Psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS- 12) among people living with HIV in Vietnam

Psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS- 12) among people living with HIV in Vietnam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS- 12) among people living with HIV in Vietnam Cao Nguyen Hoai Thuong, Nguyen Vu Anh Thu, Bui Hong Cam, Le Minh Nhan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8830973/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background HIV-related stigma remains a major psychosocial challenge affecting mental health, healthcare engagement, and quality of life among people living with HIV. Reliable and culturally appropriate brief instruments are essential for stigma assessment in both research and clinical practice; however, validated Vietnamese measures remain limited. This study aimed to evaluate the psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS-12). Methods A cross-sectional study was conducted among 245 people living with HIV receiving antiretroviral therapy at a primary healthcare facility in Ho Chi Minh City, Vietnam. Internal consistency was assessed using Cronbach’s alpha. Test–retest reliability was evaluated in a subsample of 56 participants over a 4-week interval using the intraclass correlation coefficient (ICC). Construct validity was examined using confirmatory factor analysis (CFA), comparing a hypothesized four-factor model with a one-factor alternative model. Convergent validity was assessed through correlations with depressive symptoms (Patient Health Questionnaire-9; PHQ-9) and perceived social support (Multidimensional Scale of Perceived Social Support; MSPSS). Results The Vietnamese HSS-12 demonstrated good internal consistency (Cronbach’s alpha = 0.85) and excellent test–retest reliability (ICC = 0.95). CFA supported a modified four-factor structure with acceptable model fit indices (CFI = 0.962; TLI = 0.945; RMSEA = 0.064; SRMR = 0.050), whereas the one-factor model showed poor fit. Convergent validity was supported by positive correlations between HSS-12 scores and PHQ-9 scores, and negative correlations with MSPSS scores, except for the disclosure concerns subscale. Conclusions The Vietnamese version of the HSS-12 is a reliable and valid instrument for assessing perceived HIV-related stigma among people living with HIV in Vietnam. This brief measure may facilitate standardized stigma assessment in psychological research and routine care settings. HIV stigma HIV Stigma Scale HSS-12 reliability validity Figures Figure 1 Figure 2 Background HIV remains a major global public health concern, with approximately 40.8 million people living with HIV worldwide in 2024 [ 1 ]. Although advances in antiretroviral therapy (ART) have transformed HIV into a manageable chronic condition, many people living with HIV continue to face substantial social barriers. Among these, HIV-related stigma is considered a central challenge, profoundly affecting physical health, mental health, and quality of life [ 2 , 3 ]. The concept of stigma was originally described by Erving Goffman as an attribute that discredits an individual, leading to social devaluation, exclusion, and discrimination [ 4 ]. In the context of HIV, stigma is commonly conceptualized as a multidimensional phenomenon encompassing three closely related mechanisms: enacted stigma, anticipated stigma, and internalized stigma. Enacted stigma refers to experiences of discrimination or unfair treatment faced by people living with HIV from family members, communities, or healthcare settings. Anticipated stigma reflects individuals’ fears or expectations of being stigmatized in the future if their HIV status is disclosed. In contrast, internalized stigma captures the extent to which individuals accept and internalize society’s negative beliefs about HIV, which can adversely affect self-esteem, mental health, and engagement in health-related behaviors [ 5 ]. Numerous studies have demonstrated that HIV-related stigma is closely associated with delayed HIV testing, reduced adherence to ART, limited access to healthcare services, and decreased willingness to disclose HIV status to sexual partners or family members [ 3 , 5 – 7 ]. Consequently, accurate and reliable measurement of HIV-related stigma among people living with HIV is crucial for research, clinical practice, and the design of effective stigma-reduction interventions. Several instruments have been developed to assess HIV-related stigma [ 8 ]. Among these, the 12-item short version of the HIV Stigma Scale (HSS-12), developed by Reinius et al. [ 9 ] based on the original HIV Stigma Scale by Berger et al. [ 10 ], is widely used. The HSS-12 retains the four core dimensions of HIV-related stigma while offering a concise and user-friendly structure [ 9 ]. Brief instruments are particularly useful in routine HIV care settings, where time constraints and respondent burden may limit the feasibility of longer scales. Furthermore, the scale has demonstrated good reliability and validity across diverse cultural settings and countries [ 11 – 15 ]. Although the HSS-12 has demonstrated robust psychometric properties in multiple international settings, its applicability depends on appropriate translation, cultural adaptation, and re-evaluation of measurement properties within specific cultural contexts. In Vietnam, evidence indicates that people living with HIV continue to experience stigma and discrimination within families, communities, and healthcare settings, adversely affecting mental health, healthcare engagement, and treatment adherence [ 16 – 19 ]. According to the Vietnam Authority of HIV/AIDS Control, in 2024 the country recorded 13,351 new HIV infections, with over 245,000 people currently living with HIV [ 20 ]. However, existing studies in Vietnam have relied on heterogeneous stigma measures, limiting comparability across studies and constraining the ability to rigorously evaluate stigma-reduction strategies. To date, no validated Vietnamese version of the HSS-12 is available, highlighting an important gap in standardized stigma measurement in Vietnam. Therefore, this study aimed to translate and culturally adapt the HSS-12 into Vietnamese and to evaluate its reliability and validity among people living with HIV receiving ART at a primary healthcare facility in Ho Chi Minh City, Vietnam. A validated Vietnamese HSS-12 may strengthen standardized stigma assessment in research and clinical practice, facilitate routine stigma monitoring, and support the evaluation of stigma-reduction interventions in Vietnam. Methods Study design and setting A cross-sectional study was conducted from May to June 2025 at the Substance Use and HIV/AIDS Counseling and Treatment Department of District 10 Medical Center, a primary healthcare facility in Ho Chi Minh City, Vietnam. At the time of the study, the center was providing ART to approximately 2,000 people living with HIV, making it a suitable setting for participant recruitment and psychometric evaluation of the Vietnamese version of the HSS-12. Participants The study population consisted of people living with HIV who were receiving ART at District 10 Medical Center during the study period. Inclusion criteria were: (i) aged 18 years or older; (ii) having a confirmed diagnosis of HIV and currently receiving ART at the study site; (iii) ability to communicate in and read Vietnamese; and (iv) provision of written informed consent. Exclusion criteria included: (i) the presence of severe mental disorders or cognitive impairment that could affect the ability to complete the questionnaire; and (ii) missing or incomplete responses to one or more HSS-12 items. Sample size and sampling The target sample size was determined a priori to ensure adequate sample for confirmatory factor analysis (CFA). Commonly cited guidelines suggest that a sample size of approximately 200 is acceptable for factor analysis [ 21 ]. Participants were recruited using convenience sampling during routine follow-up visits, yielding a final sample of 245 participants. For test–retest reliability, the minimum sample size was calculated using Bonett’s method for estimating the intraclass correlation coefficient (ICC) with desired precision [ 22 ]. Assuming an expected ICC of 0.88 [ 14 ], a 95% confidence interval half-width of 0.06, and two administrations (k = 2), the required minimum sample size was 56 participants. A convenience subsample of 56 participants completed the HSS-12 twice over 4-week interval. Measures Standardized self-report instruments were used in this study, including the 12-item HIV Stigma Scale (HSS-12), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Patient Health Questionnaire–9 (PHQ-9). HIV Stigma Scale – 12 (HSS-12) The 12-item HIV Stigma Scale (HSS-12), developed