A validated stigma scale measures decreased HIV-related stigma among men in a community-based HIV prevention services program in rural Maharashtra, India

Background

To validate an HIV stigma scale among men in a high HIV-prevalent rural Indian district, and measure six-month changes in stigma after introducing an HIV prevention services program.

Methods

Between August 2006 and April 2007, a community HIV-related behavioural change and HIV testing services program was initiated in rural Aurangabad district, Maharashtra, to increase HIV services knowledge, reduce HIV stigma, and increase testing utilization. A questionnaire was administered to random cross-sectional samples of 400 adult men age 18-49 at Baseline and in the Post-Intervention and a separate post-Control community. Principle component factor analysis was used to develop a 14-item stigma scale. Stigma indices were calculated and dichotomized.

Results

Factor analysis consistently identified 3 HIV stigma subscales in each sample population. From Baseline to Post-Intervention, high stigma levels significantly decreased Overall (42% vs. 20%), for Fear of HIV Transmission (33% vs 14%), and for Perception of Enacted Stigma (34% to 14%) (p < 0.001). High stigma levels increased for Moral Judgements (79% vs 86%, p < 0.05). High stigma correlated independently with low education (AOR 2.7, 95%CI 1.6-4.3), and low HIV knowledge (AOR 3.5, 95%CI 2.2-5.5). Odds of high stigma reduced over 45% with participation in the Intervention program (AOR 0.54, 95%CI (0.36-0.82)).

Discussion

This HIV stigma scale, identifying three stigma subscales consistent with other studies, was validated in 3 community-based samples of rural men in. The HIV prevention services program reduced high HIV stigma overall and in HIV knowledge-related stigma domains. The program's current efforts include addressing Moral Judgment attitudes and longer-term study for impact on HIV testing utilization. Measurably reducing HIV-related stigma is essential for HIV prevention in rural.

This HIV stigma scale, identifying three stigma subscales consistent with other studies, was validated in 3 community-based samples of rural men in India. The HIV prevention services program reduced high HIV stigma overall and in HIV knowledge-related stigma domains. The program's current efforts include addressing Moral Judgment attitudes and longer-term study for impact on HIV testing utilization. Measurably reducing HIV-related stigma is essential for HIV prevention in rural India.