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AIDS and Behavior
Published in: AIDS and Behavior 5/2008

01-09-2008 | Original Paper

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

Authors: Jennifer N. Sayles, Ron D. Hays, Catherine A. Sarkisian, Anish P. Mahajan, Karen L. Spritzer, William E. Cunningham

Published in: AIDS and Behavior | Issue 5/2008

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Abstract

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.
Literature
Bairan, A., Taylor, G. A., Blake, B. J., Akers, T., Sowell, R., & Mendiola, R. Jr. (2007). A model of HIV disclosure: Disclosure and types of social relationships. Journal of the American Academy of Nurse Practitioners, 19, 242–250.PubMedCrossRef
Berger, B. E., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Research in Nursing & Health, 24, 518–529.CrossRef
Berry, S. H., Brown, J. A., & Athey, L. A. (2002). HCSUS patient questionnaires. Santa Monica, CA: Rand Health Corporation.
Bodenlos, J. S., Grothe, K. B., Kendra, K., Whitehead, D., Copeland, A. L., & Brantley, P. J. (2004). Attitudes toward HIV health care providers scale: Development and validation. AIDS Patient Care and STDS, 18, 714–720.PubMedCrossRef
Bogart, L. M., Cowgill, B. O., Kennedy, D., Ryan, G., Murphy, D. A., Elijah, J., & Schuster, M. A. (2008). Internalized HIV stigma among people with HIV and their families: A qualitative analysis. AIDS and Behavior, 12, 244–254.PubMedCrossRef
Bunn, J. Y., Solomon, S. E., Miller, C., & Forehand, R. (2007). Measurement of stigma in people with HIV: A reexamination of the HIV Stigma Scale. AIDS Education and Prevention, 19, 198–208.PubMedCrossRef
Carr, D., & Friedman, M. A. (2005). Is obesity stigmatizing? Body weight, perceived discrimination, and psychological well-being in the United States. Journal of Health and Social Behavior, 46, 244–259.PubMedCrossRef
Carr, R. L., & Gramling, L. F. (2004). Stigma: A health barrier for women with HIV/AIDS. The Journal of the Association of Nurses in AIDS Care, 15, 30–39.PubMedCrossRef
Castro, A., & Farmer, P. (2005). Understanding and addressing AIDS-related stigma: From anthropological theory to clinical practice in Haiti. American Journal of Public Health, 95, 53–59.PubMedCrossRef
Cattell, R. B. (1966). The scree test for the number of factors. Multivariate behavioral research (pp. 245–276). London: Psychology Press.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychological Bulletin, 112, 155–159.
Cunningham, W. E., Andersen, R. M., Katz, M. H., Stein, M. D., Turner, B. J., Crystal, S., Zierler, S., Kuromiya, K., Morton, S. C., St. Clair, P., Bozzette, S. A., & Shapiro, M. F. (1999). The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Medical Care, 37, 1270–1281.PubMedCrossRef
Cunningham, W. E., Hays, R. D., Williams, K. W., Beck, K. C., Dixon, W. J., & Shapiro, M. F. (1995). Access to medical care and health-related quality of life for low-income persons with symptomatic human immunodeficiency virus. Medical Care, 33, 739–754.PubMed
Cunningham, W. E., Markson, L. E., Andersen, R. M., Crystal, S. H., Fleishman, J. A., Golin, C., Gifford, A., Liu, H. H., Nakazono, T. T., Morton, S., Bozzette, S. A., Shapiro, M. F., & Wenger, N. S. (2000). Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the United States. HCSUS Consortium. HIV Cost and Services Utilization. Journal of Acquired Immune Deficiency Syndromes, 25, 115–123.PubMedCrossRef
Cunningham, S. D., Tschann, J., Gurvey, J. E., Fortenberry, J. D., & Ellen, J. M. (2002). Attitudes about sexual disclosure and perceptions of stigma and shame. Sexually Transmitted Infections, 78, 334–338.PubMedCrossRef
Duffy, L. (2005). Suffering, shame, and silence: The stigma of HIV/AIDS. The Journal of the Association of Nurses in AIDS Care, 16, 13–20.PubMedCrossRef
