AIDS and Behavior

, Volume 12, Issue 5, pp 759–771 | Cite as

Development of Parallel Scales to Measure HIV-Related Stigma

  • Maretha J. VisserEmail author
  • Trace Kershaw
  • Jennifer D. Makin
  • Brian W. C. Forsyth
Original Paper


HIV-related stigma is a multidimensional concept which has pervasive effects on the lives of HIV-infected people as well as serious consequences for the management of HIV/AIDS. In this research three parallel stigma scales were developed to assess personal views of stigma, stigma attributed to others, and internalised stigma experienced by HIV-infected individuals. The stigma scales were administered in two samples: a community sample of 1,077 respondents and 317 HIV-infected pregnant women recruited at clinics from the same community in Tshwane (South Africa). A two-factor structure referring to moral judgment and interpersonal distancing was confirmed across scales and sample groups. The internal consistency of the scales was acceptable and evidence of validity is reported. Parallel scales to assess and compare different perspectives of stigma provide opportunities for research aimed at understanding stigma, assessing the consequences or evaluating possible interventions aimed at reducing stigma.


HIV-related stigma Stigma scales Quantitative measurement African context 



This research was supported by grant R24-HD043558 (awarded to Bridget Jeffery, Serithi project, University of Pretoria under the auspices of the Medical Research Council, Unit for Maternal and Infant Health Care Strategies) from the National Institute for Child Health and Human Development. We acknowledge the contributions of Professor B. Jeffery, Dr A. de Villiers, Ms R. Gcabo (University of Pretoria), Professor K. Sikkema (Duke University) and the Serithi research team in conducting the research, and Dr D. Cicchetti (Yale University) for assistance with the statistical analysis.


