在多哥和布基纳法索，开发和验证用于描述男男性行为者和女性性工作者中污名类型和来源的指标。
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.
机构信息
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.
Research and Evaluation Unit, Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA.
出版信息
BMC Infect Dis. 2019 Mar 5;19(1):208. doi: 10.1186/s12879-019-3693-0.
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.
背景
污名是一个多方面的概念，它会增加人类免疫缺陷病毒和性传播感染在关键人群中的获得和传播风险，包括男男性行为者（MSM）和性工作者（FSW）。尽管有大量关于污名的文献，但在撒哈拉以南非洲，对关键人群报告的污名类型和来源的研究有限。
方法
本研究利用在多哥和布基纳法索通过应答者驱动抽样招募的 1356 名男男性行为者和 1383 名性工作者收集的数据。参与者完成了一份调查工具，其中包括通过系统评价和现有指标综合制定的污名项目。使用 promax 斜交旋转的探索性因子分析，保留了 16 个项目作为 MSM 的污名度量，20 个项目作为 FSW 污名度量。为了评估这些措施的收敛效度，通过双变量逻辑回归模型检查了它们与预期变量的相关性。
结果
一个因素，即经历的污名，包括由多种类型的施害者实施的行动，包括被捕、被口头骚扰、被勒索、被身体虐待、被折磨或被迫发生性行为。其他因素则因污名的来源而有所区别，包括医疗保健工作者、家人和朋友或警察。具体而言，来自医疗保健工作者的污名包括被拒绝治疗、未得到良好治疗或被医疗保健工作者八卦，以及对寻求医疗保健的恐惧或回避。来自家人和朋友的污名包括被排除在家庭聚会之外、被家人八卦或被朋友拒绝。来自警察的污名包括被拒绝警察保护以及与警察没收避孕套有关的项目。Cronbach's alpha 范围为 0.71-0.82。男男性行为者中每个参与者的污名中位数得分，通过对每个污名项目的肯定回答进行求和而创建，在瓦加杜古最高，而性工作者在瓦加杜古和博博-迪乌拉索均最高。验证分析表明，较高的污名通常与自杀意念、性工作或同性性行为的披露以及男男性行为者或性工作者组织的参与显著相关。
结论
综上所述，这些数据表明，在西非多个城市中心测量影响男男性行为者和性工作者的污名的指标具有较好的可靠性和有效性。
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