Kabunga Amir, Bongomin Felix, Ayugi Vella, Kigongo Eustes
Department of Psychiatry, Lira University, Lira, Uganda.
Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251341729. doi: 10.1177/17455057251341729. Epub 2025 May 31.
Female sex workers (FSWs) face significant stigma, which hinders their access to healthcare, social support, and fundamental human rights. Stigma is often compounded by criminalization, violence, and discriminatory attitudes, particularly in low-income regions like Northern Uganda.
This study aims to analyze the underlying dimensions of stigma among FSWs in Gulu City, Northern Uganda, to provide insights for targeted interventions.
A community-based cross-sectional study was conducted from February to March 2023 in Gulu City, Northern Uganda.
A total of 314 FSWs aged 18-49 years participated in the study, yielding a response rate of 83.9%. Participants were recruited using consecutive sampling from hotspots such as bars, brothels, streets, and community health centers. Data were collected through face-to-face interviews using a pre-tested semi-structured questionnaire. Descriptive statistics summarized sociodemographic and economic characteristics. Principal component analysis (PCA) with varimax rotation was applied to identify the primary components of stigma. Factor retention was guided by eigenvalues >1.0, scree plot analysis, and factor loadings ⩾0.35. Reliability was assessed using Cronbach's alpha. Multivariate analysis examined the association between stigma and demographic variables.
The mean age of participants was 28.8 years (standard deviation = 6.4), with most having completed primary education (46.2%). A majority resided in urban areas (93.3%), and 70.7% reported experiencing violence from clients. PCA identified three key dimensions of stigma: social stigma, healthcare-related stigma, and self-stigma. Social stigma encompassed community rejection and discrimination, while healthcare-related stigma involved negative attitudes and experiences within health settings. Self-stigma reflected internalized shame and reduced self-worth among participants. The cumulative variance explained by the three components was 67.2%, with strong internal reliability (Cronbach's alpha = 0.88). Factors significantly associated with stigma included age, education level, and experience of violence ( < 0.05).
The multidimensional nature of stigma among FSWs in Gulu City highlights the urgent need for holistic interventions. Addressing community stigma, improving healthcare provider attitudes, and offering psychosocial support to reduce self-stigma are critical for improving health outcomes and quality of life. The use of PCA provided a robust framework to uncover key stigma dimensions and guiding tailored interventions.
女性性工作者面临着严重的污名化，这阻碍了她们获得医疗保健、社会支持和基本人权。污名化往往因刑事定罪、暴力和歧视性态度而加剧，尤其是在乌干达北部等低收入地区。
本研究旨在分析乌干达北部古卢市女性性工作者污名化的潜在维度，为有针对性的干预措施提供见解。
2023年2月至3月在乌干达北部古卢市进行了一项基于社区的横断面研究。
共有314名年龄在18 - 49岁的女性性工作者参与了该研究，应答率为83.9%。通过在酒吧、妓院、街道和社区卫生中心等热点地区采用连续抽样的方式招募参与者。通过使用预先测试的半结构化问卷进行面对面访谈收集数据。描述性统计总结了社会人口统计学和经济特征。应用主成分分析（PCA）和方差最大化旋转来识别污名化的主要成分。通过特征值>1.0、碎石图分析和因子载荷⩾0.35来指导因子保留。使用克朗巴赫α系数评估信度。多变量分析研究了污名化与人口统计学变量之间的关联。
参与者的平均年龄为28.8岁（标准差 = 6.4），大多数人完成了小学教育（46.2%）。大多数人居住在城市地区（93.3%），70.7%的人报告曾遭受客户的暴力。主成分分析确定了污名化的三个关键维度：社会污名、医疗保健相关污名和自我污名。社会污名包括社区排斥和歧视，而医疗保健相关污名涉及在医疗环境中的负面态度和经历。自我污名反映了参与者内心的羞耻感和自我价值的降低。这三个成分解释的累积方差为67.2%，具有很强的内部信度（克朗巴赫α系数 = 0.88）。与污名化显著相关的因素包括年龄、教育水平和暴力经历（<0.05）。
古卢市女性性工作者污名化的多维度性质凸显了采取整体干预措施的迫切需求。消除社区污名、改善医疗服务提供者的态度以及提供心理社会支持以减少自我污名对于改善健康结果和生活质量至关重要。主成分分析的使用提供了一个强大的框架，以揭示关键的污名维度并指导量身定制的干预措施。
