{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:33:26Z","timestamp":1791966806969,"version":"4.3.4"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Female sex workers (FSWs) face significant stigma, which hinders their access to healthcare, social support, and fundamental human rights. Stigma is often compounded by criminalization, violence, and discriminatory attitudes, particularly in low-income regions like Northern Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aims to analyze the underlying dimensions of stigma among FSWs in Gulu City, Northern Uganda, to provide insights for targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A community-based cross-sectional study was conducted from February to March 2023 in Gulu City, Northern Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 314 FSWs aged 18\u201349 years participated in the study, yielding a response rate of 83.9%. Participants were recruited using consecutive sampling from hotspots such as bars, brothels, streets, and community health centers. Data were collected through face-to-face interviews using a pre-tested semi-structured\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/journals.sagepub.com\/doi\/suppl\/10.1177\/17455057251341729\">questionnaire<\/jats:ext-link>\n                      . Descriptive statistics summarized sociodemographic and economic characteristics. Principal component analysis (PCA) with varimax rotation was applied to identify the primary components of stigma. Factor retention was guided by eigenvalues &gt;1.0, scree plot analysis, and factor loadings \u2a7e0.35. Reliability was assessed using Cronbach\u2019s alpha. Multivariate analysis examined the association between stigma and demographic variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age of participants was 28.8 years (standard deviation = 6.4), with most having completed primary education (46.2%). A majority resided in urban areas (93.3%), and 70.7% reported experiencing violence from clients. PCA identified three key dimensions of stigma: social stigma, healthcare-related stigma, and self-stigma. Social stigma encompassed community rejection and discrimination, while healthcare-related stigma involved negative attitudes and experiences within health settings. Self-stigma reflected internalized shame and reduced self-worth among participants. The cumulative variance explained by the three components was 67.2%, with strong internal reliability (Cronbach\u2019s alpha = 0.88). Factors significantly associated with stigma included age, education level, and experience of violence (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The multidimensional nature of stigma among FSWs in Gulu City highlights the urgent need for holistic interventions. Addressing community stigma, improving healthcare provider attitudes, and offering psychosocial support to reduce self-stigma are critical for improving health outcomes and quality of life. The use of PCA provided a robust framework to uncover key stigma dimensions and guiding tailored interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057251341729","type":"journal-article","created":{"date-parts":[[2025,5,31]],"date-time":"2025-05-31T07:15:18Z","timestamp":1748675718000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Multidimensional analysis of stigma among female sex workers in Northern Uganda: Principal component and factor analyses"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0481-2220","authenticated-orcid":false,"given":"Amir","family":"Kabunga","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Lira University, Lira, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Bongomin","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vella","family":"Ayugi","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9748-693X","authenticated-orcid":false,"given":"Eustes","family":"Kigongo","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Planning and Management, Lira University, Lira, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,31]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13559"},{"key":"e_1_3_3_3_2","first-page":"285","article-title":"La protecci\u00f3n internacional de los refugiados v\u00edctimas de trata de personas","volume":"42","author":"Llain Arenilla S","year":"2014","unstructured":"Llain Arenilla S, Guzm\u00e1n Su\u00e1rez SP. La protecci\u00f3n internacional de los refugiados v\u00edctimas de trata de personas. Rev Derecho 2014; 42: 285\u2013311.","journal-title":"Rev Derecho"},{"key":"e_1_3_3_4_2","first-page":"1337","article-title":"Sex trafficking and the sex industry: The need for evidence-based theory and legislation","volume":"101","author":"Weitzer R","year":"2011","unstructured":"Weitzer R. Sex trafficking and the sex industry: The need for evidence-based theory and legislation. J Crim Criminol 2011; 101: 1337.","journal-title":"J Crim Criminol"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v21i2.14"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-021-01144-1"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-020-00448-8"},{"key":"e_1_3_3_8_2","first-page":"215","article-title":"Selections from stigma","volume":"203","author":"Goffman E","year":"1997","unstructured":"Goffman E. Selections from stigma. Disabil Stud Read 1997; 203: 215.","journal-title":"Disabil Stud Read"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2022.2105377"},{"issue":"2","key":"e_1_3_3_10_2","first-page":"1","article-title":"\u201cWe are Treated as Outsiders in Our Own City\u201d: lived experiences of intersectional stigma against sex workers in Kolkata, India","volume":"21","author":"Acharya A","year":"2024","unstructured":"Acharya A, Azhar S. \u201cWe are Treated as Outsiders in Our Own City\u201d: lived experiences of intersectional stigma against sex workers in Kolkata, India. Sex Res Soc Policy 2024; 21(2): 1\u201313.","journal-title":"Sex Res Soc Policy"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-019-1084-1"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/13691058.2022.2160014"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-020-01370-x"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002680"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.114873"},{"key":"e_1_3_3_16_2","volume-title":"An analysis of the law and policy on prostitution in Uganda: a case study of Kampala District","author":"Kekimuri J","year":"2018","unstructured":"Kekimuri J. An analysis of the law and policy on prostitution in Uganda: a case study of Kampala District. Makerere University: Kampala, Uganda, 2018."},{"key":"e_1_3_3_17_2","unstructured":"Ma H. The stigma of sex work and associated health care services from the perspectives of sex workers nurses and nursing students in Hong Kong: the development of an intervention to reduce stigma towards sex workers among nurses. The University of Hong Kong: Hong Kong 2020."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2022.101511"},{"key":"e_1_3_3_19_2","volume-title":"The lived experiences of young adult female sex workers in Zimbabwe","author":"Lipeleke F","year":"2023","unstructured":"Lipeleke F. The lived experiences of young adult female sex workers in Zimbabwe. South Africa: University of Johannesburg, 2023."},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.2147\/OAJC.S399973"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41182-023-00536-6"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000794280.73744.fe"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.2307\/2091346"},{"issue":"1","key":"e_1_3_3_24_2","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.enfie.2021.03.004","article-title":"Sampling techniques and sample size calculation: how and how many participants should I select for my research?","volume":"33","author":"Arrogante O","year":"2021","unstructured":"Arrogante O. Sampling techniques and sample size calculation: how and how many participants should I select for my research? Enferm Intensiva (Engl Ed) 2021; 33(1): 44\u201347.","journal-title":"Enferm Intensiva (Engl Ed)"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2010.525606"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.4103\/sja.SJA_543_18"},{"key":"e_1_3_3_27_2","first-page":"7","article-title":"Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis","volume":"10","author":"Costello A","year":"2005","unstructured":"Costello A, Osborne J. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval 2005; 10: 7.","journal-title":"Pract Assess Res Eval"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/00018392221075344"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.2147\/HIV.S463506"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12119-020-09707-7"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1521\/aeap.2021.33.4.290"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-15809-2"},{"key":"e_1_3_3_33_2","volume-title":"Surviving a dying industry: the compounded effect of precarity and stigma on strippers in Britain","author":"Herrmann T","year":"2022","unstructured":"Herrmann T. Surviving a dying industry: the compounded effect of precarity and stigma on strippers in Britain. United Kingdom: University of York, 2022."},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-079478"}],"container-title":["Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057251341729","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17455057251341729","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057251341729","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:29:05Z","timestamp":1777710545000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17455057251341729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":33,"alternative-id":["10.1177\/17455057251341729"],"URL":"https:\/\/doi.org\/10.1177\/17455057251341729","relation":{},"ISSN":["1745-5057","1745-5065"],"issn-type":[{"value":"1745-5057","type":"print"},{"value":"1745-5065","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]},"article-number":"17455057251341729"}}