by Reinius et al. [ 9 ] based on the original HIV Stigma Scale by Berger et al. [ 10 ], was used to assess perceived HIV-related stigma. The scale comprises four dimensions: personalized stigma, disclosure concerns, negative self-image, and concerns about public attitudes. Each item is rated on a 4-point Likert scale ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). The total HSS-12 score was calculated by summing responses across all 12 items (range: 12–48), with higher scores indicating higher levels of perceived HIV-related stigma. Subscale scores range from 3 to 12 [ 9 ]. Multidimensional Scale of Perceived Social Support (MSPSS) The MSPSS is a 12-item self-report instrument designed to assess perceived social support from three sources: family, friends, and significant others, with four items per subscale [ 23 ]. Each item is rated on a 7-point Likert scale ranging from 1 (“strongly disagree”) to 7 (“strongly agree”). Subscale scores were calculated as the mean of the corresponding four items, and the total score was computed as the mean of all 12 items (range: 1–7), with higher scores indicating higher levels of perceived social support. The MSPSS has been translated into Vietnamese and validated in Vietnam, demonstrating good reliability and validity across different populations [ 24 ]. Patient Health Questionnaire–9 (PHQ-9) The PHQ-9 is a 9-item self-report instrument used to assess depressive symptom severity over the preceding two weeks [ 25 ]. Items are rated on a 4-point Likert scale (0 = “not at all” to 3 = “nearly every day”), yielding a total score ranging from 0 to 27, with higher scores indicating greater depressive symptom severity. The PHQ-9 has been validated in Vietnam, demonstrating good internal consistency (Cronbach’s alpha = 0.88) [ 26 ]. Procedure An overview of the translation, cross-cultural adaptation, and psychometric evaluation workflow is presented in Fig. 1 . Stage 1: Translation and Cross-cultural Adaptation The short version of the HIV Stigma Scale (HSS-12) was translated into Vietnamese following the cross-cultural adaptation guidelines proposed by Beaton et al. [ 27 ], with an emphasis on conceptual equivalence. The process included independent forward translation by two bilingual translators who were native Vietnamese speakers, synthesis of the translated versions, back-translation into English by two independent translators blinded to the original scale, expert committee review, and development of a pre-final version. Permission to translate and use the scale was obtained from the original author prior to the translation process. Stage 2: Pilot study The pre-final Vietnamese version of the HSS-12 was pilot-tested among 40 people living with HIV receiving ART at another healthcare facility in Ho Chi Minh City. Participants were asked to comment on the clarity, comprehensibility, and cultural relevance of the items, as well as any difficulties encountered during completion. Overall, participants reported that the items were clear and culturally appropriate, and no major issues were identified during pilot testing. Therefore, no further modifications were made, and the pre-final version was retained as the final Vietnamese HSS-12. Stage 3: Reliability and Validity Evaluation The finalized Vietnamese version of the HSS-12 was administered in the main cross-sectional study conducted at District 10 Medical Center. Data were collected during routine follow-up visits after informed consent was obtained. To assess test–retest reliability, a subsample of participants (n = 56) completed the HSS-12 again after a 4-week interval. The collected data were used to evaluate internal consistency, test–retest reliability, construct validity, and convergent validity of the scale. Data collection Data collection was conducted at the Substance Use and HIV/AIDS Counseling and Treatment Department at District 10 Medical Center during the study period. Eligible participants attending routine follow-up visits during the study period were invited to participate. After receiving information about the study objectives, procedures, and ethical considerations, those who agreed to participate provided written informed consent. Data were collected using self-administered questionnaires, which included sociodemographic characteristics, clinical information, and three standardized instruments: the HSS-12, MSPSS, and PHQ-9. Clinical and treatment-related data, including time since HIV diagnosis, duration of ART, and most recent CD4 cell counts, were extracted from medical records using a structured extraction form. To assess test–retest reliability of the HSS-12, a subsample of participants (n = 56) completed the HSS-12 again 4 weeks after the initial assessment. All questionnaires and extracted data were anonymized using unique study identification codes to ensure confidentiality while allowing linkage between the two data collection time points. Data analysis Data were entered, cleaned, and analyzed using Stata version 14.0. Descriptive statistics were used to summarize participants’ characteristics, with frequencies and percentages for categorical variables, and means with standard deviations or medians with interquartile ranges (IQR) for continuous variables, as appropriate. The internal consistency of the HSS-12 and its subscales was assessed using Cronbach’s alpha and corrected item–total correlation coefficients. A Cronbach’s alpha value of ≥ 0.70 was considered acceptable, while values ≥ 0.80 indicated good internal consistency [ 28 ]. Corrected item–total correlations of ≥ 0.30 were considered satisfactory [ 28 ]. Test–retest reliability of the HSS-12 was evaluated using the intraclass correlation coefficient (ICC) with 95% confidence intervals based on data collected after a 4-week interval. ICC values > 0.75 were interpreted as good reliability, and values ≥ 0.90 indicated excellent reliability [ 29 ]. Construct validity was examined using confirmatory factor analysis (CFA) to test the hypothesized four-factor model of the HSS-12 and a one-factor alternative model. Although the chi-square (χ²) test was used to assess overall model fit, given its sensitivity to sample size, additional fit indices were used to provide a comprehensive evaluation of model fit. Specifically, Comparative Fit Index (CFI) and Tucker–Lewis Index (TLI) values > 0.90 were considered indicative of acceptable fit, while values ≥ 0.95 indicated excellent fit [ 30 ]. Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) values < 0.08 were considered acceptable [ 31 ]. Convergent validity was assessed using Pearson’s correlation coefficients between the HSS-12 total and subscale scores and the MSPSS and PHQ-9 scores. Negative correlations with MSPSS and positive correlations with PHQ-9 were hypothesized. A two-sided p value < 0.05 was considered statistically significant. Results Baseline Characteristics of Participants Table 1 . Baseline Characteristics of Participants Characteristics All participants (n = 245) Retest participants (n = 56) Age (years) 33.8 ± 8.2 32.7 ± 8.2 Gender Male 205 (83.7) 48 (85.7) Female 37 (15.1) 7 (12.5) Other 3 (1.2) 1 (1.8) Education level Under primary school 10 (4.1) 1 (1.8) Primary school 8 (3.3) 0 (0.0) Secondary school 43 (17.6) 7 (12.5) High school 59 (24.0) 18 (32.1) Higher education 125 (51.0) 30 (53.6) Marital status Single 182 (74.3) 42 (75.0) Married 43 (17.6) 10 (17.8) Separated / Divorced / Widowed 15 (6.1) 2 (3.6) Living with partner 5 (2.0) 2 (3.6) Duration of HIV infection (years) 4 (3–9) 4 (3–9) Duration of ART (years) 4 (3–9) 4 (3–9) CD4 count (cells/mm³) ≤ 200 22 (9.0) 2 (3.6) 201–349 40 (16.4) 7 (12.5) 350–499 67 (27.5) 14 (25.0) ≥ 500 115 (47.1) 33 (58.9) Note: Values are presented as mean ± standard deviation or median (interquartile range) for continuous variables, and number (percentage) for categorical variables. CD4 data were available for 244 of 245 participants because of missing laboratory results. Abbreviations: HIV, human immunodeficiency virus; ART, antiretroviral therapy; CD4, cluster of differentiation 4 T-lymphocyte count. Table 1 presents the demographic and clinical characteristics of the 245 participants included in the study. The mean age was 33.8 ± 8.2 years, and most participants were male (83.7%). Approximately three-quarters had completed at least a high school education (75.0%). Most participants were single (74.3%). The median time since HIV diagnosis was 4 years (IQR: 3–9), and the median duration of ART was also 4 years (IQR: 3–9). Nearly half of the participants (47.1%) had a CD4 cell count of ≥ 500 cells/mm³. A total of 56 participants completed the retest assessment, and the characteristics of this subgroup were generally similar to those of the full sample. Reliability of the Vietnamese