Streamlining Stigma Measurement: Validation and Abridgment of the HIV Stigma Scale for Pregnant Women Living with HIV in South Africa.

The HIV Stigma Scale (HSS) is a 40-item psychometrically sound measure capturing four domains of perceived stigma. A 25-item version has been validated in South India. However, the HSS has not been validated among pregnant women with HIV (WWH) in South Africa, a population facing significant stigma. Moreover, they could benefit from the abridged measure to be more efficiently connected to related interventions. Analyzing data from a sample of pregnant WWH (N = 472) recruited from an antenatal care clinic in eThekweni, Kwazulu-Natal Province, we: (1) conducted confirmatory factor analyses (CFA) to determine if the 4-factor structure of the original 40-item scale holds for the 25-item version in this sample; (2) further shortened the 25-item version using data-driven item reduction, and (3) conducted a comprehensive psychometric evaluation on the abridged version that included internal consistency and construct validity. The CFA confirmed a four-factor structure of the 25-item scale (CFI = 1.00, RMSEA = 0.03, SRMR = 0.04) in pregnant WWH. For model identification, we retained three items per factor. CFA of this 12-item version revealed model fit (CFI = 1.00, RMSEA = 0.01, SRMR = 0.03). All four subscales in the abridged scale showed satisfactory internal consistency (Cronbach's α > 0.80) and construct validity. This is the first study validating the HSS among pregnant WWH in an HIV-endemic setting and developing a psychometrically robust 12-item version, maintaining the four-factor structure of the original measure. Clinically, the abridged HSS enables more efficient screening and reduces participant burden, which could improve reporting and early implementation of stigma reduction interventions in resource-limited settings.