Abstract
HIV-related stigma has been associated with depression, poor adherence, and nondisclosure of HIV-positive status, all of which can lead to increased transmission of HIV and poorer health outcomes for HIV-infected individuals. The Berger HIV Stigma scale has been used in multiple settings but never adapted and validated in India, home to the world’s second largest HIV-infected population. We assessed the reliability and validity of a Tamil translation of the original 40-item scale, and conducted confirmatory and exploratory factor analyses to assess cultural appropriateness and abbreviate the scale. Reliability and validity were high (alpha = 0.91; test–retest reliability ICC = 0.89). Exploratory and confirmatory factor analysis resulted in an abridged 25-item version of the scale that possessed better psychometric properties than the 40-item version. This culturally validated, abridged HIV-Stigma scale can be used in busy clinical settings to identify individuals in need of psychosocial support and assess post-intervention changes in stigma in Southern India.
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Simoes EA, Babu PG, John TJ, Nirmala S, Solomon S, Lakshminarayana CS, et al. Evidence for HTLV-III infection in prostitutes in Tamil Nadu (India). Indian J Med. 1987;85:335–8.
National AIDS Control Organization: Facts and figures. http://www.nacoonline.org/facts.htm (2007). Accessed 28 Mar 2007.
Kumar R, Jha P, Arora P, Mony P, Bhatia P, Millson P, et al. Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study. Lancet. 2006;367(9517):1164–72.
UNAIDS: Stigma and discrimination. http://www.unaids.org/en/Issues/Prevention_treatment/stigma.asp (2007). Accessed 9 Apr 2007.
Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64(9):1823–31.
Leonard AD, Markham CM, Bui T, Shegog R, Paul ME. Lowering the risk of secondary HIV transmission: insights from HIV-positive youth and health care providers. Perspect Sex Reprod Health. 2010;42(2):110–6.
Curioso WH, Kepka D, Cabello R, Segura P, Kurth AE. Understanding the facilitators and barriers of antiretroviral adherence in Peru: a qualitative study. BMC Public Health. 2010;10:13.
Chandra PS, Deepthivarma S, Manjula V. Disclosure of HIV infection in south India: patterns, reasons and reactions. AIDS Care. 2003;15(2):207–15.
Subramanian T, Gupte MD, Dorairaj VS, Periannan V, Mathai AK. Psycho-social impact and quality of life of people living with HIV/AIDS in South India. AIDS Care. 2009;21(4):473–81.
Thomas BE, Rehman F, Suryanarayanan D, Josephine K, Dilip M, Dorairaj VS, et al. How stigmatizing is stigma in the life of people living with HIV: a study on HIV positive individuals from Chennai, South India. AIDS Care. 2005;17(7):795–801.
Kumarasamy N, Safren SA, Raminani SR, Pickard R, James R, Krishnan AK, et al. Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study. AIDS Patient Care STDS. 2005;19(8):526–37.
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.
Franke MF, Munoz M, Finnegan K, Zeladita J, Sebastian JL, Bayona JN, et al. Validation and abbreviation of an HIV stigma scale in an adult spanish-speaking population in urban Peru. AIDS Behav. 2010;14(1):189–99.
Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health. 2007;40(1):96–8.
Bunn JY, Solomon SE, Miller C, Forehand R. Measurement of stigma in people with HIV: a reexamination of the HIV stigma scale. AIDS Educ Prev. 2007;19(3):198–208.
Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, et al. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008;67(8):1225–35.
Zelaya CE, Sivaram S, Johnson SC, Srikrishnan AK, Solomon S, Celentano DD. HIV/AIDS stigma: reliability and validity of a new measurement instrument in Chennai, India. AIDS Behav. 2008;12(5):781–8.
Van Brakel WH. Measuring health-related stigma—a literature review. Psychol Health Med. 2006;11(3):307–34.
Rao D, Choi SW, Victorson D, Bode R, Peterman A, Heinemann A, et al. Measuring stigma across neurological conditions: the development of the stigma scale for chronic illness (SSCI). Qual Life Res. 2009;18(5):585–95.
