Stigmatisierungserleben bei HIV/AIDS: erste deutsche Adaptation der HIV-Stigma Skala (HSS-D)

Zusammenfassung

Trotz guter medizinischer Behandlungsmöglichkeiten und zahlreicher Aufklärungskampagnen stellt Stigmatisierung eine starke Belastung für HIV-Infizierte und an AIDS erkrankte Patienten dar. In dieser Studie entwickelten wir eine deutsche Adaptation der HIV Stigma Scale (HSS-D). An der Untersuchung nahmen 167 homosexuelle HIV-positive Männer im Alter von 22 bis 74 Jahren teil. Die explorative Faktorenanalyse replizierte die vier-faktorielle Struktur mit den Skalen Erlebte Stigmatisierung, Offenbarungsangst, Negatives Selbstbild und Sorgen über die öffentliche Meinung. Die psychometrische Analyse führte zu einer revidierten Fassung mit 21 Items (HSS-D21). Die Gesamtskala wies eine hohe Reliabilität auf (α=0,90). Signifikante Zusammenhänge mit Angst, Depressivität, Lebenszufriedenheit und sozialer Unterstützung sprechen für die Konstruktvalidität. Der Fragebogen wurde von der Mehrheit der Patienten gut akzeptiert. Weitere Analysen an umfassenderen Stichproben erscheinen aber notwendig.

Abstract

Despite improvements in medical treatment and numerous public health campaigns stigmatization remains a potent stressor for people living with HIV/ AIDS. This study provides an initial German adaptation of the HIV Stigma Scale (HSS-D). Participants were 167 HIV-positive homosexual men aged 22–74 years. Exploratory factor analysis replicated the original four-factor structure (subscales: enacted stigma, disclosure concerns, negative self-image, concern with public attitudes). Further psychometric analysis led to a revised version comprising 21 items (HSS-D21). The scale showed high reliability (α=0.90). Significant associations with anxiety, depres­sion, life satisfaction and perceived social support confirmed for construct validity. The majority of the respondents expressed high acceptance of the stigma measure. In order to eslish a thorough German adaptation further research with diverse samples is needed.

