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Stigmatising attitudes among people offered home-based HIV testing and counseling in Blantyre, Malawi: construction and analysis of a stigma scale

MacPherson et al.

Publication year


Type of approach

Type of assistance
Directly assisted


Study population
General population

Study design

Sample size

UNAIDS HIV prevalence (2017)
9.1 [8.4 - 9.9]

Adult members of 60 households in urban Blantyre, Malawi, were selected using population-weighted random cluster sampling and offered HIV testing services (HTS) with the option to self-test before confirmatory HTS. Prior to HTS a 15-item HIV stigma questionnaire was administered. We used association testing and principal components analysis to construct a scale measure of stigma. Of 226 adults invited to participate, 216 (95.6%) completed questionnaires and 198/216 (91.7%) opted to undergo HTS (all self-tested). Stigmatising attitudes were uncommon, but anticipated stigma was common, especially fearing verbal abuse (22%) or being abandoned by their partner (11%). Three questions showed little association or consistency with the remaining 12 stigma questions and were not included in the final scale. For the 12-question final scale, Cronbach's alpha was 0.75. Level of stigma was not associated with previously having tested for HIV (p=0.318) or agreeing to HTS (p=0.379), but was associated with expressed worry about being or becoming HIV infected (p=0.003).

Summary of findings
226 household members were randomly selected and invited to participate in the study; 216 (95.6%) consented to take part and completed questionnaires. Of these 198/216 (91.7%) opted to undergo supervised oral self-testing followed by standard HTS. Of the 216 participants, 137 (63.4%) had previously tested for HIV, with 47 (21.8%) having tested in the past twelve months. Of the 216 participants, 193 (89%) indicated a stigmatizing attitude or anticipated stigma in response to at least one question. No association between level of stigma and decision to undergo HIV testing in the study (p=0.379), but that level of stigma was strongly associated with concern about being HIV-positive (p=0.003).


Acceptability details
198/216 (91.7%) opted to undergo HIV self-testing

Willingness to pay

Willingness to pay details




HIV positivity

Accuracy details

Social harm

Linkage to prevention, care and treatment


Study status

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