Skip to main content

Advertisement

SpringerLink
Log in

Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale

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

Abstract

To date, there are no established scales to assess PrEP stigma among youth. We validated the Youth PrEP Stigma Scale within the Adolescent Trials Network P3 study (2019–2021). Data from sexual and gender minority youth (16–24 years) who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported. Results yielded a three-factor solution (PrEP Disapproval by Others, Enacted PrEP Stigma, and PrEP User Stereotypes) with strong factor loadings and Cronbach’s alphas ranging from 0.83 to 0.90, suggesting excellent internal consistency. Correlations between this Scale, anticipated HIV stigma, perceived HIV risk, and disclosure of sexual identity were significant, indicating potential for robust application. Given the persistence of HIV infections among youth, stigma as a barrier to prevention, and expansion of PrEP modalities, the Youth PrEP Stigma Scale could enhance intervention and mechanistic research among youth at elevated risk for HIV acquisition.

Resumen

Hasta la fecha, no existen escalas establecidas para evaluar el estigma de la PrEP entre los jóvenes. Validamos la Escala de estigma de la PrEP para jóvenes dentro del estudio P3 de la Red de ensayos para adolescentes (2019–2021). Se evaluaron los datos de jóvenes de minorías sexuales y de género (16–24 años) a quienes se les recetó PrEP en nueve sitios domésticos (N = 235). Se informan estadísticas descriptivas, análisis factorial exploratorio y coeficientes de correlación. Los resultados arrojaron una solución de tres factores (desaprobación de PrEP por parte de otros, estigma de PrEP promulgado y estereotipos de usuarios de PrEP) con fuertes cargas factoriales y alfas de Cronbach que oscilan entre 0.83 y 0.90, lo que sugiere una excelente consistencia interna. Las correlaciones entre esta Escala, el estigma anticipado del VIH, el riesgo percibido del VIH y la divulgación de la identidad sexual fueron significativas, lo que indica un potencial para una aplicación sólida. Dada la persistencia de las infecciones por el VIH entre los jóvenes, el estigma como una barrera para la prevención y la expansión de las modalidades de PrEP, la Escala de estigma de la PrEP para jóvenes podría mejorar la intervención y la investigación mecánica entre los jóvenes con un riesgo elevado de contraer el VIH.

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

Data Availability

Data is available upon request through the University of North Carolina, Chapel Hill (UNC) BatLab via the study Principal Investigator, Dr. Lisa Hightow-Weidman.

Code Availability

Code is available upon request from our quantitative lead, Dr. İbrahim Yiğit.

References

  1. Spinner CD, Boesecke C, Zink A, Jessen H, Stellbrink H-J, Rockstroh JK, et al. HIV pre-exposure prophylaxis (PrEP): a review of current knowledge of oral systemic HIV PrEP in humans. Infection. 2016;44(2):151–8.

    Article  PubMed  Google Scholar 

  2. Camp C, Saberi P. Facilitators and barriers of 2-1-1 HIV pre-exposure prophylaxis. PLoS ONE. 2021;16(5):e0251917.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Wood BR. Prevention of HIV for persons with low-frequency, high-risk exposures: PrEP (preexposure prophylaxis), PEP (postexposure prophylaxis), or ‘PIP’ (postexposure prophylaxis in-pocket). AIDS. 2020;34(3).

  4. Ogunbajo A, Tsai AC, Kanki PJ, Mayer KH. Acceptability of and Preferences for Long-Acting Injectable HIV PrEP and Other PrEP Modalities among Sexual Minority Men in Nigeria, Africa. AIDS and Behavior; 2022.

  5. Hart-Cooper GD, Allen I, Irwin CE Jr, Scott H. Adolescent Health Providers’ Willingness to Prescribe Pre-Exposure Prophylaxis (PrEP) to Youth at Risk of HIV Infection in the United States. J Adolesc Health. 2018;63(2):242–4.

    Article  PubMed  Google Scholar 

  6. Macapagal K, Kraus A, Korpak AK, Jozsa K, Moskowitz DA. PrEP Awareness. Uptake, Barriers, and Correlates Among Adolescents Assigned Male at Birth Who Have Sex with Males in the U.S. Arch Sex Behav. 2020;49(1):113–24.

    Article  PubMed  Google Scholar 

  7. Stoner MCD, Bhushan NL, Maragh-Bass AC, Mitchell JT, Riggins L, Walker M, et al. Using Participatory Methods to Assess PrEP Interest and Uptake Among Young People Living in the Southeastern US: A Mixed Methods Assessment. AIDS Behav. 2021.

