Abstract
HIV-related internalized stigma consistently predicts poorer mental health, well-being, and sub-optimal HIV outcomes, such as poorer antiretroviral (ART) adherence. However, existing measures of HIV-related internalized stigma are likely outdated and may not capture the current reality and concerns that people living with HIV have. This study aimed to develop and validate an updated and more acceptable tool for assessing HIV-related internalized stigma. The study included 249 people living with HIV who were participants of the multi-site cohort study Multicenter AIDS Cohort (MACS)-Women's Interagency HIV study (WIHS) Combined Cohort Study (MWCCS) in the United States. Participants completed a new internalized stigma scale, namely HIV-related Internalized Stigma Scale (HISS), which was developed with extensive input from people living with HIV. Following this, the dataset was combined with contemporaneous data collected for the MWCCS annual visit, which included an older measure of internalized stigma (the negative self-image subscale of the HIV Stigma Scale-HSS), ART adherence, and mental health variables (i.e., depression and post-traumatic stress disorder [PTSD] severity). Bayesian confirmatory factor analysis indicated that the 8-item new HISS yields a single factor solution, with factor loadings ranging from 0.68 to 0.94. Significant associations were found between the HISS and the negative self-image subscale of the HSS, ART adherence, depression, and PTSD severity, providing evidence of its concurrent and convergent validity. The HISS, as an updated, reliable, and valid tool, can be useful for ongoing research in the fields of epidemiology and psychology, as well as for evaluating interventions aimed at addressing HIV-related internalized stigma.