Version of the HSS-12 Table 2 . Reliability of the HSS-12 and its subscales Item number and description Mean ± SD Item–total correlation Cronbach’s alpha ICC (95% CI) Personalised stigma 6.7 ± 2.0 0.838 0.93 (0.89–0.96) Item 10. Some people avoid touching me once they know I have HIV 2.4 ± 0.8 0.677 Item 11. People I care about stopped calling after learning I have HIV 2.2 ± 0.8 0.523 Item 12. I have lost friends by telling them I have HIV 2.1 ± 0.7 0.581 Disclosure concerns 8.5 ± 2.0 0.729 0.90 (0.84–0.94) Item 3. Telling someone I have HIV is risky 2.7 ± 0.9 0.534 Item 4. I work hard to keep my HIV a secret 2.9 ± 0.8 0.441 Item 8. I am very careful who I tell that I have HIV 2.9 ± 0.8 0.309 Concerns about public attitudes 6.7 ± 2.1 0.817 0.90 (0.83–0.94) Item 6. People with HIV are treated like outcasts 2.2 ± 0.8 0.622 Item 7. Most people believe that a person who has HIV is dirty 2.1 ± 0.8 0.603 Item 9. Most people are uncomfortable around someone with HIV 2.4 ± 0.8 0.601 Negative self-image 6.7 ± 1.9 0.690 0.92 (0.87–0.95) Item 1. I feel guilty because I have HIV 2.3 ± 0.9 0.406 Item 2. People’s attitudes about HIV make me feel worse about myself 2.1 ± 0.8 0.448 Item 5. I feel I am not as good a person as others because I have HIV 2.2 ± 0.8 0.508 HSS-12 total 28.6 ± 6.0 0.849 0.95 (0.91–0.97) Note: Values are presented as mean ± SD for the HSS-12 subscale and total scale scores. Item– total correlations represent corrected item – total correlation coefficients. ICC was calculated for the total HSS-12 score and subscale scores among retest participants (n = 56) over a 4-week interval. Abbreviations: HSS-12, HIV Stigma Scale – 12; SD, standard deviation; ICC, intraclass correlation coefficient; CI, confidence interval. As shown in Table 2, the Vietnamese version of the HSS-12 demonstrated good internal consistency, with Cronbach’s alpha coefficients ranging from 0.690 to 0.838 across the four subscales and 0.849 for the total scale. Corrected item–total correlation coefficients ranged from 0.309 to 0.677, indicating acceptable to good item discrimination, with all items exceeding the commonly accepted threshold of 0.30. Test–retest reliability assessed in 56 participants over a 4-week interval was excellent, with ICC values of 0.90–0.93 across subscales and 0.95 (95% CI: 0.91–0.97) for the total HSS-12 score. Construct Validity (CFA) of the Vietnamese Version of the HSS-12 Table 3 . Model fit indices for confirmatory factor analysis of the Vietnamese version of the HSS-12 One-factor model Four-factor model (initial) Modified four-factor model χ² (df) 436.19 (54), p < 0.001 164.95 (48), p < 0.001 89.60 (45), p < 0.001 RMSEA (90% CI) 0.170 (0.155–0.185) 0.100 (0.083–0.117) 0.064 (0.044–0.083) SRMR 0.107 0.066 0.050 CFI 0.677 0.901 0.962 TLI 0.605 0.864 0.945 AIC 6335.72 6076.48 6007.12 Note: The modified model allowed correlations between error terms of selected items within the same factor. Abbreviations: RMSEA, Root Mean Square Error of Approximation; SRMR, Standardized Root Mean Square Residual; CFI, Comparative Fit Index; TLI, Tucker – Lewis Index; AIC, Akaike Information Criterion. Confirmatory factor analysis (CFA) was conducted to examine the hypothesized four-factor structure of the Vietnamese version of the HSS-12, including personalized stigma, disclosure concerns, concerns about public attitudes, and negative self-image. As shown in Table 3, the initial four-factor model demonstrated suboptimal fit to the data (χ² = 164.95, df = 48, p < 0.001; RMSEA = 0.100, 90% CI: 0.083–0.117; CFI = 0.901; TLI = 0.864; SRMR = 0.066). After allowing theoretically justified correlated residuals between selected items within the same factor, the modified four-factor model showed substantially improved and acceptable fit indices (χ² = 89.60, df = 45, p < 0.001; RMSEA = 0.064, 90% CI: 0.044–0.083; CFI = 0.962; TLI = 0.945; SRMR = 0.050). The modified model also yielded a lower AIC value, indicating a better balance between model fit and parsimony. In contrast, the one-factor model demonstrated poor fit (χ² = 436.19, df = 54, p < 0.001; RMSEA = 0.170, 90% CI: 0.155–0.185; CFI = 0.677; TLI = 0.605; SRMR = 0.107), supporting the multidimensional structure of the HSS-12. The standardized CFA model of the modified four-factor structure is presented in Fig. 2. All items demonstrated adequate standardized factor loadings (all ≥ 0.40) on their respective latent factors, and the four stigma domains showed moderate to strong inter-factor correlations, ranging from 0.45 to 0.89. Convergent Validity of the Vietnamese Version of the HSS-12 Table 4 . Convergent validity of the Vietnamese version of the HSS-12 Personalized stigma Disclosure concerns Concerns about public attitudes Negative self-image HSS-12 total PHQ-9 0.221*** 0.163* 0.192** 0.253*** 0.279*** MSPSS − 0.254*** − 0.097 − 0.247*** − 0.186** − 0.265*** Note: Values are Pearson’s correlation coefficients (r). Abbreviations: PHQ-9, Patient Health Questionnaire-9; HSS-12, HIV Stigma Scale–12; MSPSS, Multidimensional Scale of Perceived Social Support. *p < 0.05; **p < 0.01; ***p < 0.001. As shown in Table 4, convergent validity of the Vietnamese version of the HSS-12 was supported by correlations with external measures in the expected directions. All four HSS-12 subscales and the total score were positively correlated with depressive symptoms measured by the PHQ-9 (r = 0.163–0.279, p < 0.05). In contrast, personalized stigma, concerns about public attitudes, negative self-image, and the total HSS-12 score were negatively correlated with perceived social support measured by the MSPSS (r = −0.186 to −0.265, p 0.05). Discussion This study provides initial evidence supporting the reliability and validity of the Vietnamese version of the HSS-12 among people living with HIV receiving ART in Vietnam. HIV-related stigma remains a major social barrier affecting mental health, healthcare engagement, and quality of life among people living with HIV [5, 7]. Given the lack of standardized Vietnamese instruments to assess HIV-related stigma, the present findings support the Vietnamese HSS-12 as a brief and feasible tool for stigma assessment in both research and routine care. Overall, the results indicate that the translated scale demonstrates satisfactory psychometric performance in this setting. The Vietnamese version of the HSS-12 demonstrated good internal consistency, with a Cronbach’s alpha of 0.85 for the total scale and values ranging from 0.69 to 0.84 across the subscales. These values fall within acceptable thresholds and are consistent with findings from the original study by Reinius et al. [9], as well as validation studies conducted in Brazil [11], Kenya [13], Peru [15], and Iran [14]. Although some previous studies have reported Cronbach’s alpha values below 0.70 for certain subscales, particularly in studies with small sample sizes [12, 14], the results of the present study indicate that the Vietnamese version of the HSS-12 exhibits satisfactory internal consistency within the current study context. In addition, test–retest reliability over a 4-week interval was excellent for the total HSS-12 score (ICC = 0.95), indicating excellent temporal stability. This finding is comparable to, and within the range of, those reported in studies conducted in Kenya (ICC = 0.92) [13] and Iran (ICC = 0.88) [14]. Confirmatory factor analysis (CFA) supported the hypothesized four-factor structure of the HSS-12, comprising personalized stigma, disclosure concerns, concerns about public attitudes, and negative self-image. Although the chi-square test was statistically significant, other model fit indices, including the CFI, TLI, RMSEA, and SRMR, indicated acceptable to good model fit, consistent with psychometric research recognizing the sensitivity of the chi-square statistic to sample size [30, 32]. After allowing a small number of theoretically and conceptually justified correlations between residuals of selected items within the same factor, the four-factor model demonstrated a substantial improvement in fit indices, providing support for the structural validity of the HSS-12 in the Vietnamese context. Moreover, the poor fit of the one-factor model further supported the multidimensional structure of the HSS-12. In the modified four-factor model, all items exhibited acceptable standardized factor loadings, indicating that each item adequately represented its corresponding latent construct. In addition, moderate to strong inter-factor correlations (r = 0.45–0.89) suggest that these domains are related yet distinct, reinforcing the multidimensional nature of perceived HIV-related stigma. These findings are consistent with previous validation studies conducted in Sweden [9], Brazil [11], Portugal [12], and Peru [15], and further support