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Associations among experienced and internalized stigma, social support, and depression among male and female sex workers in Kenya

  • Original article
  • Published:
International Journal of Public Health

Abstract

Objectives

This study (1) estimated the association between experienced sex work-related stigma and moderate-to-severe depressive symptoms (hereafter depression), (2) examined independent associations between internalized stigma, experienced stigma, and depression among sex workers, and (3) investigated the potential modifying role of social support.

Methods

A cross-sectional survey was conducted among 729 male and female sex workers in Kenya.

Results

The prevalence of depression was 33.9%, and nearly all participants reported at least one of the experienced and internalized stigma items. Increasing levels of experienced stigma was associated with an increased predicted prevalence of depression [aPD 0.15 (95% CI 0.11–0.18)]. Increasing internalized stigma was independently associated with higher experienced stigma and depression and appeared to account for 25.5% of the shared variance between experienced stigma and depression after adjustment for confounders. Social support from same-sex sex workers did not appear to modify the association between experienced stigma and depression.

Conclusions

Addressing the high levels of stigma that sex workers face and their mental health needs should be a public health and human rights imperative.

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Acknowledgements

The study was funded by the US Agency for International Development (USAID) and the US President’s Emergency Plan for AIDS Relief (PEPFAR) through funding to the Health Policy Project [Agreement Number AID-OAA-A-10-00067]. The content of this manuscript is the sole responsibility of the authors and does not necessarily reflect the views or policies of US Agency for International Development or the US President’s Emergency Plan for AIDS Relief (PEPFAR) and does not imply endorsement by the US Government.

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Authors and Affiliations

  1. Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA

    Melissa A. Stockton, Brian W. Pence & Joanna Maselko

  2. Kuria Foundation for Social Enterprise, Nairobi, Kenya

    David Mbote

  3. Center for Applied Public Health Research, RTI International, 6110 Executive Boulevard, Rockville, MD, 20852, USA

    Emmanuel A. Oga

  4. Global Health Division, International Development Group, RTI International, Washington, DC, USA

    John Kraemer & Laura Nyblade

  5. Department of Health Systems Administration, Georgetown University, Washington, DC, USA

    John Kraemer

  6. University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya

    Joshua Kimani

  7. Kenya Medical Research Institute, Nairobi, Kenya

    Stella Njuguna

Authors
  1. Melissa A. Stockton
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  2. Brian W. Pence
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  3. David Mbote
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  4. Emmanuel A. Oga
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  5. John Kraemer
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  7. Stella Njuguna
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  8. Joanna Maselko
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  9. Laura Nyblade
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Correspondence to Melissa A. Stockton.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Health Media Lab Institutional Review Board in the USA and the Kenya Medical Research Institute Institutional Review Board in Kenya and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Stockton, M.A., Pence, B.W., Mbote, D. et al. Associations among experienced and internalized stigma, social support, and depression among male and female sex workers in Kenya. Int J Public Health 65, 791–799 (2020). https://doi.org/10.1007/s00038-020-01370-x

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  • DOI: https://doi.org/10.1007/s00038-020-01370-x

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