Table of Contents
Abstract
The Myanmar version of the HIV stigma Scale (HIVSS-M-3) is a specialized psychometric instrument designed to quantify the multifaceted nature of stigma experienced by individuals living with HIV in Myanmar. Recognizing that existing Western-centric measures often fail to capture the unique cultural and religious nuances of Southeast Asian populations, researchers synthesized elements from Berger's established HIV stigma Scale and an Indian variant. The resulting tool integrates culturally specific dimensions, such as karma-related religious concerns, alongside traditional metrics of internalized and enacted stigma.
By providing a rigorously validated, localized measure, this instrument enables public health professionals and behavioral scientists to better understand the psychosocial barriers hindering HIV treatment adherence in a high-prevalence, resource-limited setting. The scale's development utilized a robust combination of Classical Test Theory and Rasch analysis, ensuring that the final 35-item instrument offers precise, culturally sensitive measurement free from demographic biases.
📊 Psychometric Scorecard
Authors
Purpose
In the realm of health psychology and infectious disease management, stigma remains one of the most formidable barriers to testing, treatment adherence, and overall quality of life. While global initiatives aim to rapidly scale up HIV care, progress in countries like Myanmar is frequently derailed by pervasive social discrimination. The development of the HIVSS-M-3 addresses a critical measurement gap: the absence of a culturally calibrated, Burmese-language tool to assess HIV-related stigma.
For clinicians and researchers, having a localized instrument is essential for designing targeted psychosocial interventions. It allows practitioners to pinpoint exactly which types of stigma—whether rooted in healthcare settings, family dynamics, or religious beliefs—are most prevalent, thereby guiding the allocation of limited public health resources more effectively and supporting global targets for HIV eradication.
Construct
The psychological construct of HIV-related stigma encompasses the prejudice, discounting, and discrimination directed at individuals based on their serostatus. Theoretically, this construct is highly multidimensional, typically divided into enacted stigma (actual experiences of discrimination), anticipated stigma (fear of future discrimination), and internalized stigma (endorsement of negative societal beliefs about oneself).
The HIVSS-M-3 expands upon this traditional framework by incorporating cultural specificity. It measures six distinct facets: personalized stigma, concerns regarding public attitudes, negative self-image, healthcare provider discrimination, disclosure anxieties, and religious concerns. The inclusion of religious concerns is particularly noteworthy, as it captures the intersection of local Buddhist ideologies—such as the concept of karma and past-life transgressions—with the psychological experience of chronic illness.
Validity
To establish the scale's construct validity, researchers evaluated its relationship with theoretically adjacent psychological variables. Consistent with established psychometric literature, higher scores on the stigma scale demonstrated a robust positive correlation with depressive symptoms (r = 0.60) and a strong negative correlation with perceived social support (r = -0.77). This convergent validity evidence confirms that the instrument accurately captures the deleterious psychosocial impact of stigma.
Furthermore, the researchers employed Rasch analysis to verify structural validity at the item level. The infit and outfit mean squares fell within the acceptable 0.68 to 1.40 range, indicating that the items appropriately fit the underlying latent trait model. Crucially, the analysis revealed no differential item functioning (DIF) across gender or educational levels, ensuring the scale measures stigma equitably across diverse demographic subgroups.
Convergent & Discriminant Validation Correlations
| Reference Instrument | Correlation Coefficient (r) |
|---|---|
| Center for Epidemiological Studies Depression Scale (CES-D) | r=0.60 |
| Medical Outcomes Study–Social Support Survey (MOS-SSS) | r=-0.77 |
Reliability
The internal consistency of the refined 35-item scale proved to be exceptionally strong, meeting rigorous psychometric standards for both research and potential clinical application. Across the six subscales, Cronbach's alpha coefficients ranged from 0.72 to 0.95, indicating that the items within each domain reliably measure the same underlying concept.
