Development of Self Stigma Assessment Tool for People Living With HIV/AIDS (PLWHA)


  • Wiwin Martiningsih Poltekkes Kemenkes Malang, East Java, Indonesia
  • Suprajitno Poltekkes Kemenkes Malang, East Java, Indonesia
  • Arif Mulyadi Poltekkes Kemenkes Malang, East Java, Indonesia
  • Sri Winarni Poltekkes Kemenkes Malang, East Java, Indonesia
  • Ekowati Retnaningtyas Poltekkes Kemenkes Malang, East Java, Indonesia



Assessment Tool, Self-Stigma, People Living With HIV/AIDS


Introduction: Stigma does not only come from people who give negative judgment to HIV/AIDS patients but also from patients themselves. This study explored the experiences of the self-stigma of people living with HIV/AIDS (PLWHA) and developed the self-stigma tool for PLWHA.

Methodology: We conducted a mixed-method study using an exploratory-sequential design in the East Java community, Indonesia. In the first phase, we identified 12 PLWHA through snowball sampling, and in the second phase, 133 PLWHA participated. We collected data through indepth interviews. Subsequently, the insights gained from these interviews were utilized to develop a tool for assessing self-stigma among PLWHA, known as the MARSUDI self-stigma tool.

Results: The first phase of the study revealed three main themes: 1) the feeling of self-stigma, 2) the coping mechanism, and 3) suggestions to combat the stigma. Moving on to the second phase, the MARSUDI self-stigma tool for PLWHA was developed. This tool comprises 26 items, achieving a s-cvi score exceeding 0.80. Following factorial analysis, 20 items remained with a loading factor surpassing 0.6, and contributing to 66.24% of the total variance. These items were categorized into three factors: Factor 1 (self-perception) includes 7 items, Factor 2 (self-labelling) consists of 11 items, and Factor 3 (self-discrimination) comprises 2 items.

Conclusion: The results of this study revealed that the MARSUDI self-stigma of PLWHA is valid, reliable, and acceptable.


Kontomanolis EN, Michalopoulos S, Gkasdaris G, Fasoulakis Z. The social stigma of HIV - AIDS : society ' s role. Dovepress. 2017;9:111-8. Doi: PMid:28694709 PMCid:PMC5490433

Alexandra Marshall S, Brewington KM, Kathryn Allison M, Haynes TF, Zaller ND. Measuring HIV-related stigma among healthcare providers: a systematic review. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2017;29(11):1337-45. Doi: PMid:28599599

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. Doi: PMid:26864692 PMCid:PMC4980279

Brown MJ, Serovich JM, Kimberly JA, Hu J. Psychological reactance and HIV-related stigma among women living with HIV. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2016;28(6):745-9. Doi: PMid:26883096 PMCid:PMC4955552

Tran BX, Phan HT, Latkin CA, Nguyen HLT, Hoang CL, Ho CSH, et al. Understanding global HIV stigma and discrimination: Are contextual factors suffciently studied? (Gapresearch). Int J Environ Res Public Health. 2019;16(11):1-19. Doi: PMid:31146379 PMCid:PMC6603743

Martiningsih, W., Winarni, S., Harsoyo, S., Susatya, B., and Hariyanto T. The Lived Experiences of Caring Behavior among Nurses as Counselor of HIV/AIDS in Blitar City. 3rd SPUP Int Res Conf. 2017;

Zhang, C, Li, Xiaoming, Liu, Y., Zhou, Y., Shen, Z., Chen Y. Impacts of hiv stigma on psychosocial well-being and substance use behaviors among people living with hiv/aids in china: across the life span. 2018;30(2):108-19. Doi: PMid:29688775 PMCid:PMC6056313

Hidayat J, Huang X yi, Lin H ru, Wei S jing, Chen M yen, Pranata S. Exploring the Experience of Stigma among People Living with HIV in Bali, Indonesia: Qualitative Phenomenological Study. Makara J Heal Res. 2022;26(1):44-50. Doi:

