title: Psychometric evaluation of the HIV stigma scale in a Swedish context.
abstract: BACKGROUND
  HIV-related stigma has negative consequences for infected people's lives and is a barrier to HIV prevention. Therefore valid and reliable instruments to measure stigma are needed to enable mapping of HIV stigma. This study aimed to evaluate the psychometric properties of the HIV stigma scale in a Swedish context with regard to construct validity, data quality, and reliability.
  
  
  METHODS
  The HIV stigma scale, developed by Berger, Ferrans, and Lashley (2001), was distributed to a cross-sectional sample of people living with HIV in Sweden (n = 194). The psychometric evaluation included exploratory factor analysis together with an analysis of the distribution of scores, convergent validity by correlations between the HIV stigma scale and measures of emotional well-being, and an analysis of missing items and floor and ceiling effects. Reliability was assessed using Cronbach's α.
  
  
  RESULTS
  The exploratory factor analysis suggested a four-factor solution, similar to the original scale, with the dimensions personalised stigma, disclosure concerns, negative self-image, and concerns with public attitudes. One item had unacceptably low loadings and was excluded. Correlations between stigma dimensions and emotional well-being were all in the expected direction and ranged between -0.494 and -0.210. The instrument generated data of acceptable quality except for participants who had not disclosed their HIV status to anybody. In line with the original scale, all subscales demonstrated acceptable internal consistency with Cronbach's α 0.87-0.96.
  
  
  CONCLUSIONS
  A 39-item version of the HIV stigma scale used in a Swedish context showed satisfactory construct validity and reliability. Response alternatives are suggested to be slightly revised for items assuming the disclosure of diagnosis to another person. We recommend that people that have not disclosed should skip all questions belonging to the dimension personalised stigma. Our analysis confirmed construct validity of the instrument even without this dimension.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Lindberg
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Wettergren
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Wiklander
authors.affiliation: Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Veronica
authors.initials: V
authors.lastname: Svedhem-Johansson
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden; School of Health Sciences, City University London, London, United Kingdom.
authors.forename: Lars E
authors.initials: LE
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003466:Cultural Characteristics; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D057545:Social Stigma; D013548:Sweden