Emlet, C. A. (2006). A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care and STDS, 20, 350–358.PubMedCrossRef
English, R. W. (1971). Correlates of stigma towards physically disabled persons. Rehabilitation Research and Practice Review, 2, 1–17.
Fleishman, J. A., Sherbourne, C. D., Crystal, S., Collins, R. L., Marshall, G. N., Kelly, M., Bozzette, S. A., Shapiro, M. F., & Hays, R. D. (2000). Coping, conflictual social interactions, social support, and mood among HIV-infected persons. HCSUS Consortium. American Journal of Community Psychology, 28, 421–453.PubMedCrossRef
Fortenberry, J. D., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., Malotte, C. K., & Stoner, B. P. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92, 378–381.PubMedCrossRef
Goffman, E. (1963). Notes on the management of a spoiled identity. New York: Simon & Schuster.
Hays, R. D., Anderson, R. T., & Revicki, D. (2000a). Assessing reliability and validity of measurement in clinical trials. Oxford, England: Oxford University Press.
Hays, R. D., Cunningham, W. E., Sherbourne, C. D., Wilson, I. B., Wu, A. W., Cleary, P. D., McCaffrey, D. F., Fleishman, J. A., Crystal, S., Collins, R., Eggan, F., Shapiro, M. F., & Bozzette, S. A. (2000b). Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV cost and services utilization study. The American Journal of Medicine, 108, 714–722.PubMedCrossRef
Hays, R. D., & Hayashi, T. (1990). Beyond internal consistency reliability: Rationale and user’s guide for multitrait analysis program on the microcomputer. Behavior Research Methods, Instrument, and Computers, 22, 167–175.
Herek, G. M., & Capitanio, J. P. (1998). Symbolic prejudice or fear of infection? A functional analysis of AIDS related stigma among heterosexual adults. Basic and Applied Social Psychology, 20, 230–241.CrossRef
Herek, G. M., Gillis, J. R., Glunt, E. K., Lewis, J., Welton, D., & Capitanio, J. P. (1998). Culturally sensitive AIDS educational videos for African American audiences: Effects of source, message, receiver, and context. American Journal of Community Psychology, 26, 705–743.PubMedCrossRef
Jacoby, A. (1994). Felt versus enacted stigma: A concept revisited. Evidence from a study of people with epilepsy in remission. Social Science & Medicine, 38, 269–274.CrossRef
Katz, M. H., Cunningham, W. E., Fleishman, J. A., Andersen, R. M., Kellogg, T., Bozzette, S. A., & Shapiro, M. F. (2001). Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Annals of Internal Medicine, 135, 557–565.PubMed
Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care and STDS, 21, 584–592.PubMedCrossRef
Lekas, H. M., Siegel, K., & Schrimshaw, E. W. (2006). Continuities and discontinuities in the experiences of felt and enacted stigma among women with HIV/AIDS. Qualitative Health Research, 16, 1165–1190.PubMedCrossRef
Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27, 363–385.CrossRef
Marschall, D. E., Sanfter, J. L., & Tangney, J. P. (1994). The state shame and guild scale. Fairfax, VA: George Mason University.
Murphy, D. A., Austin, E. L., & Greenwell, L. (2006). Correlates of Internalized HIV stigma among HIV-positive mothers and their uninfected adolescent children. Women Health, 44, 19–42.PubMed
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. New York: McGraw-Hill.
Nyblade, L. C. (2006). Measuring HIV stigma: Existing knowledge and gaps. Psychology, Health & Medicine, 11, 335–345.CrossRef
Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science & Medicine, 57, 13–24.CrossRef
Rao, D., Pryor, J. B., Gaddist, B. W., & Mayer, R. (2008). Stigma, secrecy, and discrimination: Ethnic/racial differences in the concerns of people living with HIV/AIDS. AIDS and Behavior, 12, 265–271.PubMedCrossRef
