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Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging “What Matters Most” to Resist Stigma

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Abstract

Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify “full personhood” could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to “what matters most” (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both \(\alpha =0.90\)). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39, p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29, p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.

Resumen

El estigma percibido detetiza la participación en la atención de VIH y está fuertemente moldeado por la cultura. Sin embargo, pocas medidas de estigma consideran cómo las capacidades culturales que significan “personalidad plena” podrían ser utilizadas para resistir el estigma. Mediante la aplicación de una teoría que conceptualiza cómo los mecanismos culturalmente destacados pueden empeorar o mitigar el estigma del VIH en relación con “lo que más importa" (WMM), desarrollamos la Escala de Estigma Cultural WMM para mujeres que viven con VIH en Botswana (WMM-WLHIV-BW) y lo evaluamos psicométricamente entre 201 encuestados con estatus de VIH conocido y desconocido. Las dos subescalas, Factores Culturales dan Forma al Estigma (CFSS) y la protección de las Capacidades Culturales contra el Estigma (CCPS) eran fiables (ambos α = 0.90). Entre WLHIV, la subescala CFSS mostró la validez inicial de la construcción con síntomas depresivos (r = .39, p =.005), similar a una escala establecida de estigma del VIH, mientras que la subescala CCPS mostró la validez de la construcción inicial con autoestima (r = .32, p = .026) y el numero de apoyo social (r = .29, p = .047), lo que sugiere que lograr capacidades culturales locales mitiga el estigma y esta asociado con resultados psicosociales positivos. Esta escala culturalmente derivada podría ayudar a WLHIV en Bostwana a mejorar los resultados relacionados con el estigma.

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Data/Code Availability

Data will be made available based upon written request to the two co-first authors, Dr. Yang and Mr. Ho-Foster.

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Acknowledgements

We wish to thank the staff of the Princess Marina Hospital IDCC clinic for supporting recruitment and data collection. We thank Billy Tsima, Julius Mwita, and Vincent Dipathane for reviewing scale items as experienced HIV clinicians, and Liz Calderon for translating the Abstract into Spanish.

Funding

This research was supported by a grant and core support services from the Penn Mental Health AIDS Research Center (PMHARC), an NIH-funded program (P30MH097488), R21 TW011084-01 (PI: Dr. Yang), and the Focus for Health Foundation. The study also benefitted from core support services provided by the Penn Center for AIDS Research, an NIH-funded program (P30AI045008).

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Author notes

  1. Dr. Yang and Mr. Ho-Foster shared equally in first-authorship.

Authors and Affiliations

  1. School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, USA

    Lawrence H. Yang, Supriya Misra & Melody Goodman

  2. Mailman School of Public Health, Columbia University, New York, NY, USA

    Lawrence H. Yang

  3. Faculty of Medicine, University of Botswana, Gaborone, Botswana

    Ari R. Ho-Foster

  4. Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Ari R. Ho-Foster

  5. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Timothy D. Becker

  6. Department of Psychology, University of Botswana, Gaborone, Botswana

    Shathani Rampa

  7. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Ohemaa B. Poku

  8. Botswana-UPenn Partnership, Gaborone, Botswana

    Patlo Entaile

  9. Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Michael B. Blank

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Contributions

LHY, AHF and MBB conceived and planned the study. AHF and PE coordinated the study. PE collected the data. LHY, OBP, SR, and AHF constructed the WMM Stigma scale items. AHF and SM analyzed the data; LHY, AHF, SM and MBB interpreted the data; MG reviewed the write-up of data analyses. TDB conducted the literature search. TDB and AHF wrote the first draft, and LHY and SM substantially revised the manuscript for intellectual content. LHY, SM, TDB and AHF revised the manuscript in response to reviewers’ comments. All authors reviewed the manuscript for important intellectual content and approved the manuscript for publication.

Corresponding author

Correspondence to Lawrence H. Yang.

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The authors declare that there are no conflicts of interest.

Ethical Approval

The study was performed in accordance with current standards for human subjects research. Ethical approval was obtained from the Botswana Ministry of Health and Wellness (PMH 5/79 282-1-2017), and the Institutional Review Boards of the University of Botswana (UBR/RES/IRB/GRAD/1617), University of Pennsylvania (823407), and New York University (IRB-FY2017-609).

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All participants were informed about the study by bilingual research assistants and provided verbal and written consent to participate.

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Yang, L.H., Ho-Foster, A.R., Becker, T.D. et al. Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging “What Matters Most” to Resist Stigma. AIDS Behav 25, 459–474 (2021). https://doi.org/10.1007/s10461-020-03012-y

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