Schlüsselwörter

HIV - Stigma - Fragebogen - AIDS - Psychometrie

Keywords

HIV - stigma - self-report - AIDS - psychometric evaluation

• Literatur

• 1 Clement U. HIV-positiv: Psychische Verarbeitung, subjektive Infek­tionstheorien und psychosexuelle Konflikte HIV-Infizierter; eine komparativ-kasuistische Studie. Stuttgart: Enke; 1992
• 2 Kim JY, Farmer P. AIDS in 2006 – moving toward one world, one hope?. N Engl J Med 2006; 355: 645-647
• 3 N.N. One World. One Hope. Proceedings of the XI International Conference on AIDS. Vancouver, Canada, 7-12 July 1996. AIDS 1996; 10 (Suppl. 3): S1-S133
• 4 Gore-Felton C, Koopman C. Behavioral mediation of the relationship between psychosocial factors and HIV disease progression. Psychosom Med 2008; 70: 569-574
• 5 Ronel J. Biopsychosoziale Zusammenhänge in der HIV-Medizin. In: Jäger H. Hrsg AIDS und HIV-Infektionen. Landsberg am Lech: Ecomed; 2005: 23-58
• 6 Rosenbrock R, Schmidt AJ. Neue Herausforderungen für die soziale und medizinische Prävention. Bundesgesundheitsbla 2012; 55: 535-542
• 7 Elford J, Ibrahim F, Bukutu C et al. HIV-related discrimination reported by people living with HIV in London, UK. AIDS Behav 2008; 12: 255-264
• 8 Sayles JN, Wong MD, Kinsler JJ et al. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med 2009; 24: 1101-1108
• 9 Sumari-de Boer IM, Sprangers MA, Prins JM et al. HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS Behav 2012; 16: 1681-1689
• 10 Vanable PA, Carey MP, Blair DC et al. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 2006; 10: 473-482
• 11 Sengupta S, Banks B, Jonas D et al. HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav 2011; 15: 1075-1087
• 12 Goffmann E. Stigma. Über Techniken der Bewältigung beschädigter Identität. Frankfurt am Main: Suhrkamp; 1967
• 13 Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav 2009; 13: 1160-1177
• 14 Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001; 24: 518-529
• 15 Bunn JY, Solomon SE, Miller C et al. Measurement of stigma in people with HIV: a reexamination of the HIV Stigma Scale. AIDS Educ Prev 2007; 19: 198-208
• 16 Sayles JN, Hays RD, Sarkisian CA et al. Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults. AIDS Behav 2008; 12: 748-758
• 17 Franke MF, Munoz M, Finnegan K et al. Validation and abbreviation of an HIV stigma scale in an adult spanish-speaking population in urban Peru. AIDS Behav 2010; 14: 189-199
• 18 Rongkavilit C, Wright K, Chen X et al. HIV stigma, disclosure and psychosocial distress among Thai youth living with HIV. Int J STD AIDS 2010; 21: 126-132
• 19 Jeyaseelan L, Kumar S, Mohanraj R et al. Assessing HIV/AIDS Stigma in South India: Validation and Abridgement of the Berger HIV Stigma Scale. AIDS Behav 2013; 17: 434-443
• 20 Herrmann C, Buss U, Snaith R. HADS-D: Hospital Anxiety and Depression Scale, Deutsche Version. Bern: Verlag Hans Huber; 1995
• 21 Henrich G, Herschbach P. Questions on Life Satisfaction (FLZ^M) – a short questionnaire for assessing subjective quality of life. Eur J Psychol Assess 2000; 16: 150-159
• 22 Schulz U, Schwarzer R. Soziale Unterstützung bei der Krankheitsbewältigung: Die Berliner Social Support Skalen (BSSS). Diagnostica 2003; 49: 73-82
• 23 Grümer S, Pinquart M. Perceived changes in personal circumstances related to social change. Associations with psychosocial resources and depressive symptoms. Eur Psychol 2011; 16: 68-78
• 24 Knoll N, Burkert S, Roigas J et al. Changes in reciprocal support provision and need-based support from partners of patients undergoing radical prostatectomy. Soc Sci Med 2011; 73: 308-315
• 25 Backhaus K, Erichson B, Plinke W et al. Multivariate Analysemethoden. Eine anwendungsorientierte Einführung. Berlin: Springer; 2003
• 26 Robert Koch Institut . Zum Welt AIDS-Tag. Epidemiologisches Bulletin 2012; /Nr.47
• 27 Dowshen N, Binns HJ, Garofalo R. Experiences of HIV-related stigma among young men who have sex with men. AIDS Patient Care STDS 2009; 23: 371-376
• 28 Grov C, Golub SA, Parsons JT et al. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care 2010; 22: 630-639
• 29 Riggs SA, Vosvick M, Stallings S. Attachment style, stigma and psychological distress among HIV+ adults. J Health Psychol 2007; 12: 922-936
• 30 Varni SE, Miller CT, McCuin T et al. Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS. J Soc Clin Psychol 2012; 31: 123-150
• 31 Gonzalez A, Miller CT, Solomon SE et al. Size matters: community size, HIV stigma, and gender differences. AIDS Behav 2009; 13: 1205-1212
• 32 Galvan FH, Davis EM, Banks D et al. HIV stigma and social support among African Americans. AIDS Patient Care STDS 2008; 22: 423-436
• 33 Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care 2009; 21: 742-753
• 34 Basta TB, Shacham E, Reece M. Symptoms of psychological distress: a comparison of rural and urban individuals enrolled in HIV-related mental health care. AIDS Patient Care STDS 2009; 23: 1053-1057
• 35 Brener L, Callander D, Slavin S et al. Experiences of HIV stigma: The role of visible symptoms, HIV centrality and community attachment for people living with HIV. AIDS Care 2013; DOI: 10.1080/09540121.2012.752784.
• 36 Stutterheim SE, Bos AE, Pryor JB et al. Psychological and social correlates of HIV status disclosure: the significance of stigma visibility. AIDS education and prevention: official publication of the International Society for AIDS Educ 2011; 23: 382-392
• 37 Rao D, Pryor JB, Gaddist BW et al. Stigma, secrecy, and discrimination: ethnic/racial differences in the concerns of people living with HIV/AIDS. AIDS Behav 2008; 12: 265-271
• 38 Balck F, Dinkel A. Partner von Patienten mit akuten Hirnschädigung: Angst und Depressivität in der akuten und sub-akuten Krankheitsphase. Psychother Psych Med 2012; 62: 352-358