Development and Psychometric Assessment of a Multidimensional Measure of Internalized HIV Stigma in a Sample of HIV-positive Adults

Division of General Internal Medicine and Health Services Research, UCLA, 911 Broxton Ave., Los Angeles, CA 90024, USA.
AIDS and Behavior (Impact Factor: 3.49). 05/2008; 12(5):748-58. DOI: 10.1007/s10461-008-9375-3
Source: PubMed


There is a need for a psychometrically sound measure of the stigma experienced by diverse persons living with HIV/AIDS (PLHA). The goal of this study was to develop and evaluate a multidimentional measure of internalized HIV stigma that captures stigma related to treatment and other aspects of the disease among sociodemographically diverse PLHA. We developed a 28-item measure of internalized HIV stigma composed of four scales based on previous qualitative work. Internal consistency reliability estimates in a sample of 202 PLHA was 0.93 for the overall measure, and exceeded 0.85 for three of the four stigma scales. Items discriminated well across scales, and correlations of the scales with shame, social support, and mental health supported construct validity. This measure should prove useful to investigators examining in the role of stigma in HIV treatment and health outcomes, and evaluating interventions designed to mitigate the impacts of stigma on PLHA.

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    • "Various researchers have mentioned several negative outcomes as a result of HIV/AIDS-related stigma and discrimination. For example, the direct negative effects on mental and emotional health of people suffering from HIV/AIDS (Link, Struening, Rahav, Phelan & Nuttbrock 1997;Logie & Gadalla 2009;Minior, Galea, Stuber, Ahern & Ompad 2003;Young, Stuber, Ahern & Galea 2005), key obstacles to use HIV services, including delays in receiving care from health centers (Alonzo & Reynolds 1995;Chesney & Smith 1999;Fortenberry et al. 2002;Holzemer et al. 2007), increasing feelings of hopelessness and despair (Buseh & Stevens 2006), increase rates of depression (Berger, Ferrans & Lashley 2001;Vanable, Carey, Blair & Littlewood 2006;Wright, Naar-King, Lam, Templin & Frey 2007), low selfesteem (Berger et al. 2001;Bunn, Solomon, Miller & Forehand 2007;Vanable et al. 2006;Wright et al. 2007), disorders in mental health (Mak, Poon, Pun & Cheung 2007), participation in risky sexual behaviors (Kinsler, Wong, Sayles, Davis & Cunningham 2007;Sayles et al. 2008;Vanable et al. 2006), and a negative impact on the illness behavior of people suffering from HIV, for example; no interest to look for centers to do HIV testing and no adherence to the medical regimen (Butt 2008;Fortenberry et al. 2002;Pascoe & Smart Richman 2009). Some studies also have raised gendered dimensions and outcomes of people, especially for women, infected with HIV/AIDS. "
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    ABSTRACT: Negative and discriminatory attitudes towards people living with HIV/AIDS (PLWHA) are one of the biggest experienced challenges by people suffering from HIV, and these attitudes have been regarded as a serious threat to the fundamental rights of all infected people who are affected or associated with this disease in Iran. This study aimed to determine the relationship between public perception about HIV/AIDS and discriminatory attitudes toward PLWHA . The present study was conducted using a descriptive and survey design. Data were collected from 450 patients (236 male and 214 female) in Tehran and Yazd cities. The research instruments were modified HIV-related knowledge/attitude and perception questions about PLWHA, and discriminatory attitudes toward PLWHA. The results showed that prevalence of discriminatory attitudes toward PLWHA in the studied population was 60.0%. There was a significant negative correlation between citizens' awareness about HIV/AIDS, HIV-related attitudes, negative perception toward people with HIV/AIDS symptoms and their discriminatory attitudes toward PLWHA (p < .01). The hierarchical multiple regression analysis showed that components of public perception about HIV/AIDS explained for 23.7% of the variance of discriminatory attitudes toward PLWHA. Negative public perceptions about HIV/AIDS in Iran associated with discriminatory attitudes toward PLWHA and cultural beliefs in Iran tend to stigmatize and discriminate against the LWHA.
    Preview · Article · Jan 2016 · SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council
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    • "ternalized stigma and a desire to save face sometimes interfered with patient - provider relationships . Although our sample size was too small to allow robust analysis of HIV stigma scale structural validity in this population ( using structural equation modeling ) , reliability estimates were comparable to those obtained for the original scale ( Sayles et al . , 2008 ) . Given the cross - sectional design , we were unable to assess causal relationships between HIV stigma , health behaviors , and clinical outcomes . Finally , we did not examine sexual or ethnic minority status as potentially important types of intersecting stigma ."
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    ABSTRACT: In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Jul 2015 · The Journal of the Association of Nurses in AIDS Care: JANAC
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    • "Cronbach's alpha was 0.81. HIV-related stigma: We adopted the HIV Stigma scale (Sayles et al., 2008) using 12 items to assess internalized stigma related to being HIV-positive. Cronbach's alpha was 0.82. "
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    ABSTRACT: Little is known about the psychosocial factors that might impact the functioning ability of heterosexual men living with HIV. We examined positive and negative coping, social support, and HIV stigma as predictors of physical and global functioning in a cross-sectional sample of 317 HIV-infected adult heterosexual male patients recruited from clinical and social service agencies in New York City. Study participants were primarily minority and low income. Sixty-four percent were African-American, 55% were single, and 90% were 40 years of age or older. The majority had long-term HIV (LTHIV), with an average duration of 15 years since diagnosis. After controlling for participant characteristics, structural equation modeling analyses revealed that positive coping and social support had a significant positive direct effect on global functioning, while stigma had a significant negative direct effect on global functioning. The physical functioning model revealed that negative coping and HIV stigma had significant negative direct effects, whereas social support had a significant positive indirect effect. Age and duration of HIV diagnosis were not associated with physical and global functioning. In conclusion, we found that heterosexual men living with LTHIV who have ineffective coping, less social support, and greater stigma have reduced functioning ability. Study findings have implications for developing interventions aimed at increasing and retaining functioning ability with the end goal of improving successful aging in this population.
    Full-text · Article · Mar 2015 · AIDS Care
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