Additionally, the application of Item Response Theory via Rasch analysis provided person reliability indices of 3.40 and 1.53, alongside separation indices of 0.92 and 0.70. These metrics demonstrate the instrument's robust capacity to consistently differentiate between respondents experiencing varying severities of stigma, confirming its utility as a precise measurement tool.
Factor Analysis
The structural architecture of the scale was determined through a comprehensive exploratory factor analysis (EFA). Initial testing confirmed the data's suitability for dimension reduction. Using parallel analysis, the researchers extracted a six-factor solution that accounted for an impressive 68.23% of the total variance in stigma scores.
During the iterative refinement process, items were subjected to strict retention criteria based on both Classical Test Theory and Rasch modeling. Items exhibiting factor loadings below 0.40, significant cross-loadings across multiple domains, or poor fit statistics were systematically eliminated. This rigorous psychometric pruning reduced the original 47-item pool to a highly optimized 35-item structure, ensuring that each retained item strongly and uniquely contributes to its respective factor.
Subscales
| Subscale | Items | Description |
|---|---|---|
| Personalized stigma | 29, 18, 33, 38, 35, 36, 32, 28, 24, 34 | Measures direct, personal experiences of rejection, distancing, or discrimination from others due to HIV status. |
| Concerns with public attitudes about HIV | 10, 20, 16, 9, 40, 14, 5 | Assesses the individual's perception of societal prejudice, stereotypes, and general negative attitudes toward people living with HIV. |
| Negative self-image | 23, 12, 7, 15, 2, 3 | Evaluates internalized stigma, including feelings of guilt, shame, and self-depreciation related to having HIV. |
| Healthcare provider's stigma | 46, 45, 44, 47 | Captures experiences of discrimination, refusal of care, or mistreatment specifically within medical and hospital settings. |
| Disclosure concerns | 17, 37, 6, 25, 19 | Measures the anxiety, effort, and fear associated with keeping one's HIV status a secret to avoid anticipated discrimination. |
| Religious concerns | 41, 43, 42 | Assesses culturally specific stigma tied to religious beliefs, such as attributing HIV infection to bad karma or past-life sins. |
Instrument
| Test Type | Self-report questionnaire |
| Format | 35 items, self-report response format |
| Scoring | Item scores are summed to yield subscale and total stigma scores |
| Language | Burmese |
| Population | Medical patients |
| Age Group | Adults (18 years and older) |
| Administration | Online administration via REDCap |
| Completion Time | Approximately 30 minutes for the full survey battery |
Myanmar version of the HIV stigma scale Items
Items are currently not available
The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.
Sample
The validation sample consisted of 156 adults living with HIV in Myanmar, recruited via a closed Facebook group using random sampling. The mean age of participants was 28.92 years (SD = 17.32). The sample was predominantly male (62.2%) and of Bamar ethnicity (76.9%), with an average of 9.57 years living with HIV.
Cite This Paper
Feifei Huang, Wei-Ti Chen, Cheng-Shi Shiu, Sai Htun Lin, Min San Tun, Thet Wai Nwe, Yin Thet Nu Oo, Htun Nyunt Oo (2021). Myanmar version of the HIV stigma scale. BMC public health. https://doi.org/10.1186/s12889-021-11685-w
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Cite this article
Mohammed looti (2026). Myanmar version of the HIV stigma scale. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/myanmar-version-of-the-hiv-stigma-scale/
Mohammed looti. "Myanmar version of the HIV stigma scale." PSYCHOLOGICAL SCALES, 14 Aug. 2026, https://scales.arabpsychology.com/s/myanmar-version-of-the-hiv-stigma-scale/.
Mohammed looti. "Myanmar version of the HIV stigma scale." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/myanmar-version-of-the-hiv-stigma-scale/.
Mohammed looti (2026) 'Myanmar version of the HIV stigma scale', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/myanmar-version-of-the-hiv-stigma-scale/.
[1] Mohammed looti, "Myanmar version of the HIV stigma scale," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.
Mohammed looti. Myanmar version of the HIV stigma scale. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.