Reliability And Validity Of HIV Testing Self-efficacy Scale And Anticipated HIV Stigma Scale And Their Impact On HIV Testing Among MSM

BackgroundAIDS is a serious public health problem which could threaten human health seriously.Men who have sex with men(MSM)are at high-risk of getting HIV infection.Among the nationally reported new cases of HIV infection,the proportion of MSM has increased year by year,from 1.5%in 2006 to 25.5%in 2016.The homosexual transmission has become the second most common transmission route of AIDS,preceded only by heterosexual transmission.HIV testing is important to HIV prevention,treatment,care and support service,but HIV testing rate remains unsatisfied among MSM.Self-efficacy is the expectation of whether a person has the ability to carry out a certain behavior.With higher self-efficacy,individuals would have higher possibility to take action and make efforts to maintenance.Anticipated HIV stigma refers to individuals' expectations that they would experience HIV stigma themselves if they were infected.In addition to socio-demographic factors and sexual behavior,factors affecting HIV testing behavior may also include psychological factors,such as HIVtesting self-efficacy and anticipated HIV stigma.It is important for AIDS control and prevention to explore effects of those factors on HIV testing behavior in order to promote HIV testing among MSM.ObjectivesTo test the reliability and validity of HIV testing self-efficacy scale and anticipated HIV stigma scale when it was used among in Chinese MSM population;to understand the self-efficacy and anticipated stigma of HIV detection among MSM population in China and to explore their effects on HIV testing.MethodsMSM in 8 cities in Guangdong and Shandong Province were recruited from Internet.A self-administered online questionnaire was used to collect data,including socio-demographic information,sexual behaviors,HIV testing behaviors,HIV testing self-efficacy and anticipated HIV stigma scale.Item analysis was used to detect and remove the ill item,and then exploratory factor analysis was performed to extract the common factors and confirmatory factor analysis was used to test the feasibility of theoretical structure.The overall model fit indices were used to evaluate the overall model fit and the composite reliability and average variance extracted were calculated to assess the fit of internal structural model.The reliability analysis include Cronbach's a coefficient and spilt-half reliability.Using HIV testing behavior as dependent variable,sociodemographic factors and sexual behavioral factors as independent variables,univariate Logistic regression was conducted.Variables which were statistically significant(P<0.1)entered in a multivariate Logistic regression model.Stepwise method was used to select the background variables that could enter the final regression model which investigates the impact of HIV testing self-efficacy and anticipated stigma on HIV testing behavior among MSM population.Results1.A total of 2006 valid questionnaires were obtained in this survey.The average age of respondents was 25.88±6.35 years old.Among them,86.4%were unmarried,37.2%had bachelor degree or above,28.7%had monthly income above 5,000 RMB.There were 23.03%respondents who ever had heterosexual sex.In the past three months,58.1%of them had sex with men,29.5%of them had more than 2 sex partners,and 15.7%had unprotected sexual behavior.A total of 1,216 people had been tested for HIV,accounting for 60.6%.1041 people have been tested in institutions,accounting for 51.9%;621 people had been self-tested,accounting for 31.0%.In the past 3 months,624 people had been tested for HIV,accounting for 31.1%.HIV testing self-efficacy score was 15.97±2.50,and anticipated HIV stigma score was 18.28±4.19.2.In item analysis,item 2 in HIV testing self-efficacy scale was deleted,becausethe Cronbach a coefficient of the scale increased after the deletion.A new scale with 5 item was formed.A single factor was extracted after factor analysis,accounting for 55.23%about total variance.The overall model fit:?2/df=5259,CFI=0.998,TLI=0.996,RMSEA=0.046,the fit of internal structure model:CR=0.853,AVE=0.542.Cronbach's a coefficient was 0.780 and spilt-half reliability was 0.788.3.In item analysis,item 7 in anticipated HIV stigma scale was deleted because it didn't meet the creation.A new scale with 6 item was formed.A single factor was extracted after factor analysis,accounting for 63.24%about total variance.The overall model fit:?2/df=12.48,CFI=0.995,TLI=0.989,RMSEA=0.076;the fit of internalstructure model:CR=0.902,AVE=0.607.Cronbach's a coefficient was 0.877and spilt-half reliability was 0.808.4.In multivariable analysis,ever had HIV testing was associated with HIV testing self-efficacy(OR:1.21,95%CI:1.16-1.26);Recent HIV testing was associated with higher HIV testing self-efficacy(OR:1.19,95%CI:1.14-1.24)and lower anticipated stigma(OR:0.96,95%CI:0.94-0.98).ConclusionsThe reliability and validity of revised HIV testing self-efficacy scale are found to be satisfied,and are adequate for HIV testing self-efficacy survey in China MSM.The reliability of anticipated HIV stigma scale are good.Although the ?2/df index was not satisfied,other overall model fit indices and AVE and CR are both good.Therefore,it is considered that the scale could be used in studies about anticipated stigma among China MSM,but it would be better to use it after appropriate modifications.The HIV testing uptake is still unsatisfied among Chinese MSM,especially for regular testing.HIV testing self-efficacy and anticipated HIV stigma affected HIV testing history and recent testing differently.Intervention programs targeting at improving self-efficacy and reducing anticipated stigma are recommended to expand HIV testing among MSM population,increase HIV regular testing and control AIDS epidemic.