Biologic outcomes include having a detectable HIV RNA VL (defined at ≥50 copies/mL) and any prevalent STI (including gonorrhea, trichomoniasis, and chlamydia).
The socio-behavioral survey instrument includes questions on individual, relational, social-contextual, and structural factors and behaviors related to HIV prevention, care, and treatment outcomes. We drew on our previous research with FSW in the DR to inform the survey items and adapted measures from other settings as needed (described below). Independent variables included in the current analysis include socio-demographics (e.g., age, civil status, residence), history and type of sex work, number of new and regular clients in the last week and month, number of steady intimate partners in the last month, reported consistent condom use (defined as always using condoms in all sex acts with a defined partner category), drug and alcohol use, current or former use of ART, engagement in care (defined as attendance at any HIV care or treatment service in the last 6 months), any reported interruption in use of ART, and AIDS Clinical Trials Group (ACTG) measures related to adherence to ART [30] (link).
We measured both internalized and experienced HIV stigma and discrimination using adapted measures from several reliable aggregate measures including those developed by Berger et al. [31] (link), Zelaya et al. [32] (link), [33] and Baral et al. [34] (link). We also employed Earnshaw's HIV Stigma Framework for the purposes of measurement, which defines internalized (or felt) stigma as the application of negative attitudes towards HIV to oneself and experienced (or enacted) stigma as the experience of being discriminated, stereotyped, or prejudiced against for being infected with HIV [35] (link). Aggregate measures for both domains demonstrated strong unidimensionality and internal reliability. The internalized stigma measure included 8 items assessed on a 4 point Likert-scale (score range 0 to 32, with 0 representing no stigma and 32 high internalized stigma) with a Cronbach's alpha of 0.87. Examples of internalized stigma items included feelings about living with HIV including whether they felt like people treated them differently or they felt like a bad or unworthy person as a result of their status. For the experienced stigma score, there were 10 items with yes or no answers to each (score range 0 to 10 with 0 representing no experienced stigma and 10 high experienced stigma) with a Cronbach's alpha of 0.78. Examples of experienced stigma included reported loss of job, denial of health and other social services, and being verbally harassed or physically abused as a result of living with HIV.
The socio-behavioral survey instrument includes questions on individual, relational, social-contextual, and structural factors and behaviors related to HIV prevention, care, and treatment outcomes. We drew on our previous research with FSW in the DR to inform the survey items and adapted measures from other settings as needed (described below). Independent variables included in the current analysis include socio-demographics (e.g., age, civil status, residence), history and type of sex work, number of new and regular clients in the last week and month, number of steady intimate partners in the last month, reported consistent condom use (defined as always using condoms in all sex acts with a defined partner category), drug and alcohol use, current or former use of ART, engagement in care (defined as attendance at any HIV care or treatment service in the last 6 months), any reported interruption in use of ART, and AIDS Clinical Trials Group (ACTG) measures related to adherence to ART [30] (link).
We measured both internalized and experienced HIV stigma and discrimination using adapted measures from several reliable aggregate measures including those developed by Berger et al. [31] (link), Zelaya et al. [32] (link), [33] and Baral et al. [34] (link). We also employed Earnshaw's HIV Stigma Framework for the purposes of measurement, which defines internalized (or felt) stigma as the application of negative attitudes towards HIV to oneself and experienced (or enacted) stigma as the experience of being discriminated, stereotyped, or prejudiced against for being infected with HIV [35] (link). Aggregate measures for both domains demonstrated strong unidimensionality and internal reliability. The internalized stigma measure included 8 items assessed on a 4 point Likert-scale (score range 0 to 32, with 0 representing no stigma and 32 high internalized stigma) with a Cronbach's alpha of 0.87. Examples of internalized stigma items included feelings about living with HIV including whether they felt like people treated them differently or they felt like a bad or unworthy person as a result of their status. For the experienced stigma score, there were 10 items with yes or no answers to each (score range 0 to 10 with 0 representing no experienced stigma and 10 high experienced stigma) with a Cronbach's alpha of 0.78. Examples of experienced stigma included reported loss of job, denial of health and other social services, and being verbally harassed or physically abused as a result of living with HIV.
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