Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging “What Matters Most” to Resist Stigma

Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions

“…For example, our team recently used the “what matters most” theoretical framework to identify cultural aspects of HIV stigma in Botswana—and ways to resist them—and used these findings to adapt a stigma reduction intervention offered during antenatal care to promote achieving the cultural capabilities that “matters most” for pregnant mothers with HIV (Poku et al., 2020; Yang et al. 2021).…”

A pilot pragmatic trial of a “what matters most”-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana

“…These WMM-based insights were used to adapt stigma intervention components to develop a multi-component stigma intervention to specifically counter the intersectional stigma experienced by pregnant women living with HIV in Botswana. Our study also incorporated a new, validated measure of intersectional stigma appropriate for this population (i.e., the WMM-WLHIV-BW; [ 17 ]) . Initial implementation outcomes indicated that intervention adoption was moderate, with 58% of eligible participants attending one or more sessions; further, of those attending at least one session, the vast majority (75%) attended ≥ 3 additional sessions, showing good intervention acceptability.…”

“…Stigma was measured using two validated scales: (1) the Berger HIV Stigma Scale (40 items; α = 0.96), which has four subscales of personalized (i.e., internalized) stigma (18 items; α = 0.95), disclosure concerns (10 items; α = 0.89), negative self-image (13 items; α = 0.90), and concern with public attitudes (20 items; α = 0.94); and (2) to assess intersectional stigma of HIV and ‘womanhood’ in Botswana, our WMM Cultural Stigma Scale for WLHIV in Botswana (WMM-WLHIV-BW) [ 17 ], which has two subscales that measure (i) how culture ‘shapes’ stigma by threatening ‘womanhood’ in intersection with HIV (e.g., via perceived promiscuity) (10 items; α = 0.94) and (ii) how culture ‘protects’ against stigma in that achieving capabilities of ‘respected womanhood’ could mitigate against HIV stigma (10 items; α = 0.91). Other psychosocial outcomes measured are: (i) depressive symptoms, measured by the Center for Epidemiological Studies Depression Scale (CES-D; 20 items; α = 0.88); (ii) post-traumatic stress disorder (PTSD) symptoms, measured by an abridged version of the Post-Traumatic Checklist for DSM-5 (PCL-5; 8 items; α = 0.93); (iii) social functioning, measured by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-12; 12 items; α = 0.82); (iv) quality of life, measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Ability to Participate in Social Roles and Activities Short Form scale (8 items; α = 0.83); and (v) perceived availability of social support measured via rating confidence that, if needed, adequate support would be available across six different domains (6 items; α = 0.84).…”

Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma

“…These findings can be used to directly develop and adapt interventions, such as aligning HIV services with WMM through more flexible community services, offering livelihood support to counter structural vulnerabilities related to employment, and targeting culturally salient aspects of stigma through peer-based programs that can demonstrate the ability for men with HIV to still achieve WMM. Future research should also consider intersections of HIV-related stigma with other stigmas such as mental illness, which is syndemic in Botswana (Becker et al, 2019), and how findings can be operationalized into a quantitative measure of culturally salient aspects of HIV-related intersectional stigma (Yang et al, 2021) for men in Botswana, to assess the effectiveness of interventions in stigma reduction and resistance. The systematic approach used here can also be replicated in other countries in SSA to investigate similarities and differences in the intersections of cultural capabilities and structural vulnerabilities with HIV-related stigma for other populations and in other contexts.…”