Skip to main content

Advertisement

SpringerLink
Log in

Health Care Provider Attitudes and Beliefs About People Living with HIV: Initial Validation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS)

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

HIV stigma is a pressing concern for people living with HIV, and particularly when it is perpetuated by health care providers, as it may affect quality of life and access to health care services. The current study describes the development and initial validation of a contextually appropriate HIV stigma scale for health care providers in North America. A ground-up qualitative approach was used to develop the scale, and it was assessed psychometrically with health care trainees across Canada. The measure demonstrates excellent internal consistency reliability and test–retest reliability, as well as convergent and divergent validity. The study supports a tripartite model of HIV stigma consisting of stereotyping, prejudice and discrimination. The scale provides a new tool to assess HIV stigma in health care providers and can be used to inform training, intervention and self-evaluation of stigmatizing attitudes, beliefs and behaviors among providers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Herek GM, Capitanio JP. Symbolic prejudice or fear of infection? A functional analysis of AIDS-related stigma among heterosexual adults. Basic Appl Soc Psychol. 1998;20(3):230–41. doi:10.1207/15324839851036705.

    Article  Google Scholar 

  2. Herek GM, Capitanio JP, Widaman KF. HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999. Am J Public Health. 2002;92(3):371–7. doi:10.2105/AJPH.92.3.371.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Emlet CA. An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Soc Work. 2006;31(4):299–308. doi:10.1093/hsw/31.4.299.

    Article  PubMed  Google Scholar 

  4. Peretti-Watel P, Spire B, Pierret J, Lert F, Obadia Y. The Vespa Group. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003). AIDS Care. 2006;18(3):254–61. doi:10.1080/09540120500456193.

    Article  CAS  PubMed  Google Scholar 

  5. Greig A, Peacock D, Jewkes R, Msimang S. Gender and AIDS: time to act. AIDS. 2008;22(Suppl 2):S35–43. doi:10.1097/01.aids.0000327435.28538.18.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Kebaabetswe PM. Barriers to participation in the prevention of mother-to-child HIV transmission program in Gaborone, Botswana: a qualitative approach. AIDS Care. 2007;19(3):355–60. doi:10.1080/09540120600942407.

    Article  CAS  PubMed  Google Scholar 

  7. Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDs. 2007;21(8):584–92. doi:10.1089/apc.2006.0202.

    Article  PubMed  Google Scholar 

  8. Rosenburg N, Taliaferro D, Ercole P. HIV-related stigma among nursing students in Cameroon. J Assoc Nurses AIDS Care. 2012;23(2):170–6. doi:10.1016/j.jana.2011.09.003.

    Article  PubMed  Google Scholar 

  9. Hoffart S, Ibrahim GM, Lam RA, Minty EP, Theam M, Schaefer JP. Medical students’ attitudes towards treating patients with HIV: a 12-year follow-up study. Med Teach. 2012;34(3):254. doi:10.3109/0142159X.2012.652710.

  10. Alonzo AA, Reynolds NR. Stigma, HIV and AIDS: an exploration and elaboration of a stigma trajectory. Soc Sci Med. 1995;41(3):303–15. doi:10.1016/02779536(94)00384-6.

    Article  CAS  PubMed  Google Scholar 

  11. Deacon H. Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature. J Community Appl Soc Psychol. 2006;16(6):418–25. doi:10.1002/casp.900.

    Article  Google Scholar 

  12. Dowshen N, Binns HJ, Garofalo R. Experiences of HIV-related stigma among young men who have sex with men. AIDS Patient Care STDs. 2009;23(5):371–6. doi:10.1089/apc.2008.0256.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Harrison M, Fusilier MR, Worley JK. Development of a measure of nurses’ AIDS attitudes and conservative views. Psychol Rep. 1994;74(3Pt1):1043–8. doi:10.2466/pr0.1994.74.3.1043.

    Article  CAS  PubMed  Google Scholar 

  14. Mulford CL, Lee MY. Reliability and validity of AIDS victim blaming scales. Psychol Rep. 1996;79(1):191–201. doi:10.2466/pr0.1996.79.1.191.

    Article  CAS  PubMed  Google Scholar 

  15. Pleck JH, O’Donnell L, O’Donnell C, Snarey J. AIDS-phobia, contact with AIDS, and AIDS-related job stress in hospital workers. J Homosex. 1988;15(3–4):41–54. doi:10.1300/J082v15n03_02.

    Article  CAS  PubMed  Google Scholar 

  16. Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363–85. doi:10.1146/annurev.soc.27.1.363.

    Article  Google Scholar 

  17. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29. doi:10.1002/nur.10011.

    Article  CAS  PubMed  Google Scholar 

  18. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24. doi:10.1016/S0277-9536(02)00304-0.

    Article  PubMed  Google Scholar 

  19. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77. doi:10.1007/s10461-009-9593-3.

    Article  PubMed  Google Scholar 

  20. International Planned Parenthood Federation, UNAIDS, International Community of Women Living with HIV/AIDS, Global Network of People Living with HIV. The People Living with HIV Stigma Index User Guide. 2008. www.hivstigmaindex.org.

  21. Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22(Suppl 2):S67–79. doi:10.1097/01.aids.0000327438.13291.62.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Wagner AC, Hart TA, Mohammed S, Ivanova E, Wong J, Loutfy MR. Correlates of HIV stigma in HIV-positive women. Arch Womens Ment Health. 2010;13(3):207–14. doi:10.1007/s00737-010-0158-2.