  8. Biello KB, Hosek S, Drucker MT, Belzer M, Mimiaga MJ, Marrow E, et al. Preferences for Injectable PrEP Among Young U.S. Cisgender Men and Transgender Women and Men Who Have Sex with Men. Arch Sex Behav. 2018;47(7):2101–7.

    Article  PubMed  Google Scholar 

  9. Dévieux J, Malow R, Stein JA, Jennings TE, Lucenko BA, Averhart C, et al. Impulsivity and HIV risk among adjudicated alcohol- and other drug-abusing adolescent offenders. AIDS Educ Prev. 2002;14(5 Suppl B):24–35.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kovensky R, Khurana A, Guyer S, Leve LD. Childhood Adversity, Impulsivity, and HIV Knowledge as Predictors of Sexual Risk Outcomes in At-Risk Female Youth. Adolescents. 2021;1(1):56–69.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Budhwani H, Naar S. Training Providers in Motivational Interviewing to Promote Behavior Change Pediatric Clinics of North America. In press.

  12. Ogunbajo A, Storholm ED, Ober AJ, Bogart LM, Reback CJ, Flynn R, et al. Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California. AIDS Behav. 2021;25(7):2301–15.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav. 2018;22(11):3681–91.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Budhwani H, Robles G, Starks TJ, MacDonell KK, Dinaj V, Naar S. Healthy Choices Intervention is Associated with Reductions in Stigma Among Youth Living with HIV in the United States (ATN 129). AIDS Behav. 2021;25(4):1094–102.

    Article  PubMed  Google Scholar 

  16. Quinn K, Bowleg L, Dickson-Gomez J. “The fear of being Black plus the fear of being gay”: The effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019;232:86–93.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Goffman E. Selections from stigma. The disability studies reader. 1997;203:215.

  18. Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes. AIDS Behav. 2017;21(1):283–91.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Budhwani H, De P. Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States. Health Equity. 2019;3(1):73–80.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Crenshaw KW. On intersectionality: Essential writings. The New Press; 2017.

  21. Logie CH, James L, Tharao W, Loutfy MR. HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med. 2011;8(11):e1001124.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Earnshaw VA, Smith LR, Cunningham CO, Copenhaver MM. Intersectionality of internalized HIV stigma and internalized substance use stigma: Implications for depressive symptoms. J Health Psychol. 2015;20(8):1083–9.

    Article  PubMed  Google Scholar 

  23. Mulawa MI, Rosengren AL, Amico KR, Hightow-Weidman LB, Muessig KE. mHealth to reduce HIV-related stigma among youth in the United States: a scoping review. Mhealth. 2021;7:35-.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wood S, Gross R, Shea JA, Bauermeister JA, Franklin J, Petsis D, et al. Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color. AIDS Behav. 2019;23(10):2719–29.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth. 2021;7:33.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rosengren AL, Lelutiu-Weinberger C, Woodhouse EW, Sandanapitchai P, Hightow-Weidman LB. A Scoping Review of HIV Pre-exposure Prophylaxis Stigma and Implications for Stigma-Reduction Interventions for Men and Transwomen Who Have Sex with Men. AIDS Behav. 2021;25(7):2054–70.

    Article  PubMed  Google Scholar 

  27. Golub SA. PrEP Stigma: Implicit and Explicit Drivers of Disparity. Curr HIV/AIDS Rep. 2018;15(2):190–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tangmunkongvorakul A, Chariyalertsak S, Amico KR, Saokhieo P, Wannalak V, Sangangamsakun T, et al. Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand. AIDS Care. 2013;25(8):961–7.

    Article  PubMed  Google Scholar 

  29. Budhwani H, Kiszla MB, Hightow-Weidman LB. Adapting Digital Health Interventions for the Evolving HIV Landscape: Examples to Support Prevention and Treatment Research. Current Opinion in HIV and AIDS. In press.

  30. Klein H, Washington TA. The Pre-Exposure Prophylaxis (PrEP) Stigma Scale: Preliminary findings from a pilot study. Int Public Health J. 2019;11(2):185–95.

    PubMed  PubMed Central  Google Scholar 

  31. Siegler AJ, Wiatrek S, Mouhanna F, Amico KR, Dominguez K, Jones J, et al. Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions. AIDS Behav. 2020;24(9):2637–49.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Algarin AB, Hee Shrader C, Hackworth BT, Varas-Diaz N, Fennie KP, Sheehan DM, et al. Development and Validation of the Community PrEP-Related Stigma Scale (Community-PSS). AIDS Educ Prev. 2021;33(2):120–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Calabrese SK, Dovidio JF, Tekeste M, Taggart T, Galvao RW, Safon CB, et al. HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood. J Acquir Immune Defic Syndr. 2018;79(1):46–53.

