Internalized HIV Stigma and Disclosure Concerns: Development and Validation of Two Scales in Spanish-Speaking Populations

Abstract

Internalized stigma and disclosure concerns are key elements for the study of mental health in people living with HIV. Since no measures of these constructs were available for Spanish population, this study sought to develop such instruments, to analyze their reliability and validity and to provide a short version. A heterogeneous sample of 458 adults from different Spanish-speaking countries completed the HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale, along with the Hospital Anxiety and Depression Scale, Rosenberg's Self-esteem Scale and other socio-demographic variables. Reliability and correlation analyses, exploratory factor analyses, path analyses with latent variables, and ANOVAs were conducted to test the scales' psychometric properties. The scales showed good reliability in terms of internal consistency and temporal stability, as well as good sensitivity and factorial and criterion validity. The HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale are reliable and valid means to assess these variables in several contexts.

Role of Self-Stigma in Pathways from HIV-Related Stigma to Quality of Life Among People Living with HIV

“…This scale is a frequently used measure of HIV-related stigma and is considered both valid and reliable. 38 , 39 For this study, we utilized each subscale individually because they represent different forms of stigma. We drew items from the short HIV stigma scale that reflect the concepts of perceived public stigma, experienced stigma, and self-stigma.…”

“… 38 In the analysis, we treated disclosure concerns as a quality-of-life outcome instead of a type of stigma because previous studies have found internalized stigma in PLHIV to be a significant predictor of disclosure concerns. 25 , 39 , 40 An example item is “I am very careful who I tell that I have HIV.” Cronbach's alpha was 0.66.…”

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study

“…Internalized stigma was assessed with the HIV Internalized Stigma Scale (HIV‐ISS; Hernansaiz‐Garrido & Alonso‐Tapia, ), a self‐report instrument in Spanish that evaluates the level of internalized stigma related to HIV during the last month. It consists of 10 items with a five‐point response scale (1 = Never or hardly ever ; 5 = All or almost all the time ).…”

“…Although there are various dimensions of HIV stigma (e.g., enacted, anticipated, and internalized; Earnshaw & Chaudoir, ), it is internalized stigma, defined as the devaluation and discrediting of oneself based on one's HIV status (Earnshaw, Bogart, Dovidio & Williams, ), the one which has been claimed to have the most severe consequences in terms of quality of life and mental and physical health (Murphy, Garrido‐Hernansaiz, Mulcahy & Hevey, ; Phillips, Moneyham & Tavakoli, ; Singh, Kumar, Mukhopadhyay & Singh, ). Internalization of HIV stigma, as mentioned before, depends on how resilient the person is (Brouard & Wills, ) and internalized stigma has indeed been consistently related to higher anxiety and depressive symptoms and lower quality of life in different populations (Heywood & Lyons, ; Murphy et al ., ; Willie et al ., ), including PLWH in Spain (Fuster‐Ruizdeapodaca, Molero, Holgado & Mayordomo, ; Hernansaiz‐Garrido & Alonso‐Tapia, ).…”

Examining Multilevel Factors Associated with the Process of Resilience among Women Living with HIV in a Large Canadian Cohort Study: A Structural Equation Modeling Approach

“…[16][17][18] Resilience has also been associated with positive health benefits, including viral suppression, 19 treatment adherence, 16 and quality of life (QoL), both physical and mental. 2,[20][21][22][23] For women living with HIV (WLWH) in particular, resilience has been linked to better QoL. 24 Women living with HIV experience significant stress and adversities due to gendered vulnerabilities of HIV, resulting in part from the socialenvironmental contexts of stigma, discrimination, economic insecurity, and inability to safely disclose (factors that have been linked to poor health outcomes).…”