Abstract:
Background: Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the
causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The
objective of this study was to validate an HIV-related stigma scale among health care providers
in a resource-poor setting.
Methods: A cross-sectional validation study was conducted in 18 health care institutions in
southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers
responded to questionnaires asking about sociodemographic characteristics, HIV knowledge,
perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with
principal component extraction and varimax with Kaiser normalization rotation were employed
to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction.
Items with item-factor loadings less than 0.4 and items loading onto more than one factor were
dropped. The convergent validity of the scales was tested by assessing the association with HIV
knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence
of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity.
Results: Seven factors emerged from the four dimensions of SAD during the EFA. The factor
loadings of the items ranged from 0.58 to 0.93. Cronbach’s alphas of the scales ranged from
0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance
of training on topics related to SAD, degree or higher education levels, high HIV case loads,
the availability of ART in the health care facility and claiming oneself as nonreligious were all
negatively associated with SAD as measured by the seven newly identified latent factors.
Conclusion: The findings in this study demonstrate that the HIV-related stigma scale is valid
and reliable when used in resource-poor settings. Considering the local situation, health care
managers and researchers may use this scale to measure and characterize HI