  1. Aggleton, P. (2000). HIV and AIDS-related stigmatization, discrimination and denial: Forms, contexts and determinants. Research studies from Uganda and India. UNAIDS Best practice collection. Geneva: UNAIDS.Google Scholar
  2. Aggleton, P., & Chase, E. (2001). Stigma, HIV/AIDS and prevention of mother-to-child transmission: A pilot study in Zambia, India, Ukraine and Burkina Faso. United Nations Children’s Fund (UNICEF)/The Panos Institute.Google Scholar
  3. Aggleton, P., & Parker, R. (2002). A conceptual framework and basis for action: HIV/AIDS stigma and discrimination. Geneva: UNAIDS.Google Scholar
  4. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.CrossRefGoogle Scholar
  5. Alicke, M. D. (1985). Global self-evaluation as determined by the desirability and controllability of trait adjectives. Journal of Personality and Social Psychology, 49(6), 1621–1630.CrossRefGoogle Scholar
  6. Alonzo, A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Science and Medicine, 41(3), 303–315.PubMedCrossRefGoogle Scholar
  7. Bauman, L. J., & Weiss, E. (1995). Multidimensional social support inventory: Revised. Bronx, NY: Albert Einstein College of Medicine.Google Scholar
  8. Berger, B., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Research in Nursing and Health, 24(6), 518–529.PubMedCrossRefGoogle Scholar
  9. Boer, H., & Emons, P. A. A. (2004). Accurate and inaccurate HIV transmission beliefs, stigmatizing and HIV protection motivation in Northern Thailand. AIDS Care, 16(2), 167–176.PubMedCrossRefGoogle Scholar
  10. Bond, V., Chase, E., & Aggleton, P. (2002). Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia. Evaluation and program planning, 25(4), 347–356.CrossRefGoogle Scholar
  11. Brown, B. M. (2004). Measuring HIV/AIDS stigma (CSSR Working Paper No. 74). Cape Town: Centre for Social Science Research.Google Scholar
  12. Brown, L., Trujillo, L., & Macintyre, K. (2001). Interventions to reduce HIV/AIDS stigma: What have we learned? Horizons Program, Tulane University.Google Scholar
  13. Browne, & Cudeck, (1993). Alternative ways of assessing model fit. In K. Bollen, & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Thousand Oaks, CA: Sage.Google Scholar
  14. Campbell, C., Foulis, C., Maimane, S., & Sibiya, Z. (2005). I have an evil child at my house: Stigma and HIV/AIDS management in a South African community. American Journal of Public Health, 95(5), 808–815.PubMedCrossRefGoogle Scholar
  15. Clark, H. J., Lindner, G., Armistead, L., & Austin, B.-J. (2003). Stigma, disclosure and psychological functioning among HIV-infected and non-infected African-American women. Women and Health, 38(4), 57–71.CrossRefGoogle Scholar
  16. Collymore, Y. (2002). Rooting out AIDS-related stigma and discrimination. Oxford: Heinemann International.Google Scholar
  17. Deacon, H., Stephney, I., & Prosalendis, S. (2005). Understanding HIV/AIDS stigma, a theoretical and methodological analysis. Cape Town: Human Sciences Research Council.Google Scholar
  18. Eagly A. H., & Chaiken S. (Eds.) (1993). The psychology of attitudes. Fort Worth, TX: Harcourt Brace Jovanovich.Google Scholar
  19. 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(5), 350–358.PubMedCrossRefGoogle Scholar
  20. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  21. Green, G. (1995). Attitudes towards people with HIV: Are they as stigmatizing as people with HIV perceive them to be. Social Science and Medicine, 41(4), 557–568.PubMedCrossRefGoogle Scholar
  22. Herek, G. M., & Capitanio, J. P. (1997). AIDS stigma and contact with persons with AIDS: Effects of direct and vicarious contact. Journal of Applied Social Psychology, 27(1), 1–36.CrossRefGoogle Scholar
  23. Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92(3), 371–377.PubMedCrossRefGoogle Scholar
  24. Jaccard, J., & Wan, C. K. (1998). LISREL approaches to interaction effects in multiple regression. Thousand Oaks, CA: Sage.Google Scholar
  25. Kalichman, S. C., Simbayi, L. C., Jooste, S., Toefy, Y., Cain, D., Cherry, C., & Kagee, A. (2005). Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS and Behaviour, 9(2), 135–143.CrossRefGoogle Scholar
  26. Keeten, C. (1999). HIV stigma hinders disclosure. The Sowetan, 12 January, p. 11.Google Scholar
  27. Letamo, G. (2003). Prevalence of, and factors associated with HIV/AIDS-related stigma and discriminatory attitudes in Botswana. Journal of Health and Population Nutrition, 21(4), 347–357.Google Scholar
  28. Lie, G., & Biswalo, P. (1994). Perceptions of the appropriate HIV/AIDS counselor in Arusha and Kilimanjaro regions of Tanzania: Implications for hospital counseling. AIDS Care, 6(2), 139–151.PubMedCrossRefGoogle Scholar
  29. Loehlin, J. (1987). Latent variable models: An introduction to factor, path, and structural analysis. Hillsdale, NJ: Lawrence Elbaum.Google Scholar
