Objective. To develop and assess a homosexuality-related stigma scale among men who have sex with men (MSM) in Hanoi, Vietnam. Methods. We conducted a cross-sectional study using respondent-driven sampling in Hanoi, Vietnam, in 2011. We used a cross-validation approach. Factor analysis was performed, and interitem correlation matrices were constructed to identify the latent factor structures, examine the goodness of fit, and assess convergent and discriminant validity of the determined scales. Internal consistency checks were performed in split samples and whole sample, and separately for each determined factor. Results. The findings were consistent in split samples. Three homosexuality-related stigma factors were identified: enacted homosexual stigma, perceived homosexual stigma, and internalized homosexual stigma. The fit indices of the confirmatory factor analysis in both split samples supported the hypothesized three-factor structures (in subsamples A and B: /degrees of freedom ratio = 1.77 and 1.59, nonnormed fit index = 0.92 and 0.94, comparative fit index = 0.93 and 0.95, and the root mean square of approximation = 0.06 and 0.05, resp.). The interitem correlation supported the convergent and discriminant validity of the scales. The reliability of the three scales indicated good consistency (Cronbach’s alpha: 0.79–0.84) across split samples and for the whole data. Conclusion. Our scales have good psychometric properties for measuring homosexuality-related stigma. These comprehensive and practical tools are crucial not only to assess stigma against MSM and its consequence, but also to guide the development of interventions targeting MSM, as well as to evaluate the efficacy of existing stigma reduction efforts in Vietnam and other countries with similar settings. 1. Introduction In Vietnam, despite prevention efforts and treatment programs to control the epidemic, HIV rates among men who have sex with men (MSM) are increasing [1–3]. HIV/AIDS related stigmas are known barriers to prevention, care, and treatment efforts [4–6]. They also influence testing and treatment behaviors by inhibiting actions that might lead to the disclosure of HIV infection status or HIV-related stigmatized behaviors [5]. While there have been attempts to address HIV/AIDS related stigmas, they continue to influence testing and treatment decisions and contribute to the perpetuation of the epidemic [6]. HIV/AIDS stigma refers to the discrimination and prejudice from others towards individuals infected with HIV or towards those who are vulnerable to HIV such as MSM, sexual
References
[1]
T. A. Nguyen, H. T. Nguyen, G. T. Le, and R. Detels, “Prevalence and risk factors associated with HIV infection among men having sex with men in Ho Chi Minh City, Vietnam,” AIDS and Behavior, vol. 12, no. 3, pp. 476–482, 2008.
[2]
Ministry of Health and National Institute of Hygiene and Epidemiology, Results of the Integrated Biological and Behavioral Surveillance (IBBS) in Vietnam 2005-2006, National Institute of Hygiene and Epidemiology and Family Health International, Hanoi, Vietnam, 2006.
[3]
Ministries of Health and National Institute of Hygiene and Epidemiology, National Integrated HIV Bio-Behavioral Surveillance, Family Health International, Hanoi, Vietnam, 2009.
[4]
V. Bond, E. Chase, and P. Aggleton, “Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia,” Evaluation and Program Planning, vol. 25, no. 4, pp. 347–356, 2002.
[5]
S. C. Kalichman and L. C. Simbayi, “HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa,” Sexually Transmitted Infections, vol. 79, no. 6, pp. 442–447, 2003.
[6]
A. P. Mahajan, J. N. Sayles, V. A. Patel et al., “Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward,” AIDS, vol. 22, pp. S67–S79, 2008.
[7]
M. C. Berry, V. F. Go, V. M. Quan, et al., “Social environment and HIV risk among MSM in Hanoi and Thai Nguyen,” AIDS Care, vol. 25, no. 1, pp. 38–42, 2013.
[8]
D. A. Ngo, M. W. Ross, H. Phan, E. A. Ratliff, T. Trinh, and L. Sherburne, “Male homosexual identities, relationships, and practices among young men WHO have sex with men in Vietnam: implications for HIV prevention,” AIDS Education and Prevention, vol. 21, no. 3, pp. 251–265, 2009.
[9]
Institute for Social Development Studies (ISDS), Understanding and Reducing Stigma Related to Men Who Have Sex With Men and HIV, Women Publishing House, Ho Chi Minh City, Vietnam, 2010.
[10]
L. M. Giang, V. D. Viet, and B. R. M. Hao, “Sexual health and men who have sex with men in Vietnam: an integrated approach to preventive health care,” Advances in Preventive Medicine, vol. 2012, Article ID 796192, 2012.
[11]
V. A. Earnshaw and S. R. Chaudoir, “From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures,” AIDS and Behavior, vol. 13, no. 6, pp. 1160–1177, 2009.
[12]
H. Deacon, “Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature,” Journal of Community and Applied Social Psychology, vol. 16, no. 6, pp. 418–425, 2006.
[13]
E. Goffman, Stigma: Notes on the Management of Spoiled Identity, Simon and Schuster, New York, NY, USA, 1963.
[14]
H. Fay, S. D. Baral, G. Trapence et al., “Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana,” AIDS and Behavior, vol. 15, no. 6, pp. 1088–1097, 2011.
