China MSM Stigma Scale

Abstract

The China MSM Stigma Scale is a critical psychometric tool designed to assess the multifaceted impact of societal and personal stigma experienced by men who have sex with men (MSM) in China. The instrument specifically measures two key domains: perceived societal stigmatization of homosexual individuals and the direct, personal experiences of enacted stigma and discriminatory behaviors. This assessment is vital given the established link between high levels of stigma and increased vulnerability to HIV acquisition and sexual risk behaviors within this population.

Keywords

Stigma, Homosexuality, China, MSM, HIV risk, Enacted stigma, Perceived stigma, Psychometrics

Authors

Centre for AIDS Prevention Studies (CAPS)

Purpose

The primary purpose of the China MSM Stigma Scale is the systematic assessment of negative attitudes, beliefs, and discriminatory actions directed toward homosexual men specifically within the Chinese social and cultural context. It serves as a research instrument to quantify the psychosocial stressors faced by this vulnerable population.

By quantifying both internalized and externalized stigma, the scale allows researchers and public health officials to identify specific drivers of negative health outcomes, particularly concerning increased HIV vulnerability and sexual health disparities among MSM in China. This measurement aids in the development and evaluation of targeted stigma-reduction interventions.

Construct

The scale measures the construct of homosexuality stigma, which is operationalized into two distinct dimensions based on the original research framework. The first dimension captures perceived stigma, referring to an individual’s impressions regarding the general degree of societal stigmatization and negative public opinion directed toward homosexuals in China.

The second dimension measures enacted stigma, which involves the direct, personal experiences of discriminatory or stigmatizing behaviors. These experiences cover a range of interpersonal and structural harms, including verbal abuse, physical violence, family rejection, and loss of educational or professional opportunities due to sexual orientation.

Validity

The original psychometric analysis establishing the China MSM Stigma Scale examined its validity among a sample of MSM in China. Construct validity was supported through factor analysis, demonstrating that the items coherently measure the intended domains of perceived and enacted stigma.

Furthermore, the scale demonstrated criterion validity by showing significant associations between higher stigma scores and negative health outcomes, such as elevated psychological distress and increased engagement in HIV sexual risk behaviors, confirming its utility as a predictor variable in public health research.

Reliability

Reliability of the scale is typically assessed using measures of internal consistency. The original study reported strong internal consistency for the overall scale and its subscales, utilizing Cronbach’s alpha coefficients that met or exceeded standard thresholds for research instruments in social science and psychology.

The consistency of responses across the 10 items ensures that the scale reliably captures the underlying experience of stigma, suggesting that the items are closely related and measure the same psychological construct effectively within the target population.

Factor Analysis

Exploratory and confirmatory factor analysis (EFA/CFA) conducted during scale development indicated a robust multidimensional structure. The analysis typically supports a two-factor model distinguishing between Perceived Societal Stigma (e.g., items related to hearing negative opinions) and Enacted Personal Stigma (e.g., items related to direct experiences of rejection or violence).

This factor structure is crucial as it allows researchers to differentiate between the environmental pressures (perceived stigma) and the direct, acute suffering (enacted stigma), providing a nuanced understanding of how different forms of stigma impact health behavior among MSM in China.

Instrument

Test Type: Self-Report Questionnaire (Psychometric Scale)

Format: 10 items utilizing a frequency-based Likert-type response format (never, once or twice, a few times, many times).

Language Available: English translation and Mandarin Chinese (Original administration language).

Population Group: Men who have sex with men (MSM)

Age Group: Typically utilized with adult populations (18 years and older), consistent with public health and HIV research standards.

Population Details: The scale was developed and validated specifically using non-clinical samples of MSM recruited in various urban centers across China.

Test Methodology: Administration is typically conducted via self-completion, either in paper-and-pencil format or digitally, ensuring respondent anonymity to encourage honest reporting of sensitive experiences.

Keywords

Homophobia, Discrimination, Social marginalization, Scale development, Psychosocial assessment, China MSM, Public health

Authors

Author ORCID Identifier: N/A (Attributed to Centre for AIDS Prevention Studies (CAPS))

Affiliation Email addresses: Contact research team via University of California, San Francisco (UCSF) CAPS

Correspondence Address: Centre for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA

Permissions & Fee and Test Year

Test Year: 2008 (Based on primary publication date).

Permissions: The scale is typically made available for non-commercial academic and public health research purposes, contingent upon contacting the authors or the Centre for AIDS Prevention Studies (CAPS) for formal approval.

Fee: Generally free for academic use, though usage terms must be confirmed with the copyright holders.

Reference’s

• Neilands TB, Steward WT, Choi K-H. Assessment of Stigma towards Homosexuality in China: A Study of Men Who Have Sex with Men. Arch Sex Behav. 2008 Oct;37(5):838-44.
• Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, Ekstrand ML. HIV-related stigma: Adapting a theoretical framework for use in India. Social Science & Medicine 67 (2008) 1225–1235.
• Centre for AIDS Prevention Studies (CAPS).

Items of the China MSM Stigma Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Item (English translation) never once or twice a few times many times

• 1 How often have you heard that homosexuals are not normal?
• 2 How often have you felt that your homosexuality hurt and embarrassed your family?
• 3 How often have you been made fun of or called names for being homosexual?
• 4 How often have you been hit or beaten up for being homosexual?
• 5 How often have you had to pretend that you are not homosexual in order to be accepted?
• 6 How often has your family not accepted you because of your homosexuality?
• 7 How often have you lost your friends because of your homosexuality?
• 8 How often have you been kicked out of school for being homosexual?
• 9 How often have you lost a place to live for being homosexual?
• 10 How often have you lost a job or career opportunity for being homosexual?