the structural validity and cross-cultural applicability of the four-factor model of the HSS-12. Convergent validity of the Vietnamese version of the HSS-12 was supported by the expected pattern of associations with external psychological measures. Higher perceived HIV-related stigma was positively associated with depressive symptoms, as measured by the PHQ-9, and negatively associated with perceived social support, as measured by the MSPSS. Although the observed correlations were small to moderate in magnitude, their directions were consistent with theoretical expectations and findings from previous international studies. Prior meta-analyses have consistently demonstrated positive associations between HIV-related stigma and depression or psychological distress, as well as negative associations with social support among people living with HIV [33, 34]. Similar patterns have also been reported in validation studies of the HSS-12 conducted in different cultural contexts, including Portugal [12]. Notably, the weak and non-significant association between disclosure concerns and perceived social support may reflect the use of selective nondisclosure as a coping strategy, whereby individuals limit disclosure to protect themselves from anticipated stigma while maintaining perceived support from close social networks [35]. Overall, these findings support the convergent validity of the Vietnamese HSS-12. The present findings should be interpreted in light of several limitations. This study used convenience sampling at a single primary healthcare facility, which may limit generalizability. In addition, convergent validity was examined using related psychosocial measures (MSPSS and PHQ-9) and self-report data, which may be subject to social desirability bias. Future studies using stigma-specific external measures and more diverse samples are warranted to further strengthen evidence for validity and generalizability. Conclusions In conclusion, the findings of this study indicate that the Vietnamese version of the HSS-12 demonstrates good reliability and validity for assessing perceived HIV-related stigma among people living with HIV in Vietnam. The scale exhibited good internal consistency, excellent test–retest reliability, and acceptable evidence of construct and convergent validity. The Vietnamese HSS-12 may be used in research and clinical settings to facilitate standardized stigma assessment and routine stigma monitoring, and to support the development and evaluation of stigma-reduction interventions. Abbreviations AIDS: Acquired Immunodeficiency Syndrome; ART: Antiretroviral therapy; CFA: Confirmatory factor analysis; CFI: Comparative Fit Index; CI: Confidence interval; HIV: Human immunodeficiency virus; HSS-12: 12-item HIV Stigma Scale; ICC: Intraclass correlation coefficient; MSPSS: Multidimensional Scale of Perceived Social Support; PHQ-9: Patient Health Questionnaire-9; RMSEA: Root Mean Square Error of Approximation; SD: Standard deviation; SRMR: Standardized Root Mean Square Residual; TLI: Tucker–Lewis Index. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Research Ethics Committee of Pham Ngoc Thach University of Medicine (Decision No. 1357/TDHYKPNT-HDDD, April 21, 2025). All participants provided written informed consent prior to participation. Participation was voluntary, and confidentiality was ensured through data anonymization and restricted access. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding from any public, commercial, or not-for-profit funding agencies. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nguyen Vu Anh Thu, Bui Hong Cam, Le Minh Nhan, and Cao Nguyen Hoai Thuong. Project administration and supervision were performed by Ho Nguyen Anh Tuan and Cao Nguyen Hoai Thuong. The first draft of the manuscript was written by Cao Nguyen Hoai Thuong and Nguyen Vu Anh Thu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement We would like to thank the staff of the Substance Use and HIV/AIDS Counseling and Treatment Department of District 10 Medical Center for their support in participant recruitment and data collection. 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Psicologia: Revista da Associação Portuguesa Psicologia. 2022;36(1):39–50. 10.17575/psicologia.1729 . Wanjala SW, Nyongesa MK, Mwangi P, Mutua AM, Luchters S, Newton C, et al. Measurement characteristics and correlates of HIV-related stigma among adults living with HIV: a cross-sectional study from coastal Kenya. BMJ Open. 2022;12(2):e050709. 10.1136/bmjopen-2021-050709 . Moradzadeh R, Navidi I, Zamanian M. Validity and Reliability of the Human Immunodeficiency Virus-Related Stigma Questionnaire in Persian. J Int Assoc Provid AIDS Care. 2023;22:23259582231189094. 10.1177/23259582231189094 . Ramos-Vera C, Basauri-Delgado M, Diaz Peña M, Tinoco Alberto J, Perez Arroyo K, Herrera Mamani B, et al. Bifactor SEM and MIRT Structure of a 12-Item Human Immunodeficiency Virus Stigma Scale in Peruvian Adults. J Prim Care Community Health. 2023;14:21501319231197589. 10.1177/21501319231197589 . Tran NK, Vu BN, Susa J, DeSilva M. Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study. PLOS Global Public Health. 2022;2(9):e0000669. 10.1371/journal.pgph.0000669 . Tran BX, Than PQT, Tran TT, Nguyen CT, Latkin CA. Changing Sources of Stigma against Patients with HIV/AIDS in the Rapid Expansion of Antiretroviral Treatment Services in Vietnam. Biomed Res Int. 2019;2019:4208638. 10.1155/2019/4208638 . Doan TT, Nguyen TT, Do DC. Characteristics of stigma and discrimination among patients with HIV/AIDS at Bach Mai Hospital. Vietnam Med J. 2024;537(1B):74–8. 10.51298/vmj.v537i1B.9101 . Thai TT, Tran VB, Nguyen NBT, Bui HHT. HIV-related stigma, symptoms of depression and their association with suicidal ideation among people living with HIV in Ho Chi Minh City, Vietnam. Psychol Health Med. 2023;28(5):1263–74. 10.1080/13548506.2022.2067342 . Vietnam Ministry of Health. Conference on the review of HIV/AIDS prevention and control activities in 2024 and directions for the 2025 action plan 2024 [cited 2025 14 January]. Available from: https://moh.gov.vn/tin-noi-bat/-/asset_publisher/3Yst7YhbkA5j/content/hoi-nghi-tong-ket-hoat-ong-phong-chong-hiv-aids-nam-2024-va-inh-huong-ke-hoach-nam-2025 Comrey AL, Lee HB. A First Course in Factor Analysis. Hillsdale, NJ: Erlbaum; 1992. Bonett DG. Sample size requirements for estimating intraclass correlations with desired precision. Stat Med. 2002;21(9):1331–5. 10.1002/sim.1108 . Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess. 1988;52(1):30–41. 10.1207/s15327752jpa5201_2 . Kieu PT, Vuong NL, Dung DV. Validation of Multidimensional Scale of Perceived Social Support (MSPSS) in Vietnamese Among People Living with HIV/AIDS. AIDS Behav. 2023;27(8):2488–96. 10.1007/s10461-022-03974-1 . Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. 10.1046/j.1525-1497.2001.016009606.x . Mughal AY, Stockton MA, Bui Q, Go V, Ha TV, Pence BW, et al. Validation of screening tools for common mental health disorders in the methadone maintenance population in Hanoi, Vietnam. BMC Psychiatry. 2021;21(1):488. 10.1186/s12888-021-03493-8 . Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91. 10.1097/00007632-200012150-00014 . Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53–5. 10.5116/ijme.4dfb.8dfd . Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155–63. 10.1016/j.jcm.2016.02.012 . Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct equation modeling: multidisciplinary J. 1999;6(1):1–55. 10.1080/10705519909540118 . López Ramos Y, Fernández Muñoz JJ, Navarro-Pardo E, Murphy M. Confirmatory Factor Analysis for the Multidimensional Scale of Perceived Social Support in a Sample of Early Retirees Enrolled in University Programs. Clin Gerontol. 2017;40(4):241–8. 10.1080/07317115.2016.1199077 . Kline RB. Principles and practice of structural equation modeling. 4 ed. New York: The Guilford Press; 2016. Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453. 10.1136/bmjopen-2016-011453 . Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53. 10.1080/09540120802511877 . Chaudoir SR, Fisher JD. The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity. Psychol Bull. 2010;136(2):236–56. 