  30. Malcolm, A., Aggleton, P., Bronfman, M., Galvao, J., Mane, P., & Verrall, J. (1998). HIV-related stigmatization and discrimination: Its forms and contexts. Critical Public Health, 8(4), 347–370.CrossRefGoogle Scholar
  31. Maman, S., Mbwambo, J., Hogan, M., Kilonza, G., Sweat, M., & Weiss, E. (2001). HIV and partner violence: Implications for HIV voluntary counselling and testing programmes in Dar es Salaam, Tanzania. New York: Population Council.Google Scholar
  32. Medley, A., Garcia-Moreno, C., McGill, S., & Maman, S. (2004). Rates, barriers and outcomes of HIV sero-status disclosure among women in developing countries: Implications for prevention of mother-to-child transmission programmes. Bulletin of the World Heath Organisation, 82(4), 299–307.Google Scholar
  33. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis, an expanded sourcebook (2nd ed.). Thousand Oaks: Sage.Google Scholar
  34. Niehaus, I. (2006). Leprosy of a deadlier kind: Conceptions of AIDS, sex and death in the South African Lowveld. Paper presented at the Institute for Social and Economic Research, Rhodes University, October.Google Scholar
  35. Nyblade, L., & MacQuarrie, K. (2006). Can we measure HIV/AIDS-related stigma and discrimination? Current knowledge about quantifying stigma in developing countries. Policy project. Washington: International Center for Research on Women (ICRW) and United States Agency for International Development (USAID).Google Scholar
  36. Nyblade, L., Pande, R., Mathur, S., MacQuarrie, K., Kidd, R., Banteyerga, H., Kidanu, A., Kilonzo, G., Mbwambo, J., & Bond, V. (2003). Disentangling HIV and AIDS stigma in Ethiopia, Tanzania and Zambia. Washington: International Center for Research on Women (ICRW).Google Scholar
  37. Ogden, J., & Nyblade, L. (2005). Common at its core: HIV-related stigma across contexts. Washington: International Center for Research on Women (ICRW).Google Scholar
  38. Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57, 13–24.PubMedCrossRefGoogle Scholar
  39. Parker, R., Aggleton, P., Attawell, K., Pulerwits, J., & Brown, L. (2002). HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action. Horizons Program. New York: The Population Council.Google Scholar
  40. Pulerwitz, J., Lippman, S., Setubal, M. S., Chinaglia, M., Takae-Ogura, C., Van Dam, J., & Diaz, J. (2004). Measuring and addressing HIV/AIDS stigma among truckers in Brazil. Paper presented at the XV International AIDS Conference Bangkok, Thailand. Abstact WEOrD1254.Google Scholar
  41. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychology Measurement, 1(3), 385–401.CrossRefGoogle Scholar
  42. Rosenberg, M. (1965). Society and the adolescent self image. Princeton, NJ: Princeton University Press.Google Scholar
  43. Santana, M. A., & Dancy, B. L. (2000). The stigma of being named “AIDS carriers” on Haitian-American women. Health Care for Women International, 21(3), 161–171.PubMedCrossRefGoogle Scholar
  44. Scambler, G., & Hopkins, A. (1986). Being epileptic, coming to terms with stigma. Sociology of Health and Illness, 8, 26–43.CrossRefGoogle Scholar
  45. Sihlangu, M. A. (2000). High on condoms low on compassion. Child First, October–November, 21–25.Google Scholar
  46. Skinner, D., & Mfecane, S. (2004). Stigma, discrimination and implications for people living with HIV/AIDS in South Africa. Journal of the Social Aspects of HIV/AIDS, 1(3), 157–164.PubMedGoogle Scholar
  47. Struwig, F. W., & Stead, G. B. (2001). Planning, designing and reporting research. Cape Town: Pearson Education.Google Scholar
  48. Tanzania Stigma-Indicators Field Test Group (2005). Working report: Measuring HIV stigma: Results of a field test in Tanzania. Washington: International Center for Research on Women (ICRW)/United States Agency for International Development (USAID).Google Scholar
  49. Taylor, S. E., & Brown, J. D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103(2), 193–210.PubMedCrossRefGoogle Scholar
  50. Westbrook, L. E., & Bauman, L. J. (1996). Perceived stigma of HIV/AIDS scale. Bronx, NY: Albert Einstein College of Medicine.Google Scholar
  51. World Health Organisation (1990). Research package: Knowledge, attitudes, beliefs and practices on AIDS, Phase 1: The questionnaire. The global programme on AIDS, Social and Behavioural Research Unit. Geneva: WHO.Google Scholar
  52. 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. Journal of Adolescent Health, 40, 96–98.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Maretha J. Visser
    • 1
    Email author
  • Trace Kershaw
    • 2
  • Jennifer D. Makin
    • 3
  • Brian W. C. Forsyth
    • 4
  1. 1.Department of PsychologyUniversity of PretoriaBrooklynSouth Africa
  2. 2.School of Public HealthYale UniversityNew HavenUSA
  3. 3.Department of Obstetrics and GynaecologyUniversity of Pretoria/Medical Research Unit for Maternal and Infant Health Care Strategies, Kalafong HospitalPretoriaSouth Africa
  4. 4.Department of PediatricsYale University School of MedicineNew HavenUSA

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