Skip to main content

Advertisement

SpringerLink
Log in

Finding the Right Angle: A Geometric Approach to Measuring Intersectional HIV Stigma

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Intersectionality has emerged as theoretically and practically important to advancing HIV stigma research. However, few psychometric measures capture the intricacies of intersectional stigma. Grounded in the HIV stigma framework and contemporary theories of intersectionality, this paper describes a novel approach to conceptualizing the measurement of intersectional stigma. Taking the notion of an intersection literally, that is the point at which two or more lines meet and form a union, we offer a geometric conceptualization for developing a psychometric instrument to measure intersectional stigma. Ratings of stigmatized attributes, such as stigma ascribed to gender, race, sexual orientation, and HIV status are assessed on independent scales to calculate their intersection using the Pythagorean Theorem, c = \(\surd\) (a2 + b2) and its extension to multiple stigmatized attributes d = \(\surd\) (a2 + b2 + c2). Data from a sample of Black /African American women living with HIV were used to test the concept of a geometric approach to measuring intersectional enacted stigma and intersectional anticipated stigma. Findings from the test of concept were encouraging and warrant further scale development research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

All data and materials are available from the authors by request.

References

  1. Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22(Suppl 2):S67-79.

    PubMed  Google Scholar 

  2. Blake Helms C, Turan JM, Atkins G, Kempf MC, Clay OJ, Raper JL, et al. Interpersonal mechanisms contributing to the association between HIV-related internalized stigma and medication adherence. AIDS Behav. 2017;21(1):238–47.

    CAS  PubMed  Google Scholar 

  3. Treves-Kagan S, El Ayadi AM, Pettifor A, MacPhail C, Twine R, Maman S, et al. Gender, HIV testing and stigma: The association of HIV testing behaviors and community-level and individual-level stigma in rural south africa differ for men and women. AIDS Behav. 2017;21(9):2579–88.

    PubMed  PubMed Central  Google Scholar 

  4. Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav. 2011;15(6):1111–20.

    PubMed  Google Scholar 

  5. Kalichman SC, Simbayi L. HIV testing attitudes, AIDS stigma and voluntary HIV counseling and testing in a black township in cape town. South Africa Sex Transm Infect. 2003;79(6):442–7.

    CAS  PubMed  Google Scholar 

  6. Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town. South Africa Sex Transm Infect. 2003;79(6):442–7.

    CAS  PubMed  Google Scholar 

  7. Kelly JD, Weiser SD, Tsai AC. Proximate context of HIV stigma and its association with HIV testing in sierra leone: A population-based study. AIDS Behav. 2016;20(1):65–70.

    PubMed  PubMed Central  Google Scholar 

  8. Herek GM, Glunt EK. An epidemic of stigma. Public reactions to AIDS Am Psychol. 1988;43(11):886–91.

    CAS  PubMed  Google Scholar 

  9. Herek GM, Capitanio JP. Public reactions to AIDS in the United States: a second decade of stigma. Am J Public Health. 1993;83(4):574–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Kalichman S, Katner H, Banas E, Kalichman M. Population density and AIDS-related stigma in large-urban, small-urban, and rural communities of the Southeastern USA. Prev Sci. 2017;18(5):517–25.

    PubMed  PubMed Central  Google Scholar 

  11. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS Behav. 2009;13:1160–77.

    PubMed  PubMed Central  Google Scholar 

  12. Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.

    PubMed  PubMed Central  Google Scholar 

  13. Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68(4):225–36.

    PubMed  PubMed Central  Google Scholar 

  14. Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS Behav. 2016;20(1):29–50.

    PubMed  Google Scholar 

  15. Babel RA, Wang P, Alessi EJ, Raymond HF, Wei C. Stigma, HIV risk, and access to HIV prevention and treatment services among men who have sex with men (MSM) in the United States: A scoping review. AIDS Behav. 2021.