10.1037/a0018193 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Apr, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviews received at journal 23 Feb, 2026 Reviewers agreed at journal 23 Feb, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviewers invited by journal 17 Feb, 2026 Editor invited by journal 12 Feb, 2026 Editor assigned by journal 10 Feb, 2026 Submission checks completed at journal 10 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8830973","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594110838,"identity":"d535537f-4bdc-47d0-b830-209e576bbf2f","order_by":0,"name":"Cao Nguyen Hoai Thuong","email":"","orcid":"","institution":"Pham Ngoc Thach University of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cao","middleName":"Nguyen Hoai","lastName":"Thuong","suffix":""},{"id":594110840,"identity":"43d01b65-a791-46c3-b5b3-49405a66ac79","order_by":1,"name":"Nguyen Vu Anh Thu","email":"","orcid":"","institution":"Pham Ngoc Thach University of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Nguyen","middleName":"Vu Anh","lastName":"Thu","suffix":""},{"id":594110842,"identity":"2a060ec2-ff69-4776-8c06-0a3ef4127723","order_by":2,"name":"Bui Hong Cam","email":"","orcid":"","institution":"Pham Ngoc Thach University of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bui","middleName":"Hong","lastName":"Cam","suffix":""},{"id":594110844,"identity":"f7ff0f60-cace-4e77-ba2b-c7fe0aab739b","order_by":3,"name":"Le Minh Nhan","email":"","orcid":"","institution":"Pham Ngoc Thach University of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Le","middleName":"Minh","lastName":"Nhan","suffix":""},{"id":594110845,"identity":"8acf36a0-7d0f-4c04-b6b1-c14531a97868","order_by":4,"name":"Ho Nguyen Anh Tuan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDCCA3AWM4gpIUOEFmYog40tAaSFhxQtPAYgirAWvtvnj0n83MGQZy7f8/nVjRoLHgb2w0c34NMieS6ZTbL3DEOxZRvvNuucY0CH8aSl3cCnxeAMM5sEbxtD4oZjvNuMc9iAWiR4zAhqkfwL1sLzzDjnH5FapCG28DA/zm0jQovkGWZja9k2iWKDY2lmzLl9EjxshPzCd4bx4c23bTZ5BocPP/6c861Ojp/98DG8WqBAIgFIsEmAmGxEKAcDkBbmD8SqHgWjYBSMgpEFAGIEQlYb31XZAAAAAElFTkSuQmCC","orcid":"","institution":"Pham Ngoc Thach University of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Ho","middleName":"Nguyen Anh","lastName":"Tuan","suffix":""}],"badges":[],"createdAt":"2026-02-09 13:25:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8830973/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8830973/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103216155,"identity":"2a25d2b7-5449-40f7-9ce6-2527f3d69570","added_by":"auto","created_at":"2026-02-23 09:31:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49657,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of the translation, cross-cultural adaptation, and psychometric evaluation process of the Vietnamese HSS-12\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8830973/v1/e29031f33dda530374fd1679.png"},{"id":103216153,"identity":"c703e0ae-70b7-414a-94c0-5ac76dfc3f45","added_by":"auto","created_at":"2026-02-23 09:31:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":448289,"visible":true,"origin":"","legend":"\u003cp\u003eStandardized CFA model for the modified four-factor structure of the Vietnamese HSS-12\u003c/p\u003e\n\u003cp\u003eConfirmatory factor analysis (CFA) was conducted to examine the hypothesized four-factor structure of the Vietnamese version of the HSS-12, including personalized stigma, disclosure concerns, concerns about public attitudes, and negative self-image. As shown in Table 3, the initial four-factor model demonstrated suboptimal fit to the data (χ² = 164.95, df = 48, p \u0026lt; 0.001; RMSEA = 0.100, 90% CI: 0.083–0.117; CFI = 0.901; TLI = 0.864; SRMR = 0.066). After allowing theoretically justified correlated residuals between selected items within the same factor, the modified four-factor model showed substantially improved and acceptable fit indices (χ² = 89.60, df = 45, p \u0026lt; 0.001; RMSEA = 0.064, 90% CI: 0.044–0.083; CFI = 0.962; TLI = 0.945; SRMR = 0.050). The modified model also yielded a lower AIC value, indicating a better balance between model fit and parsimony. In contrast, the one-factor model demonstrated poor fit (χ² = 436.19, df = 54, p \u0026lt; 0.001; RMSEA = 0.170, 90% CI: 0.155–0.185; CFI = 0.677; TLI = 0.605; SRMR = 0.107), supporting the multidimensional structure of the HSS-12.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8830973/v1/cd5c432fdb45f0d17d4829d6.png"},{"id":103505349,"identity":"9cfa7b8b-8110-482e-95f1-f248f6bd9a01","added_by":"auto","created_at":"2026-02-26 13:30:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1515814,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8830973/v1/2e322236-d073-4f88-8756-7293a1553643.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS- 12) among people living with HIV in Vietnam","fulltext":[{"header":"Background","content":"\u003cp\u003eHIV remains a major global public health concern, with approximately 40.8\u0026nbsp;million people living with HIV worldwide in 2024 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although advances in antiretroviral therapy (ART) have transformed HIV into a manageable chronic condition, many people living with HIV continue to face substantial social barriers. Among these, HIV-related stigma is considered a central challenge, profoundly affecting physical health, mental health, and quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe concept of stigma was originally described by Erving Goffman as an attribute that discredits an individual, leading to social devaluation, exclusion, and discrimination [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the context of HIV, stigma is commonly conceptualized as a multidimensional phenomenon encompassing three closely related mechanisms: enacted stigma, anticipated stigma, and internalized stigma. Enacted stigma refers to experiences of discrimination or unfair treatment faced by people living with HIV from family members, communities, or healthcare settings. Anticipated stigma reflects individuals\u0026rsquo; fears or expectations of being stigmatized in the future if their HIV status is disclosed. In contrast, internalized stigma captures the extent to which individuals accept and internalize society\u0026rsquo;s negative beliefs about HIV, which can adversely affect self-esteem, mental health, and engagement in health-related behaviors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous studies have demonstrated that HIV-related stigma is closely associated with delayed HIV testing, reduced adherence to ART, limited access to healthcare services, and decreased willingness to disclose HIV status to sexual partners or family members [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Consequently, accurate and reliable measurement of HIV-related stigma among people living with HIV is crucial for research, clinical practice, and the design of effective stigma-reduction interventions.\u003c/p\u003e \u003cp\u003eSeveral instruments have been developed to assess HIV-related stigma [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Among these, the 12-item short version of the HIV Stigma Scale (HSS-12), developed by Reinius et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] based on the original HIV Stigma Scale by Berger et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], is widely used. The HSS-12 retains the four core dimensions of HIV-related stigma while offering a concise and user-friendly structure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Brief instruments are particularly useful in routine HIV care settings, where time constraints and respondent burden may limit the feasibility of longer scales. Furthermore, the scale has demonstrated good reliability and validity across diverse cultural settings and countries [\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the HSS-12 has demonstrated robust psychometric properties in multiple international settings, its applicability depends on appropriate translation, cultural adaptation, and re-evaluation of measurement properties within specific cultural contexts. In Vietnam, evidence indicates that people living with HIV continue to experience stigma and discrimination within families, communities, and healthcare settings, adversely affecting mental health, healthcare engagement, and treatment adherence [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. According to the Vietnam Authority of HIV/AIDS Control, in 2024 the country recorded 13,351 new HIV infections, with over 245,000 people currently living with HIV [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, existing studies in Vietnam have relied on heterogeneous stigma measures, limiting comparability across studies and constraining the ability to rigorously evaluate stigma-reduction strategies. To date, no validated Vietnamese version of the HSS-12 is available, highlighting an important gap in standardized stigma measurement in Vietnam.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to translate and culturally adapt the HSS-12 into Vietnamese and to evaluate its reliability and validity among people living with HIV receiving ART at a primary healthcare facility in Ho Chi Minh City, Vietnam. A validated Vietnamese HSS-12 may strengthen standardized stigma assessment in research and clinical practice, facilitate routine stigma monitoring, and support the evaluation of stigma-reduction interventions in Vietnam.