| Background. China is now experiencing serious, localized HIV epidemics. Stigma has become the major obstacle to government's vigorous responses to the epidemic. Yet, there are few systematic studies on HIV/AIDS-related stigma in the general population of rural China where the majority of HIV infections are occurring. This study investigated the various dimensions of HIV/AIDS-related stigma and developed a stigma scale for measuring it in a rural area of China.;Methods. 154 in-depth interviews were conducted between May to September 2005 among people living with HIV/AIDS (PLWHA), PLWHA's family members, villagers and health care providers to identify the forms, related factors and impact of HIV/AIDS-related stigma. A cross-sectional survey was conducted among 300 randomly selected villagers between June and July 2006 to develop a stigma scale.;Results. HIV/AIDS-related stigma manifested in the forms of labeling, gossip, blame, physical isolation, denial of rights of PLWHA. Fear of HIV transmission, local norms, morality, gender and pre-existing stigma, economic dependency as well as local custom/culture were identified as the factors associated with stigma. Stigma affected PLWHA and their family members in aspects of their lives. It prevented villagers at risk from taking prevention measures, PLWHA from seeking HIV testing and treatment.;A two-factor stigma scale with 13 items was identified: avoidance and Social Isolation, and Shame, Look Down On. The scale had high Cronbach's alpha (0.912) and moderate test-retest correlation (0.588). All of the 13 items were judged to be relevant and clear by expert reviewers, and the two factors were consistent with findings from other studies and the result of the first phase qualitative study.;Conclusions. HIV/AIDS-related stigma exists in the rural area of Yunnan, China, despite the intensive AIDS education campaign. The negative impact of stigma on HIV prevention, care and treatment programs highlights the immediate need for better strategies to reduce HIV/AIDS-related stigma in order to achieve the universal access to HIV prevention, treatment, care and support. Based on the findings, recommendations are proposed to reduce HIV/AIDS-related stigma in the rural areas.;The stigma scale needs to be applied to further studies in order to evaluate its reliability and validity. |
