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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

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Abstract

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.

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Data Availability

An appendix is provided with the HIV Stigma Mechanism Scale questions in English and Luganda, and the non-parametric option characteristic curves (NP-OCC) for the scale revised five subconstructs.

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Funding

The parent study was supported by the National Institute of Mental Health (NIMH) Grant R01MH106391 awarded to Susan M. Kiene and Rhoda K. Wanyenze. The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Alexandra Almeida

  2. School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA

    Alexandra Almeida

  3. Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil

    Alexandra Almeida

  4. School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA

    Ijeoma Nwabuzor Ogbonnaya

  5. Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda

    Rhoda K. Wanyenze & Susan M. Kiene

  6. Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA

    Katherine Schmarje Crockett, Michael Ediau, Rose Naigino & Susan M. Kiene

  7. The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA

    Katherine Schmarje Crockett, Michael Ediau & Rose Naigino

  8. Department of Mathematics & Statistics, San Diego State University, La Jolla, CA, USA

    Chii-Dean Lin

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  1. Alexandra Almeida
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Contributions

The original study was conceived and undertaken by SMK and RKW. This manuscript presents secondary data analysis, which was completed by AA. AA, SMK, and INO interpreted the study findings. The manuscript was drafted by AA with SMK, INO, RKW, KSC, ME, RN, and CDL revising the drafted text. All authors provided final approval for the publication.

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Correspondence to Susan M. Kiene.

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The authors declare no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional (San Diego State University and Makerere University School of Public Health) and national research committee (Uganda National Council for Science and Technology) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Almeida, A., Ogbonnaya, I.N., Wanyenze, R.K. et al. 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. AIDS Behav 27, 3038–3052 (2023). https://doi.org/10.1007/s10461-023-04026-y

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