title: Preliminary development of a scale to measure stigma relating to sexually transmitted infections among women in a high risk neighbourhood.
abstract: BACKGROUND
  As stigma is a socially constructed concept, it would follow that stigma related to sexual behaviours and sexually transmitted infections would carry with it many of the gender-based morals that are entrenched in social constructs of sexuality. In many societies, women tend to be judged more harshly with respect to sexual morals, and would therefore have a different experience of stigma related to sexual behaviours as compared to men. While a variety of stigma scales exist for sexually transmitted infections (STIs) in general; none incorporate these female-specific aspects. The objective of this study was to develop a scale to measure the unique experience of STI-related stigma among women.
  
  
  METHODS
  A pool of items was identified from qualitative and quantitative literature on sexual behaviour and STIs among women. Women attending a social evening program at a local community health clinic in a low-income neighbourhood with high prevalence of substance use were passively recruited to take part in a cross-sectional structured interview, including questions on sexual behaviour, sexual health and STI-related stigma. Exploratory factor analysis was used to identify stigma scales, and descriptive statistics were used to assess the associations of demographics, sexual and drug-related risk behaviours with the emerging scales.
  
  
  RESULTS
  Three scales emerged from exploratory factor analysis--female-specific moral stigma, social stigma (judgement by others) and internal stigma (self-judgement)--with alpha co-efficients of 0.737, 0.705 and 0.729, respectively. In this population of women, internal stigma and social stigma carried higher scores than female-specific moral stigma. Aboriginal ethnicity was associated with higher internal and female-specific moral stigma scores, while older age (>30 years) was associated with higher female-specific moral stigma scores.
  
  
  CONCLUSIONS
  Descriptive statistics indicated an important influence of culture and age on specific types of stigma. Quantitative researchers examining STI-stigma should consider incorporating these female-specific factors in order to tailor scales for women.
authors.affiliation: Division of International Health and Cross Cultural Medicine, University of California San Diego, La Jolla, USA. mrusch@ucsd.edu
authors.forename: Melanie L A
authors.initials: ML
authors.lastname: Rusch
authors.forename: Jean A
authors.initials: JA
authors.lastname: Shoveller
authors.forename: Susan
authors.initials: S
authors.lastname: Burgess
authors.forename: Karen
authors.initials: K
authors.lastname: Stancer
authors.forename: David M
authors.initials: DM
authors.lastname: Patrick
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001955:British Columbia / Q000453:epidemiology; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D016002:Discriminant Analysis; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007600:Judgment; D008875:Middle Aged; D009014:Morals; D011204:Poverty Areas; D025341:Principal Component Analysis; D036301:Qualitative Research; D012111:Residence Characteristics; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000523:psychology*; D013240:Stereotyping; D011795:Surveys and Questionnaires / Q000592:standards*; D014505:Urban Population; D014930:Women / Q000523:psychology*