Background Stigma remains a barrier to female sex workers' (FSW) access to health services, reflecting fears of being identified as engaging in a criminalised and marginalised occupation, and discrimination and mistreatment by health workers. For FSW living with HIV, the additional stigma can exacerbate discrimination and reluctance to seek care.
Methods We describe intersecting patterns of anticipated and experienced stigma related to sex work and HIV status among FSW in Zimbabwe. As part of the baseline survey for the SAPPH-IRe cluster-randomised trial, we recruited 2722 FSW in 14 sites using Respondent Driven Sampling. We asked 9 questions on perceived sex-work-related stigma. Women self-identifying as HIV+ (n = 1011) answered an additional stigma scale.
Results Sex work-related stigma was higher than HIV-related stigma. This held true for internalised, perceived and experienced forms. For instance, 37% of FSW reported “feeling ashamed” due to their occupation, compared to 20% of those with HIV feeling shame due to their status; 59% of FSW felt they had “lost respect or standing” as a result of being sex workers, while 23% among the HIV+ felt HIV had reduced their social status. In relation to being “talked about badly” for being FSW or HIV+, the figures were 47% and 12%. Similarly, 19% of respondents reported being insulted as FSW but just 5% of those living with HIV felt insulted due to their status. Denial of services by health care workers was low, but nonetheless considered higher for being a sex worker compared to being HIV+.
Conclusions Sex workers in Zimbabwe have high HIV prevalence and experience layered stigma for their role as “immoral” women as well as “vectors of disease.” That sex-work related stigma is more pervasive than HIV-related stigma may be due to “normalisation” of HIV following introduction of widespread treatment, with comparatively greater disapproval for sex work.
Disclosure of interest statement The SAPPH-IRe trial is using Truvada donated by Gilead. We have no other relationships with commercial entities to disclose.