Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso

Purpose

The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.

Methods

FSWs (N = 350) and MSM (N = 330) aged ≥18 were recruited in Bobo-Dioulasso, Burkina Faso. Perceived health care stigma was defined as either ever being afraid of or avoiding health care services because someone might find out the participant has sex with men (for MSM) or sells sex (for FSW). Correlates of perceived health care stigma were examined using multivariable logistic regression.

Results

The prevalence of perceived health care stigma was 14.9% (52/350) and 24.5% (81/330) in FSWs and MSM, respectively. Among FSWs, experienced or social stigma, including verbal harassment (adjusted odds ratio aOR] = 3.59, 95% confidence interval CI] 1.48–8.71), feeling rejected by friends (aOR = 2.30, 95% CI 1.14–4.64), and feeling police refused to protect them (aOR = 2.58, 95% CI 1.27–5.25), was associated with perceived health care stigma. Among MSM, experiencing verbal harassment (aOR = 1.95, 95% CI 1.09–3.50) and feeling scared to walk in public (aOR = 2.93, 95% CI 1.47–5.86) were associated with perceived health care stigma.

Conclusions

In these key populations, perceived health care stigma was prevalent and associated with experienced and social stigmas. To increase coverage of effective HIV services, interventions should incorporate approaches to comprehensively mitigate stigma.