A Novel Intersectional HIV Stigma Measure in South Africa

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The social stigmatization of HIV impedes every step along the HIV continuum of care, including accessing HIV care, adhering to antiretroviral therapy (ART), and sustaining HIV viral suppression. HIV stigma also intersects with other stigmatized identities, such as gender and sexual orientation, with intersectional stigma creating unique experiences and barriers to HIV care. Research investigating intersectional stigma is gaining traction in high-income countries, however, studies of intersectional stigma across internalized, enacted, and anticipated stigma mechanisms remains limited, and has not yet been reported in the low-income countries of sub- Saharan Africa. Thus, while behavioral interventions to reduce the effects of HIV stigma are essential to ending HIV epidemics, studies have not yet identified intersecting stigmatized identities and their impacts on ART adherence in countries with high-HIV prevalence, such as South Africa. The absence of empirically validated psychometric measures of intersectional HIV stigma is hampering research and interventions in places with the greatest need. The proposed fellowship leverages an existing research infrastructure and project resources in South Africa to conduct two-phases of intersectional stigma research. Phase 1 will conduct elicitation interviews with women, sexual minority men, and heterosexual men receiving ART from an HIV clinic in Cape Town, South Africa. The interviews will probe participants’ experiences with respect to intersecting stigmatized identities. Insights gained from the interviews will inform the selection and tailoring of stigma scale items. An independent sample of clinic patients will provide feedback on the items and the identified stigmatized identities will be implemented in a novel approach to assessing intersectional stigma using a geometric conceptualization of intersectionality grounded in the HIV Stigma Framework to assess intersectional internalized, enacted, and anticipated stigma. In Phase 2, the newly developed intersectional stigma scales will be tested for reliability, construct validity, and predictive validity in a short-term prospective study of women, sexual minority men, and heterosexual men in HIV care and receiving ART. The completion of the study aims will offer a novel approach to assessing intersectional HIV stigma in South Africa that will inform behavioral interventions to promote ART uptake and adherence.