Holzemer WL, Makoae LN, Greeff M, Dlamini PS, Kohi TW, Chirwa ML, et al. Measuring HIV stigma for PLHAs and nurses over time in five African countries. Sahara J. 2009;6(2):76–82.
Nyblade LC. Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med. 2006;11(3):335–45.
Streiner D, Norman G. Health measurement scales: a practical guide to their development and use. New York: Oxford University Press; 1989.
Rao D, Choi S, Victorson D, Bode R, Heinemann A, Peterman A, et al. Measuring stigma across neurological conditions: the development of the stigma scale for chronic illness (SSCI). Qual Life Res. 2009;18:585–95.
Lai J, Crane P, Cella D. Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue. Qual Life Res. 2006;15(7):1179–90.
Bech, P.: The major (ICD-10) depression inventory (MDI). http://www.gp-training.net/protocol/psych/who/mdi.doc (2007). Accessed 11 Apr 2007.
Olsen LR, Jensen DV, Noerholm V, Martiny K, Bech P. The internal and external validity of the major depression inventory in measuring severity of depressive states. Psychol Med. 2003;33(2):351–6.
Cella D, Hernandez L, Bonomi A, Corona M, Vaquero M, Shiomoto G, et al. Spanish language translation and initial validation of the functional assessment of cancer therapy quality-of-life instrument. Med Care. 1998;36(9):1407–18.
Bonomi A, Cella D, Hahn E, Bjordal K, Sperner-Unterweger B, Gangeri L, et al. Multilingual translation of the functional assessment of cancer therapy (FACT) quality of life measurement system. Qual Life Res. 1996;5(3):309–20.
Streiner DL. A checklist for evaluating the usefulness of rating scales. Can J Psychiatry. 1993;38(2):140–8.
Alonzo AA, Reynolds NR. Stigma, HIV and AIDS: an exploration and elaboration of a stigma trajectory. Soc Sci Med. 1995;41:303–15.
Barua A, Kar N. Screening for depression in elderly Indian population. Indian J Psychiatry. 2010;52(2):150–3.
McDonald RP, Ho MH. Principles and practice in reporting structural equation analyses. Psychol Methods. 2002;7(1):64–82.
Crowley SL, Fan X. Structural equation modeling: basic concepts and applications in personality assessment research. J Pers Assess. 1997;68(3):508–31.
Musil CM, Jones SL, Warner CD. Structural equation modeling and its relationship to multiple regression and factor analysis. Res Nurs Health. 1998;21(3):271–81.
Goffman E. Stigma: notes on the management of spoiled identity. New York: Simon and Schuster, Inc.; 1963.
Laryea M, Gien L. The impact of HIV-positive diagnosis on the individual, Part 1: stigma, rejection, and loneliness. Clin Nurs Res. 1993;2(3):245–63. discussion 63–66.
Hattie J. Methodology review: assessing unidimensionality of tests and items. Appl Psychol Meas. 1985;9:139–64.
Acknowledgments
This project was funded by a grant from the Puget Sound Partners for Global Health (Award #26145) with additional support for LEM from the University of Washington Center for AIDS Research (National Institutes of Health P30 AI27757). The authors would like to thank Betsy Feldman for helpful statistical discussions and Katherine Murray for manuscript preparation assistance. The authors are also grateful to the leaders of the Indian Network of Positive Persons, the Positive Women’s Network and the Pushes Network for providing access to HIV-positive persons affiliated with their networks, and to the men and women who participated in this study.
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Jeyaseelan, L., Kumar, S., Mohanraj, R. et al. Assessing HIV/AIDS Stigma in South India: Validation and Abridgement of the Berger HIV Stigma Scale. AIDS Behav 17, 434–443 (2013). https://doi.org/10.1007/s10461-011-0128-3
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DOI: https://doi.org/10.1007/s10461-011-0128-3