Background: Intimate partner violence (IPV) and dimensions of stigma are thought to increase HIV risk by increasing stress and changing power dynamics that may lead to reduced self-protected behaviors. These factors may be especially important among members of groups with historically elevated HIV risk, including female sex workers (FSW). We report IPV and sex work stigma among FSW in Zambia and their association with HIV risk-related factors.
Methods: In September-October 2016, a quantitative survey was conducted with 965 HIV-uninfected FSW in Livingstone, Chirundu, and Kapiri, Zambia. IPV was measured by asking if participants had been physically or sexually abused in the previous 12 months, or if they had had sex because they were afraid not to. Sex work-related stigma was measured by a scale consisting of six questions measuring experiences of stigma related to sex work. The scale was summed and had a range of 1-24 (higher numbers indicate more stigma). Factors affecting HIV risk included HIV testing history and condom use with clients. Multivariable logistic and linear regression models were built to determine the association between 1) HIV testing and 2) condom use with clients and IPV and sex work stigma, adjusted for sociodemographic variables.
Results: Median age was 25 years (IQR 21-30 years) and 560 (59.0%) reported a monthly income of < 500 ZMK (~USD$50). Most participants (61.1%) reported at least one form of IPV in the previous 12 months. Median stigma score was 18 (IQR 14-21). Most participants reported inconsistent condom use with clients (74.6%), and most had tested for HIV at least once (79.3%). IPV and sex work stigma were associated with decreased odds of HIV testing (IPV: aOR 0.59, 95% CI 0.41-0.85; sex work stigma: aOR 0.94, 95% CI 0.89-0.99). IPV (aOR 1.73, 95% CI 1.34-2.23) but not sex work stigma (aOR 1.04, 95% CI 0.99-1.09) were associated with non-condom use with clients.
Conclusions: Experiences of IPV and sex work-related stigma were high in this population, and may contribute substantially to HIV acquisition risk. Interventions mitigating IPV and stigma may be an important component of comprehensive HIV prevention programs for FSW in Zambia.