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted from May to June 2025 at the Substance Use and HIV/AIDS Counseling and Treatment Department of District 10 Medical Center, a primary healthcare facility in Ho Chi Minh City, Vietnam. At the time of the study, the center was providing ART to approximately 2,000 people living with HIV, making it a suitable setting for participant recruitment and psychometric evaluation of the Vietnamese version of the HSS-12.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of people living with HIV who were receiving ART at District 10 Medical Center during the study period. Inclusion criteria were: (i) aged 18 years or older; (ii) having a confirmed diagnosis of HIV and currently receiving ART at the study site; (iii) ability to communicate in and read Vietnamese; and (iv) provision of written informed consent. Exclusion criteria included: (i) the presence of severe mental disorders or cognitive impairment that could affect the ability to complete the questionnaire; and (ii) missing or incomplete responses to one or more HSS-12 items.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling\u003c/h3\u003e\n\u003cp\u003eThe target sample size was determined a priori to ensure adequate sample for confirmatory factor analysis (CFA). Commonly cited guidelines suggest that a sample size of approximately 200 is acceptable for factor analysis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Participants were recruited using convenience sampling during routine follow-up visits, yielding a final sample of 245 participants. For test\u0026ndash;retest reliability, the minimum sample size was calculated using Bonett\u0026rsquo;s method for estimating the intraclass correlation coefficient (ICC) with desired precision [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Assuming an expected ICC of 0.88 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], a 95% confidence interval half-width of 0.06, and two administrations (k\u0026thinsp;=\u0026thinsp;2), the required minimum sample size was 56 participants. A convenience subsample of 56 participants completed the HSS-12 twice over 4-week interval.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eStandardized self-report instruments were used in this study, including the 12-item HIV Stigma Scale (HSS-12), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Patient Health Questionnaire\u0026ndash;9 (PHQ-9).\u003c/p\u003e \u003cp\u003e \u003cb\u003eHIV Stigma Scale\u003c/b\u003e\u0026ndash;\u003cb\u003e12 (HSS-12)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe 12-item HIV Stigma Scale (HSS-12), developed by Reinius et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] based on the original HIV Stigma Scale by Berger et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], was used to assess perceived HIV-related stigma. The scale comprises four dimensions: personalized stigma, disclosure concerns, negative self-image, and concerns about public attitudes. Each item is rated on a 4-point Likert scale ranging from 1 (\u0026ldquo;strongly disagree\u0026rdquo;) to 4 (\u0026ldquo;strongly agree\u0026rdquo;). The total HSS-12 score was calculated by summing responses across all 12 items (range: 12\u0026ndash;48), with higher scores indicating higher levels of perceived HIV-related stigma. Subscale scores range from 3 to 12 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eMultidimensional Scale of Perceived Social Support (MSPSS)\u003c/h3\u003e\n\u003cp\u003eThe MSPSS is a 12-item self-report instrument designed to assess perceived social support from three sources: family, friends, and significant others, with four items per subscale [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Each item is rated on a 7-point Likert scale ranging from 1 (\u0026ldquo;strongly disagree\u0026rdquo;) to 7 (\u0026ldquo;strongly agree\u0026rdquo;). Subscale scores were calculated as the mean of the corresponding four items, and the total score was computed as the mean of all 12 items (range: 1\u0026ndash;7), with higher scores indicating higher levels of perceived social support. The MSPSS has been translated into Vietnamese and validated in Vietnam, demonstrating good reliability and validity across different populations [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient Health Questionnaire\u0026ndash;9 (PHQ-9)\u003c/h2\u003e \u003cp\u003eThe PHQ-9 is a 9-item self-report instrument used to assess depressive symptom severity over the preceding two weeks [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Items are rated on a 4-point Likert scale (0 = \u0026ldquo;not at all\u0026rdquo; to 3 = \u0026ldquo;nearly every day\u0026rdquo;), yielding a total score ranging from 0 to 27, with higher scores indicating greater depressive symptom severity. The PHQ-9 has been validated in Vietnam, demonstrating good internal consistency (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.88) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eAn overview of the translation, cross-cultural adaptation, and psychometric evaluation workflow is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eStage 1: Translation and Cross-cultural Adaptation\u003c/h3\u003e\n\u003cp\u003e The short version of the HIV Stigma Scale (HSS-12) was translated into Vietnamese following the cross-cultural adaptation guidelines proposed by Beaton et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], with an emphasis on conceptual equivalence. The process included independent forward translation by two bilingual translators who were native Vietnamese speakers, synthesis of the translated versions, back-translation into English by two independent translators blinded to the original scale, expert committee review, and development of a pre-final version. Permission to translate and use the scale was obtained from the original author prior to the translation process.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStage 2: Pilot study\u003c/h2\u003e \u003cp\u003eThe pre-final Vietnamese version of the HSS-12 was pilot-tested among 40 people living with HIV receiving ART at another healthcare facility in Ho Chi Minh City. Participants were asked to comment on the clarity, comprehensibility, and cultural relevance of the items, as well as any difficulties encountered during completion. Overall, participants reported that the items were clear and culturally appropriate, and no major issues were identified during pilot testing. Therefore, no further modifications were made, and the pre-final version was retained as the final Vietnamese HSS-12.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStage 3: Reliability and Validity Evaluation\u003c/h2\u003e \u003cp\u003eThe finalized Vietnamese version of the HSS-12 was administered in the main cross-sectional study conducted at District 10 Medical Center. Data were collected during routine follow-up visits after informed consent was obtained. To assess test\u0026ndash;retest reliability, a subsample of participants (n\u0026thinsp;=\u0026thinsp;56) completed the HSS-12 again after a 4-week interval. The collected data were used to evaluate internal consistency, test\u0026ndash;retest reliability, construct validity, and convergent validity of the scale.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData collection was conducted at the Substance Use and HIV/AIDS Counseling and Treatment Department at District 10 Medical Center during the study period. Eligible participants attending routine follow-up visits during the study period were invited to participate. After receiving information about the study objectives, procedures, and ethical considerations, those who agreed to participate provided written informed consent.\u003c/p\u003e \u003cp\u003eData were collected using self-administered questionnaires, which included sociodemographic characteristics, clinical information, and three standardized instruments: the HSS-12, MSPSS, and PHQ-9. Clinical and treatment-related data, including time since HIV diagnosis, duration of ART, and most recent CD4 cell counts, were extracted from medical records using a structured extraction form.\u003c/p\u003e \u003cp\u003eTo assess test\u0026ndash;retest reliability of the HSS-12, a subsample of participants (n\u0026thinsp;=\u0026thinsp;56) completed the HSS-12 again 4 weeks after the initial assessment. All questionnaires and extracted data were anonymized using unique study identification codes to ensure confidentiality while allowing linkage between the two data collection time points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were entered, cleaned, and analyzed using Stata version 14.0. Descriptive statistics were used to summarize participants\u0026rsquo; characteristics, with frequencies and percentages for categorical variables, and means with standard deviations or medians with interquartile ranges (IQR) for continuous variables, as appropriate.