    Article  PubMed  PubMed Central  Google Scholar 

  34. LeGrand S, Knudtson K, Benkeser D, Muessig K, McGee A, Sullivan PS, et al. Testing the Efficacy of a Social Networking Gamification App to Improve Pre-Exposure Prophylaxis Adherence (P3: Prepared, Protected, emPowered): Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2018;7(12):e10448-e.

    Article  Google Scholar 

  35. Golub SA, Gamarel KE, Surace A. Demographic Differences in PrEP-Related Stereotypes: Implications for Implementation. AIDS Behav. 2017;21(5):1229–35.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tabachnick BG, Fidell LS. Cleaning up your act: Screening data prior to analysis. Using Multivar Stat. 2001;5:61–116.

    Google Scholar 

  37. Golub SA, Gamarel KE. The Impact of Anticipated HIV Stigma on Delays in HIV Testing Behaviors: Findings from a Community-Based Sample of Men Who Have Sex with Men and Transgender Women in New York City. AIDS Patient Care STDs. 2013;27(11):621–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Napper LE, Fisher DG, Reynolds GL. Development of the perceived risk of HIV scale. AIDS Behav. 2012;16(4):1075–83.

    Article  PubMed  Google Scholar 

  39. Bouris A, Guilamo-Ramos V, Pickard A, Shiu C, Loosier PS, Dittus P, et al. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. J Prim Prev. 2010;31(5–6):273–309.

    Article  PubMed  Google Scholar 

  40. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs. 2010;23(4):205–13.

    Article  PubMed  Google Scholar 

  41. Thompson B, Daniel LG. Factor Analytic Evidence for the Construct Validity of Scores: A Historical Overview and Some Guidelines. Educ Psychol Meas. 1996;56(2):197–208.

    Article  Google Scholar 

  42. Velicer WF, Eaton CA, Fava JL. Construct explication through factor or component analysis: A review and evaluation of alternative procedures for determining the number of factors or components. Problems and solutions in human assessment. 2000:41–71.

  43. Kaiser HF. A note on Guttman’s lower bound for the number of common factors. Br J Stat Psychol. 1961;14:1–2.

    Article  Google Scholar 

  44. Kalichman SC, Shkembi B, Eaton LA. Finding the Right Angle: A Geometric Approach to Measuring Intersectional HIV Stigma. AIDS Behav. 2022;26(1):27–38.

    Article  PubMed  Google Scholar 

Download references

Funding

Research reported in this publication was supported by the National Institute of Mental Health (NIMH) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) under Award Numbers K01MH116737 and R25MH067127 (Budhwani) and U19HD089881 (Hightow-Weidman). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Center of Population Sciences for Health Equity, College of Nursing, Florida State University, 32306, Tallahassee, FL, USA

    Henna Budhwani

  2. Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey

    İbrahim Yiğit

  3. Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA

    Allysha C. Maragh-Bass

  4. Duke Global Health Institute, Duke University, Durham, NC, USA

    Allysha C. Maragh-Bass

  5. Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA

    Crissi B. Rainer, Kristina Claude & Lisa B. Hightow-Weidman

  6. Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA

    Kathryn E. Muessig & Lisa B. Hightow-Weidman

Authors
  1. Henna Budhwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. İbrahim Yiğit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allysha C. Maragh-Bass
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Crissi B. Rainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristina Claude
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kathryn E. Muessig
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lisa B. Hightow-Weidman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LHW is the senior author and parent study Principal Investigator. HB is the lead author. LHW and HB jointly conceptualized the study in consultation with AMB and KEM. IY conducted all quantitative analyses. All authors contributed to the writing and revising of this manuscript.

Corresponding author

Correspondence to Henna Budhwani.

Ethics declarations

Conflict of Interest

None noted.

Ethics Approval

The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) Prepared, Protected, emPowered (P3: ATN protocol 142) informed assent/consent documents, and related modifications were reviewed and approved by the University of North Carolina, Chapel Hill (UNC) Institutional Review Board (IRB, #17-1951).

Consent to Participate

All participants agreed to participate and provided informed consent.

Consent for Publication

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Budhwani, H., Yiğit, İ., Maragh-Bass, A.C. et al. Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale. AIDS Behav 27, 929–938 (2023). https://doi.org/10.1007/s10461-022-03829-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-022-03829-9

Keywords

Search

Navigation