Abstract
Mental health is a significant challenge among women engaged in sex work (WESW), especially in low-resource settings. This study examined the mediating role of family-level and community-level sex work stigma, which is intrinsically linked to HIV, on the relationship between social support and depressive symptoms among WESW. We analyzed baseline data from the Kyaterekera study (R01MH116768), a cluster-randomized trial implemented in southern Uganda, which recruited 542 WESW aged 18-58 years. We applied a structural equation model to examine the hypothesized mediation pathway. Perceived social support was significantly associated with an increase in both mean scores of community-level sex work stigma (β = 0.156, 95% CI: 0.078, 0.235) and family-level sex work stigma (β = 0.165, 95% CI: 0.085, 0.246), respectively. There was a significant direct effect (β = -0.152, 95% CI: -0.239, -0.049) and total effect (β = -0.131, 95% CI: -0.212, -0.051) of social support on depressive symptoms among WESW. Our findings highlight the importance of strengthening supportive, stigma-free networks for WESW, especially where mental health services are scarce. Perceived social support was linked to reduced depressive symptoms and positively associated with sex work stigma, though stigma did not mediate this relationship. Longitudinal and mixed-method studies are needed to clarify the mechanisms underlying these associations.