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Stigmatising Attitudes among People Offered Home-Based HIV Testing and Counselling in Blantyre, Malawi: Construction and Analysis of a Stigma Scale

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  • Peter MacPherson
  • Emily L Webb
  • Augustine T Choko
  • Nicola Desmond
  • Kondwani Chavula
  • Sue Napierala Mavedzenge
  • Simon D Makombe
  • Treza Chunda
  • S Bertel Squire
  • Elizabeth L Corbett

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. Methods and Findings: 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.

Suggested Citation

  • Peter MacPherson & Emily L Webb & Augustine T Choko & Nicola Desmond & Kondwani Chavula & Sue Napierala Mavedzenge & Simon D Makombe & Treza Chunda & S Bertel Squire & Elizabeth L Corbett, 2011. "Stigmatising Attitudes among People Offered Home-Based HIV Testing and Counselling in Blantyre, Malawi: Construction and Analysis of a Stigma Scale," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-9, October.
    • Handle: RePEc:plo:pone00:0026814
    DOI: 10.1371/journal.pone.0026814
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    References listed on IDEAS

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