For each scale, survey items were coded in order to determine which stigma mechanisms were measured by the instrument. This coding scheme was driven by the definitions of the six stigma processes provided previously in this review. Therefore, survey instruments examining the perspective of HIV uninfected people were coded for items measuring prejudice, stereotypes, and/or discrimination. Items were coded as prejudice if they measured negative affect toward HIV infected people. Popular prejudice items included anger (e.g., “Angry” [43 (link)]), disgust (“Disgusted with sinfulness” [38 (link)]), and shaming (e.g., “People with HIV should be ashamed of themselves” [50 (link)]). Items were coded as stereotypes if they measured potentially inaccurate thoughts and beliefs about HIV infected people. Many of these items measured beliefs about the types of people who get HIV/AIDS (“Only disgusting people get AIDS” [35 (link)]) and the types of behavior in which they engage (“Most women with HIV/AIDS are prostitutes or sex workers” [42 (link)]). Items were coded as discrimination if they measured behavioral expressions of prejudice directed at HIV infected people or support of discriminatory social policy. These items often involved social distancing (e.g., “If I was in public or private transport, I would not like to sit next to someone with HIV” [50 (link)]) or the removal of rights (e.g., “Persons with AIDS should not be eligible for welfare benefits from the state or federal governments” [39 (link)]).
Survey instruments examining the perspective of HIV infected people were coded for items measuring enacted stigma, anticipated stigma, and internalized stigma. Items were coded as enacted stigma if they measured perceived experiences of prejudice and/or discrimination. These items spanned a wide range of experiences, including discriminatory actions (e.g., “At the hospital/clinic, I was left in a soiled bed” [11 (link)]), verbal abuse (e.g., “Someone told me HIV is what I deserve for how I lived” [9 (link)]), and social rejection (e.g., “I feel some friends have rejected me because of my illness” [8 (link)]). Items were coded as anticipated stigma if they measured the expectation of experiencing future prejudice and discrimination. Some of these items referenced discriminatory behaviors (e.g., “Most employers would not employ me because I am HIV+” [50 (link)]) while others measured the anticipation of dislike by others (e.g. “My neighbors would not like living next door if they knew I had HIV” [50 (link)]). Finally, measures were coded as assessing internalized stigma if they measured the application of shame and/or negative beliefs associated with HIV/AIDS to the self. Items assessing shame (e.g., “I feel ashamed that I have HIV” [50 (link)]), guilt, (e.g., “I feel guilty because I have HIV” [9 (link)]), and worthlessness (e.g., “I felt completely worthless” [11 (link)]) were common examples.
Survey instruments examining the perspective of HIV infected people were coded for items measuring enacted stigma, anticipated stigma, and internalized stigma. Items were coded as enacted stigma if they measured perceived experiences of prejudice and/or discrimination. These items spanned a wide range of experiences, including discriminatory actions (e.g., “At the hospital/clinic, I was left in a soiled bed” [11 (link)]), verbal abuse (e.g., “Someone told me HIV is what I deserve for how I lived” [9 (link)]), and social rejection (e.g., “I feel some friends have rejected me because of my illness” [8 (link)]). Items were coded as anticipated stigma if they measured the expectation of experiencing future prejudice and discrimination. Some of these items referenced discriminatory behaviors (e.g., “Most employers would not employ me because I am HIV+” [50 (link)]) while others measured the anticipation of dislike by others (e.g. “My neighbors would not like living next door if they knew I had HIV” [50 (link)]). Finally, measures were coded as assessing internalized stigma if they measured the application of shame and/or negative beliefs associated with HIV/AIDS to the self. Items assessing shame (e.g., “I feel ashamed that I have HIV” [50 (link)]), guilt, (e.g., “I feel guilty because I have HIV” [9 (link)]), and worthlessness (e.g., “I felt completely worthless” [11 (link)]) were common examples.