Internalized stigma reported by people living with HIV

This indicator directly measures internalized stigma, an important manifestation of stigma that has been demonstrated to impede HIV care and treatment among people living with HIV. It is calculated from responses to a single question, which assesses internalized stigma among respondents living with HIV. The question is drawn from a validated measure of internalized stigma.

Changes in the indicator should be interpreted as follows: an increase in the prevalence indicates an increase in internalized stigma and a need for mitigating actions, whereas a decrease in the prevalence indicates progress towards and a reduction in internalized stigma.

Using population-based survey data to construct this indicator will enhance comparison across countries and contexts, as the indicator will be based on data from people who self-report living with HIV drawn from a random sample of the general public. This reduces potential response and selection biases that are possible when using a snowball sampling approach, as is done with the People Living with HIV Stigma Index. However, in countries where HIV prevalence is low, or where HIV stigma is very high, population-based surveys may not achieve large sample sizes of self-reported people living with HIV. In these instances, targeted studies like the People Living with HIV Stigma Index may be more appropriate.

Typically, internalized stigma is captured with a composite indicator composed of agreement with one of at least three items. As this indicator is based on responses to only one question, it is possible that internalized stigma may be underestimated, but the single item recommended to construct this indicator had the highest level of agreement of the three items previously validated together.