Psychometric Validation of a Scale to Assess Culturally-Salient Aspects of HIV Stigma Among Women Living with HIV in Botswana: Engaging What Matters Most to Resist Stigma

Perceived stigma deters engagement in HIV care and is powerfully shaped by culture. Yet few stigma measures consider how cultural capabilities that signify full personhood could be engaged to resist stigma. By applying a theory conceptualizing how culturally-salient mechanisms can worsen or mitigate HIV stigma in relation to what matters most (WMM), we developed the WMM Cultural Stigma Scale for Women Living with HIV in Botswana (WMM-WLHIV-BW) and psychometrically evaluated it among 201 respondents with known and unknown HIV status. The two subscales, Cultural Factors Shape Stigma (CFSS) and Cultural Capabilities Protect against Stigma (CCPS) were reliable (both alpha=0.90). Among WLHIV, the CFSS Subscale showed initial construct validity with depressive symptoms (r = .39,p = .005), similar to an established HIV stigma scale, whereas the CCPS Subscale showed initial construct validity with self-esteem (r = .32, p = .026) and social support number (r = .29,p = .047), suggesting that achieving local cultural capabilities mitigates stigma and is linked with positive psychosocial outcomes. This culturally-derived scale could help WLHIV in Botswana experience improved stigma-related outcomes.

Automated summary

Perceived stigma in HIV care is influenced by culture, and a new Cultural Stigma Scale was developed and evaluated in Botswana to explore how cultural capabilities could help women living with HIV resist stigma. The study found that cultural factors shape stigma while cultural capabilities protect against stigma, and these cultural capabilities are linked with positive psychosocial outcomes such as self-esteem and social support.