Reidpath, D. D., & Chan, K. Y. (2005). A method for the quantitative analysis of the layering of internalized HIV stigma. AIDS Care, 17, 425–432.PubMed
Rintamaki, L. S., Davis, T. C., Skripkauskas, S., Bennett, C. L., & Wolf, M. S. (2006). Social stigma concerns and HIV medication adherence. AIDS Patient Care and STDS, 20, 359–368.PubMedCrossRef
Rutledge, S. E., & Abell, N. (2005). Awareness, acceptance, and action: An emerging framework for understanding AIDS stigmatizing attitudes among community leaders in Barbados. AIDS Patient Care and STDS, 19, 186–199.PubMedCrossRef
Sandelowski, M., & Barroso, J. (2003). Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women. Research in Nursing & Health, 26, 153–170.CrossRef
Sandelowski, M., Lambe, C., & Barroso, J. (2004). Stigma in HIV-positive women. Journal of Nursing Scholarship, 36, 122–128.PubMedCrossRef
Sayles, J. N., Ryan, G. W., Silver, J. S., Sarkisian, C. A., & Cunningham, W. E. (2007). Experiences of social stigma and implications for health care among a diverse population of HIV positive adults. Journal of Urban Health, 84, 814–828.PubMedCrossRef
Schuster, M., Collins, R., Cunningham, W. E., Morton, S. C., Zierler, S., Wong, M., Tu, W., & Kanouse, D. E. (2005). Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care. Journal of General Internal Medicine, 20, 807–813.PubMedCrossRef
Shapiro, M. F., Morton, S. C., McCaffrey, D. F., Senterfitt, J. W., Fleishman, J. A., Perlman, J. F., Athey, L. A., Keesey, J. W., Goldman, D. P., Berry, S. H., & Bozzette, S. A. (1999). Variations in the care of HIV-infected adults in the United States: Results from the HIV cost and services utilization study. The Journal of the American Medical Association, 281, 2305–2315.CrossRef
Simbayi, L., Kalichman, S., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A. (2007). Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science & Medicine, 64, 1823–1831.CrossRef
Sowell, R. L., Seals, B. F., Moneyham, L., Demi, A., Cohen, L., & Brake, S. (1997). Quality of life in HIV-infected women in the south-eastern United States. AIDS Care, 9, 501–512.PubMedCrossRef
Stirratt, M. J., Remien, R. H., Smith, A., Copeland, O. Q., Dolezal, C., & Krieger, D. (2006). The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS and Behavior, 10, 483–493.PubMedCrossRef
Swendeman, D., Rotheram-Borus, M. J., Comulada, S., Weiss, R., & Ramos, M. E. (2006). Predictors of internalized HIV stigma among young people living with HIV. Health Psychology, 25, 501–509.PubMedCrossRef
Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of internalized HIV stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS and Behavior, 10, 473–482.PubMedCrossRef
Ware, J. Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.PubMedCrossRef
Wight, R. G., Aneshensel, C. S., Murphy, D. A., Miller-Martinez, D., & Beals, K. P. (2006). Perceived HIV stigma in AIDS caregiving dyads. Social Science & Medicine, 62, 444–456.CrossRef
Willis, G. B. (1994). Office of research and methodology, National Center for Health Statistics. Cognitive methods staff working paper series, 7.
Wright, K., Naar-King, S., Lam, P., Templin, T., & Frey, M. (2007). Stigma scale revised: Reliability and validity of a brief measure of stigma for HIV+ youth. The Journal of Adolescent Health, 40, 96–98.PubMedCrossRef
Metadata
Title
Development and Psychometric Assessment of a Multidimensional Measure of Internalized HIV Stigma in a Sample of HIV-positive Adults
Authors
Jennifer N. Sayles
Ron D. Hays
Catherine A. Sarkisian
Anish P. Mahajan
Karen L. Spritzer
William E. Cunningham
Publication date
01-09-2008
Publisher
Springer US
Published in
AIDS and Behavior / Issue 5/2008
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-008-9375-3

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