ABSTRACT

Female sex workers (FSW) often face severe stigma and discrimination and are extremely vulnerable to HIV and other sexually transmitted infections. In the fields of HIV and mental health, internalized stigma is associated with poor health care engagement. Due to the lack of valid, standardized measures for internalized sex work-related stigma, its dimensions and role are not well-understood. This study aimed to validate the six-item Internalized AIDS-Related Stigma Scale adapted to capture internalized sex work-related stigma by examining the scale’s psychometric properties and performance among a cross-sectional, snowball sample of FSW (N = 497) in Kenya. While the original pre-hypothesized six-item model yielded acceptable CFI and SRMR values (CFI = 0.978 and SRMR = 0.038), the RMSEA was higher than desirable (RMSEA = 0.145). Our final four-item model demonstrated improved goodness of fit indices (RMSEA = 0.053; CFI = 0.999; and SRMR = 0.005). Both the pre-hypothesized six-item and reduced final four-item model demonstrated good internal consistency (Cronbach’s alphas of 0.8162 and 0.8754, respectively). Higher levels of internalized stigma were associated with depression, riskier sexual behavior, and reduced condom use. This very brief measure will allow for reliable assessment of internalized stigma among FSW. Further investigation of internalized stigma among male sex workers, particularly the intersection of sex work-related and same-sex behavior-related stigmas, is needed.

 抽象的

女性性工作者 (FSW) 经常面临严重的耻辱和歧视，并且极易感染艾滋病毒和其他性传播感染。在艾滋病毒和心理健康领域，内在的耻辱与医疗保健参与度低有关。由于缺乏针对内化性工作相关耻辱的有效、标准化措施，其规模和作用尚不清楚。本研究旨在通过检查肯尼亚 FSW（N = 497）横截面滚雪球样本中量表的心理测量特性和表现，验证六项内化艾滋病相关耻辱量表，该量表适用于捕获内化性工作相关耻辱。虽然原始预先假设的六项模型产生了可接受的 CFI 和 SRMR 值（CFI = 0.978 和 SRMR = 0.038），但 RMSEA 高于预期值（RMSEA = 0.145）。我们的最终四项模型证明了拟合优度指数的提高（RMSEA = 0.053；CFI = 0.999；SRMR = 0.005）。预先假设的六项模型和简化的最终四项模型都表现出良好的内部一致性（Cronbach 的 alpha 分别为 0.8162 和 0.8754）。较高水平的内在耻辱与抑郁、较高风险的性行为和减少安全套使用有关。这项非常简短的措施将能够对 FSW 内部的耻辱进行可靠的评估。需要进一步调查男性性工作者的内在耻辱，特别是与性工作相关的耻辱和与同性行为相关的耻辱的交叉点。