Abstract:
Abstract
While HIV stigma has received signifcant attention, limited work has been conducted on the measurement of intersecting
stigmas. We developed the Experiences of Sex Work Stigma (ESWS) scale in the Dominican Republic (DR) and Tanzania.
We conducted in-depth interviews with 20 female sex workers (FSW) per country to identify scale domains followed by
cognitive debriefng interviews to assess content validity. Items were administered in a survey to FSW in DR (n =211)
and Tanzania (n=205). Factor analysis established four sex work stigma domains including: shame (internalized), dignity
(resisted), silence (anticipated) and treatment (enacted). Reliability across domains ranged from 0.81 to 0.93. Using item
response theory (IRT) we created context-specifc domain scores accounting for diferential item functioning between coun tries. ESWS domains were associated with internalized HIV stigma, depression, anxiety, sexual partner violence and social
cohesion across contexts. The ESWS is the frst reliable and valid scale to assess multiple domains of sex work stigma and
can be used to examine the efects of this form of intersectional stigma on HIV-related outcomes across settings.
Keywords HIV · Sex work · Intersectional · Stigma · Scale · IRT · Reliability · Validity
