Factor Structure, Reliability, and Validity of the 10-Item HIV Stigma Scale for Adolescents and Youth Living with HIV in Rural, Southwestern Uganda.

Abstract

HIV stigma undermines HIV treatment outcomes for adolescents and young adults living with HIV. However, there are few stigma measures that are appropriate for this age and the Ugandan cultural context. Between October and December 2021, we administered the 10-item stigma scale for adolescents living with HIV (ALHIV-SS) to 300 adolescents and young adults (aged 15-24 years) with perinatally-acquired HIV in Mbarara, Uganda. Exploratory factor analysis of the ALHIV-SS revealed three factors corresponding to internalized, anticipated, and enacted forms of stigma. The ALHIV-SS was internally consistent overall (Cronbach's α = 0.78) and for each of the subscales: internalized stigma, 0.76; enacted stigma, 0.68; and anticipated stigma, 0.57. The ALHIV-SS was strongly correlated with depression (Spearman's ρ = 0.44; p < 0.001). Mean stigma scores were also higher among study participants who had thoughts of self-harm (6.5 vs. 3.0, t = 5.7, P < 0.001), those who reported sometimes forgetting to take their ART (4.0 vs. 2.8, t = 3.3, P = 0.001), and among those who reported any days in the past 2 weeks on which they took no ART (3.9 vs. 3.2, t = 1.59, P = 0.11). The findings suggest that the 10-item ALHIV-SS is a valid, reliable, and coherent measure of HIV stigma among adolescents and young adults living with perinatally acquired HIV in Uganda.