Berhe H, Godana W, Sidamo NB, Birgoda GT, Gebresillasie L, Hussen S, et al. Perceived Social Support and Associated Factors Among Adults Living with HIV/AIDS Attending ART Clinic at Public Hospitals in Gamo Zone, Southern Ethiopia 2021. HIV/AIDS - Res Palliat Care. 2022;14(2):103-17. Doi: PMid:35341218 PMCid:PMC8943604

Tsai A.,C., Weiser S., D., Steward W., T., Mukiibi Nosmo, F., B., Kawuma, A., Kembabai A. et al. Evidence for the Reliability and Validity of the Internalized AIDS- Related Stigma Scale in Rural Uganda. Aids Behav. 2014;17(1):427-33. Doi: PMid:22869104 PMCid:PMC3505811

Rintamaki L, Kosenko K, Hogan T, Scott AM, Dobmeier C, Tingue E, et al. The role of stigma management in HIV treatment adherence. Int J Environ Res Public Health. 2019;16(24):1-15. Doi: PMid:31835334 PMCid:PMC6950713

Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, et al. Stigma in health facilities: Why it matters and how we can change it. BMC Med. 2019;17(1):1-15. Doi: PMid:30764806 PMCid:PMC6376713

Polit, D. F., & Beck CT. The Content Validity Index : Are You Sure You Know What's Being Reported ? Critique and Recommendations, Research in Nursing & Health. 2006;29:489-97. Doi: PMid:16977646

Yusoff MSB. ABC of Content Validation and Content Validity Index Calculation. Educ Med J. 2019;11(2):49-54. Doi:

Wang VCX. scholarly Publishing And Research Methods Across Disciplines. USA: IGI Global; 2019. Doi:

Rich C, Mavhu W, France NF, Munatsi V, Byrne E, Willis N, et al. Exploring the beliefs, experiences and impacts of HIV-related self-stigma amongst adolescents and young adults living with HIV in Harare, Zimbabwe: A qualitative study. PLoS One [Internet]. 2022;17(5 May):1-18. Doi: PMid:35584100 PMCid:PMC9116620

Wei L, Yan H, Guo M, Tian J, Jiang Q, Zhai M, et al. Perceived HIV Stigma, Depressive Symptoms, Self-esteem, and Suicidal Ideation Among People Living with HIV/AIDS in China: a Moderated Mediation Modeling Analysis. J Racial Ethn Heal Disparities [Internet]. 2023;10(2):671-9. Doi: PMid:35165837 PMCid:PMC8853186

Kohli N, Kumar V, Yadav S, Tripathi P. People with HIV/AIDS: Stigma, Self-Esteem and Psychological Health. Psychol Stud (Mysore) [Internet]. 2023; Doi:

Chime OH, Arinze-Onyia SU, Ossai EN. Examining the effect of peer-support on self-stigma among persons living with hiv/aids. Pan Afr Med J. 2019;34:1-10. Doi: PMid:32180874 PMCid:PMC7060949

Usman S, Kadar KS. The peer support on quality of life in people with HIV/AIDS. Enfermería Clínica [Internet]. 2021;31:S730-4. Doi:

Valente TC de O, da Silva LM, Cavalcanti APR. Spiritual Needs as Expressed by People Living with HIV: A Systematic Review. Religions. 2022;13(4):1-16. Doi:

Xu JF, Ming ZQ, Zhang YQ, Wang PC, Jing J, Cheng F. Family support, discrimination, and quality of life among ART-treated HIV-infected patients: A two-year study in China. Infect Dis Poverty. 2017;6(1):1-10. Doi: PMid:29157301 PMCid:PMC5697335

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 [Internet]. 2017;63:45-53. Doi: PMid:28371668




How to Cite

Martiningsih W, Suprajitno, Mulyadi A, Winarni S, Retnaningtyas E. Development of Self Stigma Assessment Tool for People Living With HIV/AIDS (PLWHA). Natl J Community Med [Internet]. 2024 Apr. 1 [cited 2024 Apr. 22];15(04):251-8. Available from:



Original Research Articles