title: Development of internalized and personal stigma among patients with and without HIV infection and occupational stigma among health care providers in Southern China.
abstract: BACKGROUND
  HIV/AIDS-related stigma is a major barrier of access to care for those infected with HIV. The aim of this study was to examine, validate, and adapt measuring scales of internalized, personal, and occupational stigma developed in Africa into a Chinese context.
  
  
  METHODS
  A cross-sectional study was conducted from January to September 2015 in Kunming, People's Republic of China. Various scales were constructed on the basis of the previous studies with modifications by experts using exploratory and confirmatory factor analyses (EFA + CFA). Validation of the new scales was done using multiple linear regression models and hypothesis testing of the factorial structure invariance.
  
  
  RESULTS
  The numbers of subjects recruited for the development/validation samples were 696/667 HIV-positive patients, 699/667 non-HIV patients, and 157/155 health care providers. EFA revealed a two-factor solution for internalized and personal stigma scales (guilt/blaming and being refused/refusing service), which were confirmed by CFA with reliability coefficients (r) of 0.869 and 0.853, respectively. The occupational stigma scale was found to have a three-factor structure (blaming, professionalism, and egalitarianism) with a reliability coefficient (r) of 0.839. Higher correlations of factors in the HIV patients (r=0.537) and non-HIV patients (r=0.703) were observed in contrast to low-level correlations (r=0.231, 0.286, and 0.266) among factors from health care providers.
  
  
  CONCLUSIONS
  The new stigma scales are valid and should be used to monitor HIV/AIDS stigma in different groups of Chinese people in health care settings.
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; School of Public Health, Kunming Medical University.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Sawitri
authors.initials: S
authors.lastname: Assanangkornchai
authors.affiliation: Yunnan Center for Disease Prevention and Control.
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Yunnan Center for Disease Prevention and Control.
authors.forename: Manhong
authors.initials: M
authors.lastname: Jia
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Edward B
authors.initials: EB
authors.lastname: McNeil
authors.affiliation: Infectious Diseases Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Virasakdi
authors.initials: V
authors.lastname: Chongsuvivatwong
keywords: HIV/AIDS-related stigma; being refused; blaming; confirmatory factor analysis; exploratory factor analysis; guilt; refusing service