  16. Jackson-Best F, Edwards N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health. 2018;18(1):919.

    PubMed  PubMed Central  Google Scholar 

  17. Mena E, Bolte G, Group AGS. Intersectionality-based quantitative health research and sex/gender sensitivity: a scoping review. Int J Equity Health. 2019;18(1):199.

    Google Scholar 

  18. Carbado D, Crenshaw KW, Mays V, Tomlinson B. Intersectioanlity: Mapping the Movements of a Theory. Du BoisRev. 2013;10(2):303–12.

    Google Scholar 

  19. Quinn K, Bowleg L, Dickson-Gomez J. “The fear of being Black plus the fear of being gay”: The effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019;232:86–93.

    PubMed  PubMed Central  Google Scholar 

  20. Crenshaw K. Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989;1:139–1367.

    Google Scholar 

  21. de Vries B. LG(BT) persons in the second half of life: the intersectional influences of stigma and cohort. LGBT Health. 2014;1(1):18–23.

    PubMed  Google Scholar 

  22. Earnshaw VA, Reed NM, Watson RJ, Maksut JL, Allen AM, Eaton LA. Intersectional internalized stigma among Black gay and bisexual men: A longitudinal analysis spanning HIV/sexually transmitted infection diagnosis. J Health Psychol. 2021;26(3):465–76.

    PubMed  Google Scholar 

  23. Goodin BR, Owens MA, White DM, Strath LJ, Gonzalez C, Rainey RL, et al. Intersectional health-related stigma in persons living with HIV and chronic pain: implications for depressive symptoms. AIDS Care. 2018;30(sup2):66–73.

    PubMed  PubMed Central  Google Scholar 

  24. Logie CH, James L, Tharao W, Loutfy MR. HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med. 2011;8(11):e1001124.

    PubMed  PubMed Central  Google Scholar 

  25. Mora-Rios J, Ortega-Ortega M, Natera G. Subjective experience and resources for coping with stigma in people with a diagnosis of schizophrenia: An intersectional approach. Qual Health Res. 2016;26(5):697–711.

    PubMed  Google Scholar 

  26. Pachankis JE, Hatzenbuehler ML, Berg RC, Fernandez-Davila P, Mirandola M, Marcus U, et al. Anti-LGBT and anti-immigrant structural stigma: An intersectional analysis of sexual minority men’s HIV risk when migrating to or within Europe. J Acquir Immune Defic Syndr. 2017;76(4):356–66.

    PubMed  PubMed Central  Google Scholar 

  27. Rice WS, Logie CH, Napoles TM, Walcott M, Batchelder AW, Kempf MC, et al. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med. 2018;208:9–17.

    PubMed  PubMed Central  Google Scholar 

  28. Sangaramoorthy T, Jamison A, Dyer T. Intersectional stigma among midlife and older Black women living with HIV. Cult Health Sex. 2017;19(12):1329–43.

    PubMed  PubMed Central  Google Scholar 

  29. Triandafilidis Z, Ussher JM, Perz J, Huppatz K. An intersectional analysis of women’s experiences of smoking-related stigma. Qual Health Res. 2017;27(10):1445–60.

    PubMed  Google Scholar 

  30. Bowleg L, Del Rio-Gonzalez AM, Holt SL, Perez C, Massie JS, Mandell JE, et al. Intersectional epistemologies of ignorance: how behavioral and social science research shapes what we know, think we know, and don’t know about U.S. black men’s sexualities. J Sex Res. 2017;54:577–603.

    PubMed  Google Scholar 

  31. Stirratt M, Mayer I, Ouellette S, Gara M. Measuring identity multiplicity and intersectionality: Hierarchical Classes Analysis (HICLAS) of sexual, racial, and gender identities. Self and Identity. 2008;7:89–111.

    Google Scholar 

  32. Turan J, Elafros M, Logie C, Banik S, Turan B, Crockett KB, Pescosolido B, Murray S. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17(7). https://doi.org/10.1186/s12916-018-1246-9.

  33. Turan JMEM, Logie C, Banik S, Turan B, Crockett KB, Pescosolido B, Murray S. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019. https://doi.org/10.1186/s12916-018-1246-9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107(6):863–9.

