Measuring stigma affecting sex workers (SW) and men who have sex with men (MSM): A systematic review

Abstract

BackgroundStigma involves discrediting a person or group based on a perceived attribute, behaviour or reputation associated with them. Sex workers (SW) and men who have sex with men (MSM) are key populations who are often at increased risk for the acquisition and transmission of HIV and who are affected by stigma that can negatively impact their health and well-being. Although stigma was included as an indicator in the US National HIV/AIDS Strategic Plan and there have been consultations focused on adding a stigma indicator within PEPFAR and the Global Fund in relation to potentiating HIV risks among key populations, there remains limited consensus on the appropriate measurement of SW- or MSM-associated stigma. Consequently, this systematic review summarizes studies using quantitative, qualitative, or mixed methods approaches to measure stigma affecting sex workers and men who have sex with men.Methods and findingsThis systematic review included English, French, and Spanish peer-reviewed research of any study design measuring SW- or MSM-associated stigma. Articles were published from January 1, 2004 to March 26, 2014 in PsycINFO, PubMed, EMBASE, CINAHL Plus, Global Health, and World Health Organization Global Health Library Regional Indexes.Of the 541 articles reviewed, the majority measured stigma toward MSM (over 97%), were conducted in North America, used quantitative methods, and focused on internalized stigma.ConclusionsWith the inclusion of addressing stigma in several domestic and international HIV strategies, there is a need to ensure the use of validated metrics for stigma. The field to date has completed limited measurement of stigma affecting sex workers, and limited measurement of stigma affecting MSM outside of higher income settings. Moving forward requires a concerted effort integrating validated metrics of stigma into health-related surveys and programs for key populations.

The role of sex work laws and stigmas in increasing HIV risks among sex workers

“…Stigma measures were asked as attributable to engagement in sex work, except for measures of physical and sexual violence. Stigma measures were informed by a systematic review of stigma metrics and were validated with data from Togo and Burkina Faso 26,62,63 .…”

“…The relationship between HIV and uniformed officers refusal to provide protection varies by legal status (MH p value < 0.01) with an increased odds in settings without legal specification (aOR: 1.64; 95% CI: 1.29-2.08; p value < 0.001) and criminalized settings (aOR: 1.38; 95% CI: 1.10-1.72; p value = 0.005) compared with partially legalized settings. Blackmail is associated with HIV in non-specified settings (aOR: 1.50; 95% CI: 1.37-1.65; p value: < 0.001) and criminalized settings (aOR: 1.35; 95% CI: 1.07-1.71; p value: 0.010) compared with partially legalized 27 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) Median years in sex work (IQR) settings. HIV is associated with physical violence in criminalized settings versus partially legalized settings (aOR: 1.34; 95% CI: 1.11-1.62; p value = 0.002).…”

“…Sexual behavior stigmas can include anticipated, perceived, or enacted stigmas attributable to an individual's sexual behavior, including engagement in sex work 25 . However, the majority of studies measuring stigmas among key populations have focused on stigmas affecting sexual and gender minorities, with only 2% of identified stigma measurement related to sex work 26 . Understanding sex work-related stigmas, especially across different legal contexts has direct implications for the implementation and effectiveness of HIV treatment programs.…”

HIV-related data among key populations to inform evidence-based responses: protocol of a systematic review

“…Where data are available, they are often not used in key documents and policy decisions, despite an international call to further evidence-based policies [ 14 ]. Systematic reviews conducted in the past among key populations have comprehensively identified where data exist and synthesized available data to provide estimates on a range of indicators, including HIV prevalence, HIV incidence, and population size estimates [ 5 , 6 , 14 , 18 , 19 , 25 – 30 ]. However, with rapidly evolving methods for estimating population size and HIV transmission dynamics, these estimates have become dated both in terms of age of data and their usability by key stakeholders.…”

Alcohol abstinence stigma and alcohol use among HIV patients in Thai Nguyen, Vietnam

“…This potential dual stigma-HIV and alcohol abstinence-has not yet been addressed for PWH. Although stigma is generally associated with harmful health behaviors such as injection drug use or sex work, safe health behaviors may be stigmatized [21][22][23]. Currently, there are no quantitative measures to capture alcohol abstinence stigma.…”