[15]
A. Jacoby, “Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission,” Social Science and Medicine, vol. 38, no. 2, pp. 269–274, 1994.
[16]
I. H. Meyer and L. Dean, “Patterns of sexual behavior and risk taking among young New York City gay men,” AIDS Education and Prevention, vol. 7, supplement 5, pp. 13–23, 1995.
[17]
G. Petros, C. O. Airhihenbuwa, L. Simbayi, S. Ramlagan, and B. Brown, “HIV/AIDS “othering” in South Africa: the blame goes on,” Culture, Health and Sexuality, vol. 8, no. 1, pp. 67–77, 2006.
[18]
T. B. Neilands, W. T. Steward, and K.-H. Choi, “Assessment of stigma towards homosexuality in China: a study of men who have sex with men,” Archives of Sexual Behavior, vol. 37, no. 5, pp. 838–844, 2008.
[19]
H. Liu, T. Feng, A. G. Rhodes, and H. Liu, “Assessment of the Chinese version of HIV and homosexuality related stigma scales,” Sexually Transmitted Infections, vol. 85, no. 1, pp. 65–69, 2009.
[20]
D. Bruce, Associations of racial and homosexual stigmas with risk behaviors among Latino men who have sex with men [Ph.D. dissertation], Department of Public Health, University of Illinois at Chicago, Chicago, Ill, USA, 2006.
[21]
D. B. Preston, A. R. D'Augelli, C. D. Kassab, and M. T. Starks, “The relationship of stigma to the sexual risk behavior of rural men who have sex with men,” AIDS Education and Prevention, vol. 19, no. 3, pp. 218–230, 2007.
[22]
Vietnam Administration of HIV/AIDS Control, “Viet Nam AIDS response progress report,” 2012, http://www.vaac.gov.vn/Desktop.aspx/Content/Publication-data.
[23]
R. M. Díaz, G. Ayala, E. Bein, J. Henne, and B. V. Marin, “The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities,” American Journal of Public Health, vol. 91, no. 6, pp. 927–932, 2001.
[24]
R. Kohvai, “A study of cross-validation and bootstrap for accuracy estimation and model selection,” in Proceedings of the 14th International Joint Conferences on Artificial Intelligence, vol. 2, pp. 1137–1143, 1995.
[25]
M. A. Pett, N. R. Lackey, and J. J. Sullivan, Making Sense of Factor Analysis: The Use of Factor Analysis for Instrument Development in Health Care Research, Sage, Thousand Oaks, Calif, USA, 2003.
[26]
R. DeVellis, Scale Development: Theory and Application, Sage, Newbury, Calif, USA, 1991.
[27]
W. M. K. Trochim, “The research methods knowledge base,” 2nd edition, 2006, http://www.socialresearchmethods.net/kb/convdisc.php.
[28]
J. F. Hair, R. E. Anderson, and R. L. Tatham, Multivariate Data Abaktsus Wutg Readings, Macmillan, New York, NY, USA, 2nd edition, 1987.
[29]
R. L. Gorsuch, Factor Analysis, Lawrence Erlbaum Associates, Hillsdale, NJ, USA, 2nd edition, 1983.
[30]
B. G. Tabachnick and L. S. Fidell, Using Multivariate Statistics, Harper and Row, New York, NY, USA, 3rd edition, 1996.
[31]
T. Brown, Confirmatory Factor Analysis for Applied Research, Guilford Press, New York, NY, USA, 2006.
[32]
L.-T. Hu and P. M. Bentler, “Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives,” Structural Equation Modeling, vol. 6, no. 1, pp. 1–55, 1999.
[33]
B. M. Byrne, “Burnout: investigating the impact of background variables for elementary, intermediate, secondary, and university educators,” Teaching and Teacher Education, vol. 7, no. 2, pp. 197–209, 1991.
[34]
J. M. Bland and D. G. Altman, “Cronbach's alpha,” British Medical Journal, vol. 314, no. 7080, p. 572, 1997.
[35]
M. Stone, “Cross-validatory choice and assessment of statistical predictions,” Journal of the Royal Statistical Society B, vol. 36, no. 2, pp. 111–147, 1974.
[36]
C. R. Hill and J. N. Hugher, “An examination of the convergent and discriminant validity of the strengths and difficulties questionnaire,” School Psychology Quarterly, vol. 22, no. 3, pp. 380–406, 2008.
[37]
C. E. Lance, C. L. Noble, and S. E. Scullen, “A critique of the correlated trait-correlated method and correlated uniqueness models for multitrait-multimethod data,” Psychological Methods, vol. 7, no. 2, pp. 228–244, 2002.
[38]
D. T. Campbell and D. W. Fiske, “Convergent and discriminant validation by the multitrait-multimethod matrix,” Psychological Bulletin, vol. 56, no. 2, pp. 81–105, 1959.
[39]
D. A. Cole, “Utility of confirmatory factor analysis in test validation research,” Journal of Consulting and Clinical Psychology, vol. 55, no. 4, pp. 584–594, 1987.
[40]
D. A. Kenny and D. Kashy, “Analysis of the multitrait-multimethod matrix by confirmatory factor analysis,” Psychological Bulletin, vol. 112, no. 1, pp. 165–172, 1992.
