Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa

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dc.contributor.authorStangl, Anne L.en_ZA
dc.contributor.authorLilleston, Pamelaen_ZA
dc.contributor.authorMathema, Hlenganien_ZA
dc.contributor.authorPliakas, Triantafyllosen_ZA
dc.contributor.authorKrishnaratne, Sharien_ZA
dc.contributor.authorSievwright, Kirstyen_ZA
dc.contributor.authorBell-Mandla, Nomhleen_ZA
dc.contributor.authorVermaak, Redwaanen_ZA
dc.contributor.authorMainga, Tilaen_ZA
dc.contributor.authorSteinhaus, Maraen_ZA
dc.contributor.authorDonnell, Deborahen_ZA
dc.contributor.authorSchaap, Aben_ZA
dc.contributor.authorBock, Peteren_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorHayes, Richarden_ZA
dc.contributor.authorHoddinott, Graemeen_ZA
dc.contributor.authorBond, Virginiaen_ZA
dc.contributor.authorHargreaves, James R.en_ZA
dc.date.accessioned2021-10-07T10:35:20Zen_ZA
dc.date.available2021-10-07T10:35:20Zen_ZA
dc.date.issued2019-10en_ZA
dc.descriptionCITATION: Stangl, A. L. et al. Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa. Journal of the International AIDS Society, 22(12). doi:10.1002/jia2.25421en_ZA
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com/journal/17582652en_ZA
dc.description.abstractIntroduction: Integrating standardized measures of HIV stigma and discrimination into research studies of emerging HIV prevention approaches could enhance uptake and retention of these approaches, and care and treatment for people living with HIV (PLHIV), by informing stigma mitigation strategies. We sought to develop a succinct set of measures to capture key domains of stigma for use in research on HIV prevention technologies. Methods: From 2013 to 2015, we collected baseline data on HIV stigma from three populations (PLHIV (N = 4053), community members (N = 5782) and health workers (N = 1560)) in 21 study communities in South Africa and Zambia participating in the HPTN 071 (PopART) cluster-randomized trial. Forty questions were adapted from a harmonized set of measures developed in a consultative, global process. Informed by theory and factor analysis, we developed seven scales, with values ranging from 0 to 3, based on a 4-point agreement Likert, and calculated means to assess different aspects of stigma. Higher means reflected more stigma. We developed two measures capturing percentages of PLHIV who reported experiencing any stigma in communities or healthcare settings in the past 12 months. We validated our measures by examining reliability using Cronbach's alpha and comparing the distribution of responses across characteristics previously associated with HIV stigma. Results: Thirty-five questions ultimately contributed to seven scales and two experience measures. All scales demonstrated acceptable to very good internal consistency. Among PLHIV, a scale captured internalized stigma, and experience measures demonstrated that 22.0% of PLHIV experienced stigma in the community and 7.1% in healthcare settings. Three scales for community members assessed fear and judgement, perceived stigma in the community and perceived stigma in healthcare settings. Similarly, health worker scales assessed fear and judgement, perceived stigma in the community and perceived co-worker stigma in healthcare settings. A higher proportion of community members and health workers reported perceived stigma than the proportion of PLHIV who reported experiences of stigma. Conclusions: We developed novel, valid measures that allowed for triangulation of HIV stigma across three populations in a large-scale study. Such comparisons will illuminate how stigma influences and is influenced by programmatic changes to HIV service delivery over time.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/10.1002/jia2.25421en_ZA
dc.identifier.citationStangl, A. L. et al. Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa. Journal of the International AIDS Society, 22(12). doi:10.1002/jia2.25421en_ZA
dc.identifier.issn1758-2652 (online)en_ZA
dc.identifier.otherdoi:10.1002/jia2.25421en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/123170en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherInternational AIDS Societyen_ZA
dc.rights.holderAuthors retain rightsen_ZA
dc.subjectHIV-positive persons -- Social conditionsen_ZA
dc.subjectStigma (Social psychology)en_ZA
dc.subjectDiscriminationen_ZA
dc.subjectHIV infections -- Prevention -- Sub-Saharan Africaen_ZA
dc.subjectClinical trials -- Sub-Saharan Africaen_ZA
dc.subjectAntiretroviral therapyen_ZA
dc.titleDevelopment of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africaen_ZA
dc.typeArticleen_ZA
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