Research article

Preliminary development of a scale to measure stigma relating to sexually transmitted infections among women in a high risk neighbourhood

Melanie LA Rusch¹ , Jean A Shoveller² , Susan Burgess³ , Karen Stancer⁴ , David M Patrick^2,5 and Mark W Tyndall^6,7

¹Division of International Health and Cross Cultural Medicine, University of California San Diego, La Jolla, USA

²Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada

³Department of Family Practice, University of British Columbia, Vancouver, Canada

⁴Downtown Community Health Centre, Vancouver Coastal Health, Vancouver, Canada

⁵British Columbia Centre for Disease Control, Vancouver, Canada

⁶British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

⁷Department of Medicine, University of British Columbia, Vancouver, Canada

author email corresponding author email

BMC Women's Health 2008, 8:21doi:10.1186/1472-6874-8-21

Published:	20 November 2008

Abstract

Background

As stigma is a socially constructed concept, it would follow that stigma related to sexual behaviours and sexually transmitted infections would carry with it many of the gender-based morals that are entrenched in social constructs of sexuality. In many societies, women tend to be judged more harshly with respect to sexual morals, and would therefore have a different experience of stigma related to sexual behaviours as compared to men. While a variety of stigma scales exist for sexually transmitted infections (STIs) in general; none incorporate these female-specific aspects. The objective of this study was to develop a scale to measure the unique experience of STI-related stigma among women.

Methods

A pool of items was identified from qualitative and quantitative literature on sexual behaviour and STIs among women. Women attending a social evening program at a local community health clinic in a low-income neighbourhood with high prevalence of substance use were passively recruited to take part in a cross-sectional structured interview, including questions on sexual behaviour, sexual health and STI-related stigma. Exploratory factor analysis was used to identify stigma scales, and descriptive statistics were used to assess the associations of demographics, sexual and drug-related risk behaviours with the emerging scales.

Results

Three scales emerged from exploratory factor analysis – female-specific moral stigma, social stigma (judgement by others) and internal stigma (self-judgement) – with alpha co-efficients of 0.737, 0.705 and 0.729, respectively. In this population of women, internal stigma and social stigma carried higher scores than female-specific moral stigma. Aboriginal ethnicity was associated with higher internal and female-specific moral stigma scores, while older age (>30 years) was associated with higher female-specific moral stigma scores.

Conclusion

Descriptive statistics indicated an important influence of culture and age on specific types of stigma. Quantitative researchers examining STI-stigma should consider incorporating these female-specific factors in order to tailor scales for women.