\u003c/p\u003e \u003cp\u003eThe internal consistency of the HSS-12 and its subscales was assessed using Cronbach\u0026rsquo;s alpha and corrected item\u0026ndash;total correlation coefficients. A Cronbach\u0026rsquo;s alpha value of \u0026ge;\u0026thinsp;0.70 was considered acceptable, while values\u0026thinsp;\u0026ge;\u0026thinsp;0.80 indicated good internal consistency [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Corrected item\u0026ndash;total correlations of \u0026ge;\u0026thinsp;0.30 were considered satisfactory [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Test\u0026ndash;retest reliability of the HSS-12 was evaluated using the intraclass correlation coefficient (ICC) with 95% confidence intervals based on data collected after a 4-week interval. ICC values\u0026thinsp;\u0026gt;\u0026thinsp;0.75 were interpreted as good reliability, and values\u0026thinsp;\u0026ge;\u0026thinsp;0.90 indicated excellent reliability [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConstruct validity was examined using confirmatory factor analysis (CFA) to test the hypothesized four-factor model of the HSS-12 and a one-factor alternative model. Although the chi-square (χ\u0026sup2;) test was used to assess overall model fit, given its sensitivity to sample size, additional fit indices were used to provide a comprehensive evaluation of model fit. Specifically, Comparative Fit Index (CFI) and Tucker\u0026ndash;Lewis Index (TLI) values\u0026thinsp;\u0026gt;\u0026thinsp;0.90 were considered indicative of acceptable fit, while values\u0026thinsp;\u0026ge;\u0026thinsp;0.95 indicated excellent fit [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) values\u0026thinsp;\u0026lt;\u0026thinsp;0.08 were considered acceptable [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConvergent validity was assessed using Pearson\u0026rsquo;s correlation coefficients between the HSS-12 total and subscale scores and the MSPSS and PHQ-9 scores. Negative correlations with MSPSS and positive correlations with PHQ-9 were hypothesized. A two-sided p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline Characteristics of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Baseline Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll participants\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 245)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetest participants\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n = 56)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e33.8 \u0026plusmn; 8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e32.7 \u0026plusmn; 8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e205 (83.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e48 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e37 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eUnder primary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e43 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e59 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e18 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e125 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e30 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e182 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e42 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e43 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e10 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eSeparated / Divorced / Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eLiving with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of HIV infection (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (3\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of ART (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (3\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCD4 count (cells/mm\u0026sup3;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026le; 200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e22 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e201\u0026ndash;349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e40 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e350\u0026ndash;499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e67 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e14 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026ge; 500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e115 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e33 (58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Values are presented as mean \u0026plusmn; standard deviation or median (interquartile range) for continuous variables, and number (percentage) for categorical variables. CD4 data were available for 244 of 245 participants because of missing laboratory results.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: HIV, human immunodeficiency virus; ART, antiretroviral therapy; CD4, cluster of differentiation 4 T-lymphocyte count.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 presents the demographic and clinical characteristics of the 245 participants included in the study. The mean age was 33.8 \u0026plusmn; 8.2 years, and most participants were male (83.7%). Approximately three-quarters had completed at least a high school education (75.0%). Most participants were single (74.3%). The median time since HIV diagnosis was 4 years (IQR: 3\u0026ndash;9), and the median duration of ART was also 4 years (IQR: 3\u0026ndash;9). Nearly half of the participants (47.1%) had a CD4 cell count of \u0026ge; 500 cells/mm\u0026sup3;. A total of 56 participants completed the retest assessment, and the characteristics of this subgroup were generally similar to those of the full sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability of the Vietnamese Version of the HSS-12\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eReliability of the HSS-12 and its subscales\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 482px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem number and description\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u0026ndash;total correlation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026rsquo;s alpha\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICC (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonalised stigma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.7 \u0026plusmn; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.93 (0.89\u0026ndash;0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 10. Some people avoid touching me once they know I have HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.4 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 11. People I care about stopped calling after learning I have HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.2 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 12. I have lost friends by telling them I have HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.1 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure concerns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8.5 \u0026plusmn; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.90 (0.84\u0026ndash;0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 3. Telling someone I have HIV is risky\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.7\u0026nbsp;\u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 4. I work hard to keep my HIV a secret\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.9\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 8. I am very careful who I tell that I have HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.9\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcerns about public attitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.7 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.90 (0.83\u0026ndash;0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 6. People with HIV are treated like outcasts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.2\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 7. Most people believe that a person who has HIV is dirty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.1\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 9. Most people are uncomfortable around someone with HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.4\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative self-image\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.7 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.92 (0.87\u0026ndash;0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 1. I feel guilty because I have HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.3\u0026nbsp;\u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 2. People\u0026rsquo;s attitudes about HIV make me feel worse about myself\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.1\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003eItem 5. I feel I am not as good a person as others because I have HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.2\u0026nbsp;\u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 482px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHSS-12 total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e28.6 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.95 (0.91\u0026ndash;0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Values are presented as mean \u0026plusmn; SD for the HSS-12 subscale and total scale scores. Item\u0026ndash;\u003c/em\u003e\u003cem\u003etotal correlations represent corrected item\u003c/em\u003e\u0026ndash;\u003cem\u003etotal correlation coefficients. ICC was calculated for the total HSS-12 score and subscale scores among retest participants (n = 56) over a 4-week interval.