    PubMed  PubMed Central  Google Scholar 

  35. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3 Suppl 2):18640.

    PubMed  PubMed Central  Google Scholar 

  36. Earnshaw V, Kalichman SC. Stigma experienced by people living with HIV/AIDS. In: Liamputtong P, editor. Stigma, Discrimination and Living with HIV/AIDS: A Cross-Cultural Perspective. New York: Springer Science; 2013.

    Google Scholar 

  37. Balsam KF, Molina Y, Beadnell B, Simoni J, Walters K. Measuring multiple minority stress: the LGBT People of Color Microaggressions Scale. Cultur Divers Ethnic Minor Psychol. 2011;17(2):163–74.

    PubMed  PubMed Central  Google Scholar 

  38. Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, et al. Multiple dimensions of stigma and health related factors among young black men who have sex with men. AIDS Behav. 2017;21(1):207–16.

    PubMed  PubMed Central  Google Scholar 

  39. Berger M. Workable sisterhood: The political journey of stigmatized women with HIV/AIDS. Princeton NJ: Princeton University Press; 2004.

    Google Scholar 

  40. Jackson SD, Mohr JJ, Sarno EL, Kindahl AM, Jones IL. Intersectional experiences, stigma-related stress, and psychological health among Black LGBQ individuals. J Consult Clin Psychol. 2020;88(5):416–28.

    PubMed  Google Scholar 

  41. Rosenthal L, Lobel M. Gendered racism and the sexual and reproductive health of Black and Latina Women. Ethn Health. 2020;25(3):367–92.

    PubMed  Google Scholar 

  42. Scheim AI, Bauer GR. The Intersectional Discrimination Index: Development and validation of measures of self-reported enacted and anticipated discrimination for intercategorical analysis. Soc Sci Med. 2019;226:225–35.

    PubMed  Google Scholar 

  43. Earnshaw VA, Reed NM, Watson RJ, Maksut JL, Allen AM, Eaton LA. Intersectional internalized stigma among Black gay and bisexual men: A longitudinal analysis spanning HIV/sexually transmitted infection diagnosis. J Health Psychol. 2021;26(3):465–76.

    PubMed  Google Scholar 

  44. Earnshaw VA, Smith LR, Cunningham CO, Copenhaver MM. Intersectionality of internalized HIV stigma and internalized substance use stigma: Implications for depressive symptoms. J Health Psychol. 2015;20(8):1083–9.

    PubMed  Google Scholar 

  45. Lewis TT, Yang FM, Jacobs EA, Fitchett G. Racial/ethnic differences in responses to the everyday discrimination scale: a differential item functioning analysis. Am J Epidemiol. 2012;175(5):391–401.

    PubMed  PubMed Central  Google Scholar 

  46. Peek ME, Nunez-Smith M, Drum M, Lewis TT. Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients. Ethn Dis. 2011;21(4):502–9.

    PubMed  Google Scholar 

  47. Shariff-Marco S, Breen N, Landrine H, Reeve BB, Krieger N, Gee GC, et al. Measuring everyday racial/ethnic discriminition in health surveys: How best to ask the questions, in one or two stages, across multiple racial/ethnic groups? Du Bois Rev. 2011;8(1):159–77.

    PubMed  PubMed Central  Google Scholar 

  48. Kalichman SC, Simbayi LC, Cloete A, Ginindza T, Mthembu P, Cherry C, et al. Measuring AIDS stigmas in people living with HIV/AIDS: The Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93.

    PubMed  Google Scholar 

  49. Kalichman SC, Katner H, Banas E, Hill M, Kalichman MO. HIV-related stigma and non-adherence to antiretroviral medications among people living with HIV in a rural setting. Soc Sci Med. 2020;258:113092.

    PubMed  PubMed Central  Google Scholar 

  50. Kalichman SC, Nachimson D. Self-efficacy and disclosure of HIV positive serostatus to sexual partners. Health Psychol. 1999;18:281–7.

