Developing and validating the Multidimensional Sexual Identity Stigma Scale among men who have sex with men in South Africa.

Sexual identity stigma is associated with negative outcomes including increased HIV/STI risk and suicidality. This study used the HIV Stigma Framework to guide the development of a Multidimensional Sexual Identity Stigma (MSIS) scale. A refined sexual identity stigma scale was tested with 292 men who have sex with men (MSM) in Port Elizabeth (n = 177) and Cape Town (n = 115), South Africa. The scale included enacted, anticipated, and internalized Stigma Framework domains, and added a new orientation concealment domain. Exploratory factor analysis and correlations with related constructs were conducted. Factor analysis of the final 23-item scale revealed a 4-factor solution theoretically congruent with our 4-domain model. The overall scale indicated high internal reliability (α = 0.87). The subscales also demonstrated internal reliability for all domains: Enacted (α = 0.66), orientation concealment (α = 0.86), anticipated (α = 0.87), and internalized stigma (α = 0.80). The MSIS scale exhibited content validity, internal reliability, and construct validity. Future research should confirm scale validity. We anticipate that MSIS will allow for future assessment of how different types of sexual identity stigma impact health.