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Individual and Collective Forms of Stigma Resistance: Pathways Between HIV and Sex Work Stigma and Viral Suppression Among Female Sex Workers in the Dominican Republic

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Abstract

Intersecting forms of stigma including both HIV and sex work stigma have been known to impede HIV prevention and optimal treatment outcomes among FSW. Recent research has indicated that intersectional stigma can be resisted at the community and individual level. We assessed pathways between HIV stigma, sex work stigma, social cohesion and viral suppression among a cohort of 210 FSW living with HIV in the Dominican Republic. Through Poisson regression we explored the relationship between HIV outcomes and internalized, anticipated and enacted HIV and sex work stigma, and resisted sex work stigma. We employed structural equation modeling to explore the direct effect of various forms of stigma on HIV outcomes, and the mediating effects of multi-level stigma resistance including social cohesion at the community level and occupational dignity at the individual level. 76.2% of FSW were virally suppressed and 28.1% had stopped ART at least once in the last 6 months. ART interruption had a significant negative direct effect on viral suppression (OR = 0.26, p < 0.001, 95% CI: 0.13–0.51). Social cohesion had a significant positive direct effect on viral suppression (OR = 2.07, p = 0.046, 95% CI: 1.01–4.25). Anticipated HIV stigma had a significant negative effect on viral suppression (OR = 0.34, p = 0.055, 95% CI: 0.11–1.02). This effect was mediated by the interaction between cohesion and dignity which rendered the impact of HIV stigma on viral suppression not significant. Findings demonstrate that while HIV stigma has a negative impact on viral suppression among FSW, it can be resisted through individual and collective means. Results reinforce the importance of community-driven, multi-level interventions.

Resumen

Se sabe que las formas interseccionales de estigma, que incluyen tanto el estigma del VIH como del trabajo sexual, impiden los resultados de la prevención y el tratamiento del VIH entre las trabajadoras sexuales femininas (TSF). Investigaciones recientes han indicado que se puede resistir el estigma interseccional a nivel comunitario e individual. Evaluamos las vías entre el estigma del VIH, el estigma del trabajo sexual, la cohesión social y la supresión viral entre una cohorte de 210 TSF que viven con el VIH en la República Dominicana. A través de la regresión de Poisson, exploramos la relación entre los resultados del VIH y el estigma del VIH y del trabajo sexual internalizado, anticipado y promulgado, y la resistencia al estigma del trabajo sexual. Empleamos modelos de ecuaciones estructurales para explorar el efecto directo de diversas formas de estigma en los resultados del VIH y los efectos mediados y moderadores de la resistencia al estigma en múltiples niveles, incluida la cohesión social a nivel comunitario y la dignidad ocupacional a nivel individual. El 76.2% de las TSF tenían supresión viral y el 28.1% había suspendido el TAR al menos una vez en los últimos 6 meses. La interrupción del TAR tuvo un efecto directo negativo significativo sobre la supresión viral (OR = 0.26, p < 0.001). La cohesión social tuvo un efecto directo positivo significativo sobre la supresión viral (OR = 2.07, p = 0.046). El estigma anticipado del VIH tuvo un efecto negativo significativo en la supresión viral (OR = 0.34, p = 0.055). Este efecto fue mediado por la interacción entre la cohesión y la dignidad que hizo que el impacto del estigma del VIH en la supresión viral no fuera significativo. Los hallazgos demuestran que, si bien el estigma del VIH tiene un impacto negativo en la supresión viral entre las TSF, se puede resistir a través de medios individuales y colectivos. Los resultados refuerzan la importancia de las intervenciones multinivel impulsadas por la comunidad.

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Acknowledgements

We would like to thank all the study participants for their time and engagement, the research team, and our community-based partners in the Dominican Republic.

Funding

This research was supported by funding from the National Institute of Mental Health (NIMH) of the U.S. National Institutes of Health (NIH) through R01MH110158 (PI: Kerrigan).

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Authors and Affiliations

  1. George Washington University Milken Institute School of Public Health, Washington, DC, USA

    Deanna Kerrigan & Wendy Davis

  2. University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    Clare Barrington

  3. Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic

    Yeycy Donastorg, Martha Perez & Hoisex Gomez

  4. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    S. Wilson Beckham, Tahilin Sanchez Karver & Noya Galai

  5. Public Health Innovation and Action, New York, NY, USA

    Andrea Mantsios

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  1. Deanna Kerrigan
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Correspondence to Andrea Mantsios.

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Kerrigan, D., Barrington, C., Donastorg, Y. et al. Individual and Collective Forms of Stigma Resistance: Pathways Between HIV and Sex Work Stigma and Viral Suppression Among Female Sex Workers in the Dominican Republic. AIDS Behav 28, 357–366 (2024). https://doi.org/10.1007/s10461-023-04169-y

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