Abstract
BackgroundHIV-related stigma, or the degree to which people living with HIV endorse negative stereotypes associated with HIV, is associated with poor continuum of care outcomes. We translated the 12-item Short HIV Stigma scale and evaluated its psychometric properties in a Brazilian context with regard to construct validity and reliability.MethodsThe first step included translation, back-translation, evaluation, peer review, and pre-testing of the Short HIV Sigma scale developed by Reinius et al. (Health Qual Life Outcomes 15(1):115, 2017).The second step involved piloting the scale in three convenience samples of adults recruited online through advertisements on different platforms: Grindr (October/2019) and Hornet (February–March/2020), geospatial network apps for sexual encounters for gay, bisexuals and other men who have sex with men, and social media apps (Facebook and WhatsApp, October/2019). The psychometric evaluation included confirmatory factor analysis, differential item functioning using the Multiple-Indicator Multiple-Cause model, and correlations between subscale scores and antiretroviral treatment use and adherence. Reliability was assessed using Cronbach’s alpha, and ordinal alpha and omega from the polychoric correlation matrix.ResultsIn total, 114, 164, and 1824 participants completed the measure items through Grindr, social media, and Hornet, respectively. We confirmed a 4-factor structure with factors for personalized stigma (3 items), disclosure concerns (3 items), concerns with public attitudes (3 items), and negative self-image (3 items). Small differential item functioning with respect to sample was found for one item (“I feel guilty because I have HIV”), which did not substantively influence estimates of latent factor scores. Grindr and Hornet’s participants scored significantly higher than social media participants on all factors except personalized stigma. Higher subscale scores correlated with antiretroviral treatment use among participants from Hornet and with lower treatment adherence in participants from Grindr and Hornet. Reliability as measured by Cronbach’s alpha, ordinal alpha and omega were 0.83, 0.88 and 0.93 for the entire scale.DiscussionThe Brazilian Portuguese version of the Short HIV Stigma scale had satisfactory psychometric properties with present results suggesting that scores from different samples may be compared without concern that measurement differences substantively influence results though further studies with greater representation of women and heterosexual men are warranted.
Highlights
HIV-related stigma, or the degree to which people living with HIV endorse negative stereotypes associ‐ ated with HIV, is associated with poor continuum of care outcomes
Step 1: Translation Following established guidelines [33], translation of the items of the Short HIV Stigma scale into Brazilian Portuguese was performed by three independent translators, after which a meeting was held to discuss and reach a consensus translated version of the scale.three additional independent reviewers translated the Portuguese version back to English, after which another meeting was held with the six members of the translation team and a mediator who was a member of the research team to compare the original items with the back-translated items and identify where items or words seemed to differ
We found that the Brazilian Portuguese version of the Short HIV Stigma scale had satisfactory psychometric properties and construct validity was supported by the correlations between subscale scores and the use of and adherence to antiretroviral treatment
Summary
HIV-related stigma, or the degree to which people living with HIV endorse negative stereotypes associ‐ ated with HIV, is associated with poor continuum of care outcomes. Though the epidemic is classified as stable at the national level, with prevalence of 0.4% in the general population [2], HIV prevalence is significantly higher in these key populations [2]. Lower education, residing in a less developed region (most notably the North and Northeast), and high levels of social vulnerability are all independently associated with a higher likelihood of presenting to care with more advanced disease, not using antiretroviral therapy, and not achieving viral suppression [4]. An important driver of these findings may be the different forms of stigma and discrimination that are prevalent in the Brazilian society [5]
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