    CAS  PubMed  Google Scholar 

  51. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psych Measure. 1977;1:385–401.

    Google Scholar 

  52. Brock D, Sarason I, Sarason B, Pierce G. Simultaneous assessment of perceived global and relationship-specific support. J Soc Pers Relat. 1996;13:143–52.

    Google Scholar 

  53. Russell DW. UCLA Loneliness Scale (Version 3): reliability, validity, and factor structure. J Pers Assess. 1996;66(1):20–40.

    CAS  PubMed  Google Scholar 

  54. Littlewood RA, Vanable PA, Carey MP, Blair DC. The association of benefit finding to psychosocial and health behavior adaptation among HIV+ men and women. J Behav Med. 2008;31(2):145–55.

    PubMed  PubMed Central  Google Scholar 

  55. Eaton LA, Allen A, Maksut JL, Earnshaw V, Watson RJ, Kalichman SC. HIV microaggressions: a novel measure of stigma-related experiences among people living with HIV. J Behav Med. 2020;43(1):34–43.

    PubMed  Google Scholar 

  56. Genberg BL, Kawichai S, Chingono A, Sendah M, Chariyalertsak S, Konda KA, et al. Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS Behav. 2008;12(5):772–80.

    PubMed  Google Scholar 

  57. Major B, Dovidio J, Link B, Calbrese S. Stigma and its implications for health: Introduction an overview. In: Major B, Dovidio J, Link B, editors. The Oxford Handbook of Stigma, Discrimination, and Health. United Kingdom: Oxfor University Press; 2018. p. 3–28.

    Google Scholar 

  58. Lozano L, Garcia-Cueto E, Muniz J. Effect of the number of response categories on the reliability and validity of rating scales. Methodology. 2008;4:73–9.

    Google Scholar 

  59. Flickinger TE, DeBolt C, Xie A, Kosmacki A, Grabowski M, Waldman AL, et al. Addressing stigma through a virtual community for people living with HIV: A mixed methods study of the positivelinks mobile health intervention. AIDS Behav. 2018;22:3395–406.

    PubMed  PubMed Central  Google Scholar 

  60. Brown LK, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev. 2003;15(1):49–69.

    PubMed  Google Scholar 

  61. Go VF, Frangakis C, Le Minh N, Ha TV, Latkin CA, Sripaipan T, et al. Increased survival among HIV-infected PWID receiving a multi-level HIV risk and stigma reduction intervention: Results from a randomized controlled trial. J Acquir Immune Defic Syndr. 2017;74(2):166–74.

    PubMed  PubMed Central  Google Scholar 

  62. Frye V, Paige MQ, Gordon S, Matthews D, Musgrave G, Kornegay M, et al. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model. Eval Program Plann. 2017;63:45–53.

    PubMed  Google Scholar 

  63. Doyle DM, Molix L. Perceived discrimination and social relationship functioning among sexual minorities: Structural stigma as a moderating factor. Anal Soc Issues Public Policy. 2015;15(1):357–81.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This research was supported by National Institute of Mental Health  Grant R21-MH121314. The funder had no role in the execution or writing of this study.

Author information

Authors and Affiliations

  1. Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA

    Seth C. Kalichman, Bruno Shkembi & Lisa A. Eaton

Authors
  1. Seth C. Kalichman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Shkembi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa A. Eaton
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SCK, B.S., LAE all contributed to the design of the study and preparation of the manuscript. SCK conducted the data analyses. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Seth C. Kalichman.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

The University of Connecticut Institutional Review Board approved all of the study procedures. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

All participants provided written informed consent in compliance with conducting self-administered confidential surveys.

Consent for Publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kalichman, S.C., Shkembi, B. & Eaton, L.A. Finding the Right Angle: A Geometric Approach to Measuring Intersectional HIV Stigma. AIDS Behav 26 (Suppl 1), 27–38 (2022). https://doi.org/10.1007/s10461-021-03437-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03437-z

Keywords

Search

Navigation