# Intersectional Stigma and Pre-Exposure Prophylaxis Continuation among Female Sex Workers in Namibia

> **NIH NIH F31** · JOHNS HOPKINS UNIVERSITY · 2020 · $45,520

## Abstract

PROJECT SUMMARY/ABSTRACT
Background. HIV continues to disproportionately impact
female sex workers (FSW)
in sub-Saharan Africa
(SSA), highlighting the urgent need to address factors that put them at risk. Stigma is a key structural barrier to
accessing HIV testing and prevention services among marginalized populations, but few HIV scientists have
considered it from an intersectional lens. Further, studies assessing PrEP-related stigma have largely not
considered the ways in which PrEP stigma intersects with other forms of stigma, such as sexual practices stigma
or occupational stigma, to influence patterns of PrEP use.
Study Goal and Aims. The goal of this study is to understand how intersectional stigmas, as experienced by
FSW
in Namibia, influence PrEP continuation. Specifically, the study aims to (1) qualitatively explore experiences
of intersectional stigma among in Namibia and how it influences their PrEP outcomes; (2) estimate the
burden and predictors of intersectional stigmas among ; and (3) determine the relationship between
intersectional stigmas and PrEP continuation.
Approach. This study will use an exploratory sequential mixed-methods approach to gain an in-depth
understanding of intersectional stigmas and their impact on PrEP access and continuation among
FSW
FSW
a marginalized
population
in Namibia. Aim 1 will utilize secondary data from approximately
20 in-depth interviews with FSW
and
primary data from approximately 15 in-depth interviews with PrEP providers to better understand experiences
and definitions of stigma. Aim 2 will estimate the burden of intersectional stigmas, using multiple measures of
attribute specific stigma (e.g. PrEP stigma) and non-attributed stigma (i.e. stigma related to one’s overall identity,
rather than specific attributes or behaviors). Aim 2 will also estimate factors associated with experiencing
intersectional stigmas among
FSW
. In Aim 3, the relationship between multiple intersectional stigmas and PrEP
continuation will be estimated using structural equation modeling.
Fellowship Information. The proposed research aligns with NIH HIV research priorities to reduce health
disparities in HIV infection outcomes and with NIMH research priorities to integrate social and behavioral science
with an effective biomedical strategy for HIV prevention. In-depth understanding of intersectional stigmas among
this vulnerable population
will provide important insights into stigma as a structural barrier to PrEP access and
use, and will inform further implementation and scale-up of PrEP programs with
FSW
in SSA. This NRSA will be
dissertation research for Ms. Kaitlyn Atkins, a PhD student at the Johns Hopkins Bloomberg School of Public
Health. Ms. Atkins will be mentored by a Sponsor, two Co-Sponsors, a Scientific Advisor, and a Measurement
Consultant. A training plan has been developed to provide her with tailored experience to support her towards
achieving her goal of becoming a leading, independent HIV researcher.

## Key facts

- **NIH application ID:** 10160481
- **Project number:** 1F31MH124583-01A1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Kaitlyn M Atkins
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $45,520
- **Award type:** 1
- **Project period:** 2020-11-01 → 2023-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10160481

## Citation

> US National Institutes of Health, RePORTER application 10160481, Intersectional Stigma and Pre-Exposure Prophylaxis Continuation among Female Sex Workers in Namibia (1F31MH124583-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10160481. Licensed CC0.

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