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Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso.
BMC Infect Dis. 2019 Mar 05; 19(1):208.BI

Abstract

BACKGROUND

Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa.

METHODS

This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures' convergent validity, their correlations with expected variables were examined through bivariate logistic regression models.

RESULTS

One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach's alpha ranged from 0.71-0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW.

CONCLUSIONS

Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.

Authors+Show Affiliations

Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA. grossoas@gmail.com. Research and Evaluation Unit, Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA. grossoas@gmail.com.Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA.Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA.Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso.Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso.Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso.Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso., Lomé, Togo.Arc-en-ciel, BP 805000, Lomé, Togo.FAMME, BP 12.321 Ville, Lomé, Togo.FAMME, BP 12.321 Ville, Lomé, Togo.Conseil National de Lutte contre le SIDA et les IST, 01 BP 2237, Lomé, 01, Togo.Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30832604

Citation

Grosso, Ashley L., et al. "Development and Reliability of Metrics to Characterize Types and Sources of Stigma Among Men Who Have Sex With Men and Female Sex Workers in Togo and Burkina Faso." BMC Infectious Diseases, vol. 19, no. 1, 2019, p. 208.
Grosso AL, Ketende SC, Stahlman S, et al. Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. BMC Infect Dis. 2019;19(1):208.
Grosso, A. L., Ketende, S. C., Stahlman, S., Ky-Zerbo, O., Ouedraogo, H. G., Kouanda, S., Samadoulougou, C., Lougue, M., Tchalla, J., Anato, S., Dometo, S., Nadedjo, F. D., Pitche, V., & Baral, S. D. (2019). Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. BMC Infectious Diseases, 19(1), 208. https://doi.org/10.1186/s12879-019-3693-0
Grosso AL, et al. Development and Reliability of Metrics to Characterize Types and Sources of Stigma Among Men Who Have Sex With Men and Female Sex Workers in Togo and Burkina Faso. BMC Infect Dis. 2019 Mar 5;19(1):208. PubMed PMID: 30832604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. AU - Grosso,Ashley L, AU - Ketende,Sosthenes C, AU - Stahlman,Shauna, AU - Ky-Zerbo,Odette, AU - Ouedraogo,Henri Gautier, AU - Kouanda,Seni, AU - Samadoulougou,Cesaire, AU - Lougue,Marcel, AU - Tchalla,Jules, AU - Anato,Simplice, AU - Dometo,Sodji, AU - Nadedjo,Felicity D, AU - Pitche,Vincent, AU - Baral,Stefan D, Y1 - 2019/03/05/ PY - 2017/08/30/received PY - 2019/01/08/accepted PY - 2019/3/6/entrez PY - 2019/3/6/pubmed PY - 2019/4/12/medline KW - Burkina Faso KW - HIV KW - MSM KW - Sex workers KW - Sexual minorities KW - Social stigma KW - Togo SP - 208 EP - 208 JF - BMC infectious diseases JO - BMC Infect Dis VL - 19 IS - 1 N2 - BACKGROUND: Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. METHODS: This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures' convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. RESULTS: One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach's alpha ranged from 0.71-0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. CONCLUSIONS: Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/30832604/Development_and_reliability_of_metrics_to_characterize_types_and_sources_of_stigma_among_men_who_have_sex_with_men_and_female_sex_workers_in_Togo_and_Burkina_Faso_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3693-0 DB - PRIME DP - Unbound Medicine ER -