Characterising the relationship between migration and stigma affecting healthcare engagement among female sex workers in Lomé, Togo

ABSTRACT

Migration in West Africa is common and complicates the sustained delivery of comprehensive HIV care programmes for those with specific vulnerabilities to HIV, including female sex workers (FSW). This study evaluated whether migration potentiates the burden of stigma affecting FSW in Lomé, Togo. Respondent driven sampling identified 354 FSW who completed HIV testing and a questionnaire. Multivariable logistic regression was used to identify factors associated with stigma among FSW. Among study participants, 76.3% (270/354) were migrants, with 30.2% (107/354) reporting stigma. Migrant FSW were less likely to report stigma (aOR 0.40; 95% CI:0.22–0.73). FSW who had an abortion (aOR 3.40; 95% CI:1.79–6.30) and were tested for a sexually transmitted infection (STI) or HIV (aOR 2.03; 95% CI:1.16–3.55) were more likely to report stigma. Among FSW, 59.8% (211/353) disclosed selling sex to a health worker. Disclosure was more common among FSW who had been tested for an STI or HIV (36.7%; 77/210), or both (55.7%; 117/210), and resulted in an attenuated but significant association between STI or HIV testing and stigma, indicating that disclosure partially mediated the relationship. These results highlight the need to mitigate healthcare-related stigma affecting FSW, while also considering decentralised HIV testing approaches, including HIV self-testing.

KEYWORDS:

• Stigma
• healthcare engagement
• female sex workers
• HIV
• migration

Acknowledgements

The authors are grateful to the women who participated in this study, the Togo Ministry of Health for approving and collaborating on the study, Erin Papworth and Ping-An (Annie) Chen for their support in implementing the study, and the team at USAID and USAID West Africa for their important role in the success of this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and materials

The dataset analysed by the current study is available from the corresponding author on reasonable request.

ORCID

Molly E. Lasater http://orcid.org/0000-0002-7203-5865

Additional information

Funding

This work was supported by the USAID and Project SEARCH, Task Order No. 2, was funded by the US Agency for International Development under Contract No. GHH-I-00-0700,032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project was led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP). The funding body had no role in the design of the study or collection, analysis, and interpretation of data or in writing the manuscript. Molly Lasater was supported by National Institute of Mental Health National Research Service Award (GRANT 12054488; Award ID 1F31 MH110155- 01A1).