RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA.
BMC Health Serv Res. 2024 May 21;24(1):647. doi: 10.1186/s12913-024-11098-6.
Men who have sex with men (MSM) are at heightened risk for HIV acquisition, yet they may delay or avoid HIV testing due to intersectional stigma experienced at the healthcare facility (HCF). Few validated scales exist to measure intersectional stigma, particularly amongst HCF staff. We developed the Healthcare Facility Staff Intersectional Stigma Scale (HCF-ISS) and assessed factors associated with stigma in Ghana.
We analyzed baseline data from HCF staff involved in a study testing a multi-level intervention to reduce intersectional stigma experienced by MSM. Data are from eight HCFs in Ghana (HCF Staff n = 200). The HCF-ISS assesses attitudes and beliefs towards same-sex relationships, people living with HIV (PLWH) and gender non-conformity. Exploratory factor analysis assessed HCF-ISS construct validity and Cronbach's alphas assessed the reliability of the scale. Multivariable regression analyses assessed factors associated with intersectional stigma.
Factor analysis suggested an 18-item 3-factor scale including: Comfort with Intersectional Identities in the Workplace (6 items, Cronbach's alpha = 0.71); Beliefs about Gender and Sexuality Norms (7 items, Cronbach's alpha = 0.72); and Beliefs about PLWH (5 items, Cronbach's alpha = 0.68). Having recent clients who engage in same-gender sex was associated with greater comfort with intersectional identities but more stigmatizing beliefs about PLWH. Greater religiosity was associated with stigmatizing beliefs. Infection control training was associated with less stigma towards PLWH and greater comfort with intersectional identities.
Achieving the goal of ending AIDS by 2030 requires eliminating barriers that undermine access to HIV prevention and treatment for MSM, including HCF intersectional stigma. The HCF-ISS provides a measurement tool to support intersectional stigma-reduction interventions.
男男性行为者（MSM）感染艾滋病毒的风险较高，但由于在医疗保健机构（HCF）中经历的交叉歧视，他们可能会延迟或避免进行 HIV 检测。目前几乎没有经过验证的量表来衡量交叉歧视，尤其是在 HCF 工作人员中。我们开发了医疗保健机构工作人员交叉歧视量表（HCF-ISS），并评估了加纳与歧视相关的因素。
我们分析了参与一项测试多层面干预措施的 HCF 工作人员的基线数据，该干预措施旨在减少 MSM 所经历的交叉歧视。数据来自加纳的八家 HCF（HCF 工作人员 n=200）。HCF-ISS 评估了对同性关系、艾滋病毒感染者（PLWH）和性别不一致的态度和信念。探索性因素分析评估了 HCF-ISS 的结构有效性，Cronbach's alpha 评估了该量表的可靠性。多变量回归分析评估了与交叉歧视相关的因素。
因素分析表明，一个 18 项 3 因素量表包括：在工作场所对交叉身份的舒适度（6 项，Cronbach's alpha=0.71）；对性别和性行为规范的信念（7 项，Cronbach's alpha=0.72）；以及对 PLWH 的信念（5 项，Cronbach's alpha=0.68）。最近有与同性发生性行为的客户与对交叉身份的更大舒适度相关，但对 PLWH 的污名化信念更强。更高的宗教信仰与污名化信念相关。感染控制培训与对 PLWH 的污名化减少和对交叉身份的更大舒适度相关。
要实现到 2030 年终结艾滋病的目标，就必须消除破坏男男性行为者获得艾滋病毒预防和治疗的障碍，包括医疗保健机构的交叉歧视。HCF-ISS 提供了一种衡量工具，以支持减少交叉歧视的干预措施。
