The Influence of Stigma and Discrimination on Female Sex Workers’ Access to HIV Services in St. Petersburg, Russia

Abstract

Stigma associated with HIV and risk behaviors is known to be a barrier to health care access for many populations. Less is known about female sex workers (FSW) in Russia, a population that is especially vulnerable to HIV-infection, and yet hard-to-reach for service providers. We administered a questionnaire to 139 FSW to better understand how stigma and discrimination influence HIV service utilization. Logistic regression analysis indicated that HIV-related stigma is negatively associated with uptake of HIV testing, while sex work-related stigma is positively associated with HIV testing. HIV-positive FSW are more likely than HIV-negative FSW to experience discrimination in health care settings. While decreasing societal stigma should be a long-term goal, programs that foster inclusion of marginalized populations in Russian health care settings are urgently needed.

Perspectives of the influence of stigma on care-seeking behavior among ethnic Russians living with HIV/AIDS in Ida-Virumaa, Estonia

“…Amirkhanian et al, 2011;Y. A. Amirkhanian, Kelly, & McAuliffe, 2003;Balabanova, Coker, Atun, & Drobniewski, 2006;Bobrova et al, 2006;King et al, 2013;Mimiaga et al, 2010;Rhodes et al, 2006;Rhodes et al, 2012;Sarang et al, 2010;Shilovskaya;Zigon, 2011). The similarities between this study's findings and those of the literature suggest that fear of being publicly identified as having HIV and of the discrimination that may result represents a significant barrier to accessing care and ART adherence for PLWHIV living in post-Soviet countries.…”

“…The cultural metaphors and stigma of HIV, PLWHIV, at-risk populations and disease stigma held in Ida-Virumaa are similar to the perspectives held in the Soviet Union and the Russian Federation (Feshbach, 2006;Goodwin et al, 2003;Hønneland & Rowe, 2005;King, Maman, Bowling, Moracco, & Dudina, 2013;Rhodes et al, 2006;Sarang, Rhodes, Sheon, & Page, 2010;Wallander, 2006;Zigon, 2011). However, there is one important difference between Ida-Virumaa and the findings of studies conducted in other postSoviet countries.…”

“…I have used these abbreviations solely for the purpose of aiding the reader, and not as a means of generalizing or dehumanizing the members of these populations. Through the course of this thesis, I ask the readers to understand that the individual members of these populations are vulnerable people who face others, public perspectives, nationalism, ethnic divisions, government policies and stigma of HIV, AIDS and of at risk populations, particularly IDUs, represent a significant barrier to the efficacy of these programs (Feshbach, 2006;Gilinskiy, 2006;Hønneland & Rowe, 2005;King, Maman, Bowling, Moracco, & Dudina, 2013;Lowndes, Alary, & Platt, 2003;Nivikov, 1987;Orlova, 2009;Paoli, 2002aPaoli, , 2002bPlatt, Wall, et al, 2006;Rhodes et al, 2002;Rhodes et al, 2006;Rhodes et al, 2012;Rowe & Rechel, 2006;Sarang, Rhodes, Sheon, & Page, 2010;Shilovskaya;UNGASS, 2010;Wallander, 2006;Zigon, 2011). For example, the Russian Federation, the most influential state within the region, has implemented strict laws that punitively target drug users, which have resulted in the outlawing of methadone replacement therapy, the use of safe injection sites by police as a means to bait and arrest IDUs (Rhodes et al, 2006;Sarang et al, 2010), and the current political discussion to create forced labor camps, commonly known as gulags, for Russia's estimated 8 million IDUs (Tétrault-Farber, 2015).…”

“…Consequently, Russia's HIV and IDU policy has been riveted with inaction, public downplay of the severity of the epidemic, minimal allocation of funding, and policies that punitively target IDUs, which included outlawing methadone replacement therapy, while at the same time enabling and supporting organized crime and drug dealers. (Feshbach, 2006;Gilinskiy, 2006;King et al, 2013;Orlova, 2009;Paoli, 2002a;Rhodes et al, 2006;Sarang et al, 2010;Wallander, 2006;Zigon, 2011).…”

Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

“…17,18 Although experienced and/or perceived stigma could act as a mechanism through which MSM who engage in transactional sex in Latin America have decreased engagement in HIV care, we were unable to quantify experiences of stigma in this study. Future work should consider the role of experienced and/or perceived stigma specifically as a barrier to engaging in care in this population.…”