Perceived and Enacted HIV-Related Stigma in Eastern and Southern Sierra Leone: A Psychometric Study of an HIV Stigma Scale

Abstract

Background: HIV stigma continues to hinder the care of people with HIV (PWH), especially in low-resource settings. We aimed to adapt and validate a concise HIV stigma scale for perceived HIV stigma in Sierra Leone. Methods: We enrolled participants in two HIV clinics in Eastern and Southern Sierra Leone in 2022. We assessed perceived stigma using a 12-item adaptation of Berger's HIV Stigma Scale and enacted stigma using select USAID indicators. We used ordinal logistic regression to identify predictors of perceived stigma and Pearson's correlation to examine associations between perceived and enacted stigma. Results: 624 PWH were enrolled. The final adapted 6-item HIV stigma scale demonstrated acceptable internal consistency (Cronbach's α = 0.72) and a four-factor solution accounting for 84.8% of variance: concern about public attitude (2 items), personalized stigma (2 items), negative self-image (1 item), and disclosure concerns (1 item). The prevalence of perceived HIV stigma was 68.6%, with disclosure concerns as the most prominent contributor. Enacted HIV stigma was reported by only 6.7% of participants, with partner/spousal abandonment and workplace stigma being the most common discriminatory experiences. Employment (β = 0.525, p <0.001), residence in Eastern Sierra Leone (β = 3.215, p < 0.001), and experiencing enacted stigma (β = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (β = -0.499, p < 0.001), and HIV disclosure (β = -0.710, p < 0.001) were protective against perceived stigma. Enacted stigma strongly correlated with partner abandonment and family isolation (r = 0.223, p < 0.001). Conclusion: We found high levels of perceived HIV stigma, underscoring the need for targeted interventions to combat stigma and discrimination for PWH in Sierra Leone.

Bifactor SEM and MIRT Structure of a 12-Item Human Immunodeficiency Virus Stigma Scale in Peruvian Adults

“…6 Regarding the initial version of the instrument, difficulties have been observed in its application due to its large number of items, which can generate fatigue in the participants and difficulties in its use in environments with a large number of patients. 23 In previous research, adequate psychometric properties have been found in more concise versions of the instrument, as reported by Mlouki et al, 24 who identified a 12-item model with 3 dimensions in patients from Tunisia, Africa. Similarly, De los Santos 25 examined the 2-factor structure using 11 items in a US population living with HIV.…”

“…13 On the other hand, although the HIV Stigma Scale has been adapted and translated into different languages such as Spanish, 14 Portuguese, 15,16 Swedish, 17 Urdu, 18 Xhosa, 19 Tamil, 20 Japanese, 21 or Thai. 22 In a meta-analytical study, it is recognized that this instrument exists in multiple versions that vary in the number of items, including 7,8,10,12,13,13,17,18,21,23,25,32, and 39 items, and its internal structure differs even among models with the same number of items, as between 2 and 5 dimensions and various internal structures have been identified. 6 Regarding the initial version of the instrument, difficulties have been observed in its application due to its large number of items, which can generate fatigue in the participants and difficulties in its use in environments with a large number of patients.…”

“…The most widely used abbreviated version of the HIV Stigma Scale is that developed by Reinius et al, 4 since it maintains the 4 dimensions originally proposed by the author through 12 items and has proven to have solid psychometric properties in various contexts. 15,16,23,26 However, in these investigations, the exhaustive evaluation of its structure through more rigorous analyses, such as the Item Response Theory model, which would allow isolating the characteristics of the participants from the psychometric findings, is lacking. 27 The stigma associated with HIV has a significant negative impact on the quality of life of people living with this condition, and can result in social isolation, as well as contribute to the development of depression and anxiety in these individuals.…”