    Article  PubMed  Google Scholar 

  23. Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12(15). www.jiasociety.org/content/12/1/15. doi:10.1186/1758-2652-12-15.

  24. Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53. doi:10.1080/09540120802511877.

    Article  CAS  PubMed  Google Scholar 

  25. Treichler PA. How to have theory in an epidemic. Durham, NC: Duke University Press; 1999.

    Google Scholar 

  26. Preston DB, Young EW, Koch PB, Forti EM. The nurses’ attitudes about AIDS scale (NAAS): development and psychometric analysis. AIDS Educ Prev. 1995;7(5):443–54.

    CAS  PubMed  Google Scholar 

  27. Froman RD, Owen SV. Further validation of the AIDS Attitude Scale. Res Nurs Health. 1997;20(2):161–7. doi:10.1002/(SICI)1098-240X(199704)20:2<161::AID-NUR8>3.0.CO;2-I.

    Article  CAS  PubMed  Google Scholar 

  28. Stein JA, Li L. Measuring HIV-related stigma among Chinese service providers: confirmatory factor analysis of a multidimensional scale. AIDS Behav. 2008;12(5):789–95. doi:10.1007/s10461-007-9339-z.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Rutledge SE, Whyte J, Abell N, Brown KM, Cesnales NI. Measuring stigma among health care and social service providers: the HIV/AIDS Provider Stigma Inventory. AIDS Patient Care STDs. 2011;25(11):673–82. doi:10.1089/apc.2011.0008.

    Article  PubMed  Google Scholar 

  30. Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93. doi:10.1080/09540120802032627.

    Article  PubMed  Google Scholar 

  31. Yardley L, Bishop F. Mixing qualitative and quantitative methods: a pragmatic approach. In: Willig C, Stainton-Rogers W, editors. Qualitative Research in Psychology. Thousand Oaks, CA: SAGE; 2008.

    Google Scholar 

  32. Brown T. Confirmatory factor analysis. New York: Guilford; 2006.

    Google Scholar 

  33. Johnson RB, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004;33(7):14–26. doi:10.3102/0013189X033007014.

    Article  Google Scholar 

  34. Wagner AC, McShane KE, Hart TA, Margolese S. Health care provider attitudes and beliefs about people living with HIV: a critical qualitative investigation (under review).

  35. Prilleltensky I. Psychology and the status quo. Am Psychol. 1989;44(5):795–802. doi:10.1037/0003-066X.44.5.795.

    Article  Google Scholar 

  36. Borkan J. Immersion/crystallization. In: Crabtree BF, Miller WL, editors. Doing qualitative research. Thousand Oaks, CA: Sage; 1999.

    Google Scholar 

  37. Wagner AC, Margolese S, McShane KE, Hart TA. Conceptualizing HIV-related stigma in terms of discrimination, stereotyping and prejudice among health care providers. Paper presented at: The 12th Social Research Conference on HIV, Hepatitis C, and Related Diseases; 2012; Sydney, Australia.

  38. Strahan R, Gerbasi KC. Short, homogeneous versions of the Marlowe-Crowne Social Desirability Scale. J Clin Psychol. 1972;28(2):191–3. doi:10.1002/1097-4679(197204)28:2<191:AID-JCLP2270280220>3.0.CO;2-G.

    Article  Google Scholar 

  39. Fischer DG, Fick C. Measuring social desirability: short forms of the Marlowe-Crowne Social Desirability Scale. Educ Psychol Meas. 1993;53(2):417–24. doi:10.1177/0013164493053002011.

    Article  Google Scholar 

  40. IBM Corp. IBM SPSS statistics for Windows, version 20.0. Armonk, NY: IBM Corp; 2011.

    Google Scholar 

  41. Bollen KA. Structural equations with latent variables. New York: Wiley; 1989.

    Book  Google Scholar 

  42. Steiger JH. Structural model evaluation and modification: an interval estimation approach. Multivariate Behav Res. 1990;25(2):173–80. doi:10.1207/s15327906mbr2502_4.

    Article  Google Scholar 

  43. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park, CA: Sage; 1993.

    Google Scholar 

  44. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107(2):238–46. doi:10.1037/0033-2909.107.2.238.

    Article  CAS  PubMed  Google Scholar 

  45. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55. doi:10.1080/10705519909540118.

    Article  Google Scholar 

  46. Kline RB. Principles and practice of structural equation modeling. 2nd ed. New York: Guilford; 2005.

    Google Scholar 

  47. Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Pearson Education Inc; 2007.

    Google Scholar 

  48. Costello AB, Osborne J. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. PARE. 2005;10(7). http://www.pareonline.net/pdf/v10n7.pdf.

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Ryerson University, 933 Jorgensen Hall, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada

    Anne C. Wagner, Trevor A. Hart, Kelly E. McShane & Todd A. Girard

  2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Trevor A. Hart

  3. Independent Consultant, Toronto, ON, Canada

    Shari Margolese

Authors
  1. Anne C. Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trevor A. Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kelly E. McShane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shari Margolese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Todd A. Girard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne C. Wagner.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wagner, A.C., Hart, T.A., McShane, K.E. et al. Health Care Provider Attitudes and Beliefs About People Living with HIV: Initial Validation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS). AIDS Behav 18, 2397–2408 (2014). https://doi.org/10.1007/s10461-014-0834-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0834-8

Keywords

Search

Navigation