Measuring Stigma: Measures for compounded/layered stigma

Stigma Measures

Measuring Stigma
Measures for compounded/layered stigma

Excerpted from Evidence-based Generic Tools for Operational Research on HIV, Carla Makhlouf Obermeyer (ed.), 2008 (forthcoming), Geneva: World Health Organization.

Compounded stigma refers to multiple, interrelated stigmatizing attitudes that mutually reinforce one another and often act to further marginalize vulnerable groups. For example, existing stigma against injecting drug users (IDUs) in a community may increase if IDUs become a population that is disproportionately affected by and associated with HIV. In turn, all individuals with HIV in that community may be assumed to be IDUs and therefore experience stigma not only for having HIV but also for being members of that marginalized group.

There are many challenges when attempting to quantitatively measure compounded stigma because the association between prevalence of HIV and a particularly vulnerable group (e.g., IDUs) may more or less accurately reflect the epidemiology in a particular setting. That is, IDUs may be in fact disproportionately affected by HIV. For example, individuals expressing the view that sex workers are responsible for spreading HIV in the community might be expressing compounded stigma related to sex work and HIV, or they could be accurately describing the epidemiology of HIV in their area. There are no well-established quantitative measures of compounded stigma at this time. However, the following items are examples of measures that have been used:

Indicate your agreement or disagreement with each statement (specific vulnerable groups can be substituted depending on local contexts):

●	People with HIV are promiscuous.
●	It is the female sex workers who spread HIV.
●	Women get HIV because they are prostitutes.
●	Homosexuality is the cause of HIV.
●	Injection drug users should be blamed for spreading HIV.
●	Men who have sex with other men should be put in jail for spreading HIV.

Because of the complexity of compounded stigma and the difficulty in measuring it accurately through survey questions, our recommendation is that research on this type of stigma be supplemented with qualitative research to explore nuances and causality.

Domains of stigma and discrimination

Measures for inappropriate fear of contagion and resulting avoidance of people living with HIV

Measures for negative judgments of people living with HIV

Measures for enacted stigma (discrimination)

Measures for compounded/layered stigma

Measures for other aspects of stigma

How to use the survey items

Methodological issues for data collection

An example: Developing a stigma index in India

Example of a survey module

Additional survey items

HIV Stigma Scale