gratitude to the partner organizations, research assistants and survey participants. 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]. 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. President’s Emergency Plan for AIDS Relief (PEPFAR), and does not imply endorsement by the U.S. Government.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declarations

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 the National Institute of Mental Health (T32MH096724).

Disclosure: The authors declare that they have no conflict of interest.

Additional information

Funding

The study was funded by the U.S. Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief through funding to the Health Policy Project (agreement AID-OAA-A-10-00067).The content of this publication 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. President’s Emergency Plan for AIDS Relief and does not imply endorsement by the U.S. Government. Additional support for analysis was provided by RTI International. MAS was supported by the National Institute of Mental Health [Grant Number T32MH096724].