Application of the Chinese version of Zelaya’s HIV-related stigma scale to undergraduates in mainland China

Abstract

BackgroundThis cross-sectional study aims to validate the Chinese version of Zelaya’s HIV-related Stigma Scale (CVZHSS) among a large undergraduate sample in mainland China, and apply it to measure the level of different dimensions of stigma and their respective determinants.MethodsFrom September 10, 2018, to January 9, 2019, a total of 10,665 eligible undergraduates conveniently drawn from 30 provinces in mainland China (except for Tibet) completed the self-designed online questionnaire distributed via sojump.com voluntarily, anonymously and confidentially. Both exploratory and confirmatory factor analyses (EFA and CFA) were first performed to test its construct validity, Cronbach’s alpha was then used to assess its internal consistency, and Logistic regression analyses were finally carried out to identify predictors of various dimensions of stigma.ResultsAs expected from the original model, four factors (i.e., “fear of casual transmission”, “moral judgment”, “personal stigma” and “perceived community stigma”) were extracted using principal component analysis with varimax rotation, accounting for 63.26% of the total variance. The CFA further confirmed the four-factor construct (CFI = 0.92, GFI = 0.91, RMSEA = 0.07). In addition, all the four factors demonstrated acceptable internal consistency with Cronbach’s alpha ranging from 0.83 to 0.92. Stigma as measured by “fear of casual transmission” (74.4%), “moral judgement” (61.6%), “personal stigma” (79.0%) and “perceived community stigma”(36.5%) is highly prevalent among undergraduates. Except for non-freshmen, less knowledge about HIV and unsafe sex which were consistently associated with higher levels of stigma in all four dimensions, other eight variables including gender, residential area, major, sexual orientation, having ever being tested perception of HIV risk, willingness to utilize HTC service and awareness of the national AIDS policy played differential roles in affecting different dimensions of stigma.ConclusionsThe CVZHSS is a reliable and valid measurement tool and can be used to identify undergraduates with high levels of stigma. However, the four dimensions (Fear, moral judgement, personal stigma and perceived community stigma) were respectively influenced by different determinants, and thus should be treated independently when designing, implementing and evaluating stigma reduction programs.

Applying the health belief model to identify predictors of self-perceived risk of HIV infection among undergraduates in mainland China

“…Based on a review of prior studies and measures of HBM constructs, twelve independent variables hypothesized to in uence self-perception of HIV risk were identi ed and tested in this study, as illustrated in Figure 1. Consistent with previous studies [20,24,25], a combination of perceived susceptibility to HIV infection (e.g., "A healthy looking person can be HIV positive" [16,20,24]), perceived severity of HIV infection (e.g., "HIV is a highly contagious, incurable disease [16,24,25]), and perceived bene ts of health promoting behaviors (e.g., "Correct and consistent use of condoms during sexual intercourse could reduce the risk of HIV transmission" [16,24,25]) has been termed "HIV-related knowledge", which is measured by the 12-item scale of Yes/No/I do not know questions [24,25]. Stigma and discrimination against people living with HIV, which has been identi ed as a major barrier to HIV prevention, diagnose, care and treatment, was based on the Chinese version of Zelaya's 24-item scale of Yes/No/It depends on the situation statements [24,25].…”

“…The outcome variable for this study is self-perception of HIV risk, measured by asking undergraduates to estimate their risk of acquiring HIV and ve choices were provided: 1=no risk at all, 2=uncertainty, 3=small risk, 4=moderate risk, and 5=high risk [11,24]. Consistent with our previous studies [24,25], perceived risk was treated as a dichotomous variable, which is equal to 0 if undergraduates perceived themselves to have no risk of acquiring HIV infection, and is 1 otherwise.…”

Measuring Health Behavior Problems in Chinese Adolescents: Scale Development and Preliminary Validation

“…1), since the RMSEA value (= 0.06), was below 0.08, CMIN/DF (3.18) was below 5, RMR (0.04) was below 0.05, and each of CFI (0.92), GFI (0.90), and TLI (0.91) were at least 0.90 based on the criteria recommended by Dullie [36]. Besides this, the factor loadings ranged between 0.53 and 0.88 and were signi cant, indicating a good relationship between the observed variable and latent variable [37].…”

Utilising a WeChat intervention to improve HIV and AIDS education among college students in China

“…However, more than half of the students in this same study believed that HIV was transmitted via mosquito bites (Li et al, 2016). Ruan et al (2019) found that medical students feared becoming infected through everyday contact, and they exhibited lower levels of personal stigma towards PLWH compared to non-medical students (Ruan et al, 2019). (AQ: Please clarify whether ‘Li et al (2016)’ refers to ‘Li et al (2016a)’ or ‘Li et al (2016b)’ throughout the text.…”

“…When knowledgeable about Chinese National AIDS Policy and the routes of HIV transmission, undergraduate students perceived themselves at lower risk of contracting PLWH and held less discriminatory attitudes (i.e. moral judgement, personal stigma and perceived community stigma) (Ruan et al, 2019). In other research, Chen et al (2016) found attitudes varied between students from rural and urban areas.…”