title: Stigmatising attitudes among people offered home-based HIV testing and counselling in Blantyre, Malawi: construction and analysis of a stigma scale.
abstract: BACKGROUND
  HIV/AIDS related stigma is a major barrier to uptake of HIV testing and counselling (HTC). We assessed the extent of stigmatising attitudes expressed by participants offered community-based HTC, and their anticipated stigma from others to assess relationship with HIV test uptake. From these data, we constructed a brief stigma scale for use around the time of HIV testing.
  
  
  RESULTS
  Adult members of 60 households in urban Blantyre, Malawi, were selected using population-weighted random cluster sampling and offered HTC with the option to self-test before confirmatory HTC. Prior to HTC a 15-item HIV stigma questionnaire was administered. We used association testing and principal components analysis (PCA) to construct a scale measure of stigma. Of 226 adults invited to participate, 216 (95.6%) completed questionnaires and 198/216 (91.7%) opted to undergo HTC (all self-tested). Stigmatising attitudes were uncommon, but anticipated stigma was common, especially fearing verbal abuse (22%) or being abandoned by their partner (11%). Three questions showed little association or consistency with the remaining 12 stigma questions and were not included in the final scale. For the 12-question final scale, Cronbach's alpha was 0.75. Level of stigma was not associated with previously having tested for HIV (p = 0.318) or agreeing to HTC (p = 0.379), but was associated with expressed worry about being or becoming HIV infected (p = 0.003).
  
  
  CONCLUSIONS
  Anticipated stigma prior to HTC was common among both men and women. However, the high uptake of HTC suggests that this did not translate into reluctance to accept community-based testing. We constructed a brief scale to measure stigma at the time of HIV testing that could rapidly identify individuals requiring additional support following diagnosis and monitor the impact of increasing availability of community-based HTC on prevalence of stigma.
authors: Liverpool School of Tropical Medicine, Liverpool, United Kingdom. p.macpherson@liverpool.ac.uk
authors: Peter
authors: P
authors: MacPherson
authors: Emily L
authors: EL
authors: Webb
authors: Augustine T
authors: AT
authors: Choko
authors: Nicola
authors: N
authors: Desmond
authors: Kondwani
authors: K
authors: Chavula
authors: Sue
authors: S
authors: Napierala Mavedzenge
authors: Simon D
authors: SD
authors: Makombe
authors: Treza
authors: T
authors: Chunda
authors: S Bertel
authors: SB
authors: Squire
authors: Elizabeth L
authors: EL
authors: Corbett
mesh_terms: D000328:Adult; D001290:Attitude; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012648:Self Care; D057545:Social Stigma; D013240:Stereotyping; D011795:Surveys and Questionnaires; D055815:Young Adult