Intersectional Stigma and Pre-Exposure Prophylaxis Continuation among Female Sex Workers in Namibia

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Background. HIV continues to disproportionately impact female sex workers (FSW) in sub-Saharan Africa (SSA), highlighting the urgent need to address factors that put them at risk. Stigma is a key structural barrier to accessing HIV testing and prevention services among marginalized populations, but few HIV scientists have considered it from an intersectional lens. Further, studies assessing PrEP-related stigma have largely not considered the ways in which PrEP stigma intersects with other forms of stigma, such as sexual practices stigma or occupational stigma, to influence patterns of PrEP use. Study Goal and Aims. The goal of this study is to understand how intersectional stigmas, as experienced by FSW in Namibia, influence PrEP continuation. Specifically, the study aims to (1) qualitatively explore experiences of intersectional stigma among in Namibia and how it influences their PrEP outcomes; (2) estimate the burden and predictors of intersectional stigmas among ; and (3) determine the relationship between intersectional stigmas and PrEP continuation. Approach. This study will use an exploratory sequential mixed-methods approach to gain an in-depth understanding of intersectional stigmas and their impact on PrEP access and continuation among FSW FSW a marginalized population in Namibia. Aim 1 will utilize secondary data from approximately 20 in-depth interviews with FSW and primary data from approximately 15 in-depth interviews with PrEP providers to better understand experiences and definitions of stigma. Aim 2 will estimate the burden of intersectional stigmas, using multiple measures of attribute specific stigma (e.g. PrEP stigma) and non-attributed stigma (i.e. stigma related to one’s overall identity, rather than specific attributes or behaviors). Aim 2 will also estimate factors associated with experiencing intersectional stigmas among FSW . In Aim 3, the relationship between multiple intersectional stigmas and PrEP continuation will be estimated using structural equation modeling. Fellowship Information. The proposed research aligns with NIH HIV research priorities to reduce health disparities in HIV infection outcomes and with NIMH research priorities to integrate social and behavioral science with an effective biomedical strategy for HIV prevention. In-depth understanding of intersectional stigmas among this vulnerable population will provide important insights into stigma as a structural barrier to PrEP access and use, and will inform further implementation and scale-up of PrEP programs with FSW in SSA. This NRSA will be dissertation research for Ms. Kaitlyn Atkins, a PhD student at the Johns Hopkins Bloomberg School of Public Health. Ms. Atkins will be mentored by a Sponsor, two Co-Sponsors, a Scientific Advisor, and a Measurement Consultant. A training plan has been developed to provide her with tailored experience to support her towards achieving her goal of becoming a leading, independent HIV researcher.