Am J Epidemiol. 2020 Jul 1;189(7):690-697. doi: 10.1093/aje/kwz270.
Overcoming stigma affecting gay, bisexual, and other men who have sex with men (MSM) is a foundational element of an effective response to the human immunodeficiency virus (HIV) pandemic. Quantifying the impact of stigma mitigation interventions necessitates improved measurement of stigma for MSM around the world. In this study, we explored the underlying factor structure and psychometric properties of 13 sexual behavior stigma items among 10,396 MSM across 8 sub-Saharan African countries and the United States using cross-sectional data collected between 2012 and 2016. Exploratory factor analyses were used to examine the number and composition of underlying stigma factors. A 3-factor model was found to be an adequate fit in all countries (root mean square error of approximation = 0.02-0.05; comparative fit index/Tucker-Lewis index = 0.97-1.00/0.94-1.00; standardized root mean square residual = 0.04-0.08), consisting of "stigma from family and friends," "anticipated health-care stigma," and "general social stigma," with internal consistency estimates across countries of α = 0.36-0.80, α = 0.72-0.93, and α = 0.51-0.79, respectively. The 3-factor model of sexual behavior stigma cut across social contexts among MSM in the 9 countries. These findings indicate commonalities in sexual behavior stigma affecting MSM across sub-Saharan Africa and the United States, which can facilitate efforts to track progress on global stigma mitigation interventions.
克服影响男同性恋者、双性恋者和其他与男性发生性关系的男性(MSM)的污名化是有效应对人类免疫缺陷病毒(HIV)大流行的基础要素。量化耻辱感减轻干预措施的影响需要改善对全球 MSM 的耻辱感的衡量。在这项研究中,我们使用 2012 年至 2016 年期间收集的横断面数据,探索了 8 个撒哈拉以南非洲国家和美国的 10396 名 MSM 中 13 项性行为耻辱感项目的潜在因素结构和心理测量特性。使用探索性因素分析来检查潜在耻辱感因素的数量和组成。在所有国家中,发现 3 因素模型是一个合适的拟合(近似均方根误差=0.02-0.05;比较拟合指数/塔克-刘易斯指数=0.97-1.00/0.94-1.00;标准化均方根残差=0.04-0.08),包括“来自家庭和朋友的耻辱感”、“预期的医疗保健耻辱感”和“普遍的社会耻辱感”,在各国的内部一致性估计值为α=0.36-0.80、α=0.72-0.93 和α=0.51-0.79。性行为耻辱感的 3 因素模型跨越了 9 个国家 MSM 的社会背景。这些发现表明,在撒哈拉以南非洲和美国的 MSM 中,性行为耻辱感存在共性,可以促进努力跟踪全球耻辱感减轻干预措施的进展。
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