A Psychometric Evaluation and a Framework Test of the HIV Stigma Mechanisms Scale Among a Population-Based Sample of Men and Women Living with HIV in Central Uganda

• Published in: AIDS and behavior Vol. 27; no. 9; pp. 3038 - 3052
• Main Authors: Almeida, Alexandra, Ogbonnaya, Ijeoma Nwabuzor, Wanyenze, Rhoda K., Crockett, Katherine Schmarje, Ediau, Michael, Naigino, Rose, Lin, Chii-Dean, Kiene, Susan M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2023; Springer Nature B.V
• Subjects: Convergence; Evaluation; Families & family life; Female; Health Psychology; Health services; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Infectious Diseases; Male; Measures; Medical personnel; Medicine; Medicine & Public Health; Multiple regression analysis; Original Paper; Psychometrics; Public Health; Quantitative psychology; Reliability; Reproducibility of Results; Social Stigma; Stigma; Uganda - epidemiology; Well being; Uganda; Uganda; Scale; HIV; Stigma; Sub-Saharan Africa
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-023-04026-y

HIV stigma is a critical barrier to HIV prevention and care. This study evaluates the psychometric properties of the HIV Stigma Mechanisms Scale (HIV-SMS) among people living with HIV (PLHIV) in central Uganda and tests the underlying framework. Using data from the PATH/Ekkubo study, (n = 804 PLHIV), we assessed the HIV-SMS’ reliability and validity (face, content, construct, and convergent). We used multiple regression analyses to test the HIV-SMS’ association with health and well-being outcomes. Findings revealed a more specific (5-factor) stigma structure than the original model, splitting anticipated and enacted stigmas into two subconstructs: family and healthcare workers (HW). The 5-factor model had high reliability (α = 0.92–0.98) and supported the convergent validity (r = 0.12–0.42, p < 0.01). The expected relationship between HIV stigma mechanisms and health outcomes was particularly strong for internalized stigma. Anticipated-family and enacted-family stigma mechanisms showed partial agreement with the hypothesized health outcomes. Anticipated-HW and enacted-HW mechanisms showed no significant association with health outcomes. The 5-factor HIV-SMS yielded a proper and nuanced measurement of HIV stigma in central Uganda, reflecting the importance of family-related stigma mechanisms and showing associations with health outcomes similar to and beyond the seminal study.