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003e\u003cem\u003eHSS-12, HIV Stigma Scale\u003c/em\u003e\u0026ndash;\u003cem\u003e12; SD, standard deviation; ICC, intraclass correlation coefficient; CI, confidence interval.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, the Vietnamese version of the HSS-12 demonstrated good internal consistency, with Cronbach\u0026rsquo;s alpha coefficients ranging from 0.690 to 0.838 across the four subscales and 0.849 for the total scale. Corrected item\u0026ndash;total correlation coefficients ranged from 0.309 to 0.677, indicating acceptable to good item discrimination, with all items exceeding the commonly accepted threshold of 0.30. Test\u0026ndash;retest reliability assessed in 56 participants over a 4-week interval was excellent, with ICC values of 0.90\u0026ndash;0.93 across subscales and 0.95 (95% CI: 0.91\u0026ndash;0.97) for the total HSS-12 score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstruct Validity (CFA) of the Vietnamese Version of the HSS-12\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eModel fit indices for confirmatory factor analysis of the Vietnamese version of the HSS-12\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne-factor model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFour-factor model (initial)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModified four-factor model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2; (df)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e436.19 (54), p \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e164.95 (48), p \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e89.60 (45), p \u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRMSEA (90% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003cp\u003e(0.155\u0026ndash;0.185)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003cp\u003e(0.083\u0026ndash;0.117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003cp\u003e(0.044\u0026ndash;0.083)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSRMR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.962\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTLI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e6335.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e6076.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e6007.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: The modified model allowed correlations between error terms of selected items within the same factor.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: RMSEA, Root Mean Square Error of Approximation; SRMR, Standardized Root Mean Square Residual; CFI, Comparative Fit Index; TLI, Tucker\u003c/em\u003e\u0026ndash;\u003cem\u003eLewis Index; AIC, Akaike Information Criterion.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConfirmatory factor analysis (CFA) was conducted to examine the hypothesized four-factor structure of the Vietnamese version of the HSS-12, including personalized stigma, disclosure concerns, concerns about public attitudes, and negative self-image. As shown in Table 3, the initial four-factor model demonstrated suboptimal fit to the data (\u0026chi;\u0026sup2; = 164.95, df = 48, p \u0026lt; 0.001; RMSEA = 0.100, 90% CI: 0.083\u0026ndash;0.117; CFI = 0.901; TLI = 0.864; SRMR = 0.066).\u0026nbsp;After allowing theoretically justified correlated residuals between selected items within the same factor, the modified four-factor model showed substantially improved and acceptable fit indices (\u0026chi;\u0026sup2; = 89.60, df = 45, p \u0026lt; 0.001; RMSEA = 0.064, 90% CI: 0.044\u0026ndash;0.083; CFI = 0.962; TLI = 0.945; SRMR = 0.050).\u0026nbsp;The modified model also yielded a lower AIC value, indicating a better balance between model fit and parsimony. In contrast, the one-factor model demonstrated poor fit (\u0026chi;\u0026sup2; = 436.19, df = 54, p \u0026lt; 0.001; RMSEA = 0.170, 90% CI: 0.155\u0026ndash;0.185; CFI = 0.677; TLI = 0.605; SRMR = 0.107), supporting the multidimensional structure of the HSS-12.\u003c/p\u003e\n\u003cp\u003eThe standardized CFA model of the modified four-factor structure is presented in Fig. 2. All items demonstrated adequate standardized factor loadings (all \u0026ge; 0.40) on their respective latent factors, and the four stigma domains showed moderate to strong inter-factor correlations, ranging from 0.45 to 0.89.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConvergent Validity of the Vietnamese Version of the HSS-12\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eConvergent validity of the Vietnamese version of the HSS-12\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonalized stigma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure concerns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcerns about public attitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative self-image\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHSS-12 total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHQ-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.221***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.163*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.192**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.253***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.279***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMSPSS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u003c/strong\u003e0.254***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u003c/strong\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u003c/strong\u003e0.247***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u003c/strong\u003e0.186**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u003c/strong\u003e0.265***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Values are Pearson\u0026rsquo;s correlation coefficients (r).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: PHQ-9, Patient Health Questionnaire-9; HSS-12, HIV Stigma Scale\u0026ndash;12; MSPSS, Multidimensional Scale of Perceived Social Support.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*p \u0026lt; 0.05; **p \u0026lt; 0.01; ***p \u0026lt; 0.001.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 4, convergent validity of the Vietnamese version of the HSS-12 was supported by correlations with external measures in the expected directions. All four HSS-12 subscales and the total score were positively correlated with depressive symptoms measured by the PHQ-9 (r = 0.163\u0026ndash;0.279, p \u0026lt; 0.05). In contrast, personalized stigma, concerns about public attitudes, negative self-image, and the total HSS-12 score were negatively correlated with perceived social support measured by the MSPSS (r = \u0026minus;0.186 to \u0026minus;0.265, p \u0026lt; 0.01). Disclosure concerns showed a weak and non-significant correlation with MSPSS (r = \u0026minus;0.097, p \u0026gt; 0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides initial evidence supporting the reliability and validity of the Vietnamese version of the HSS-12 among people living with HIV receiving ART in Vietnam. HIV-related stigma remains a major social barrier affecting mental health, healthcare engagement, and quality of life among people living with HIV [5, 7]. Given the lack of standardized Vietnamese instruments to assess HIV-related stigma, the present findings support the Vietnamese HSS-12 as a brief and feasible tool for stigma assessment in both research and routine care. Overall, the results indicate that the translated scale demonstrates satisfactory psychometric performance in this setting.\u003c/p\u003e\n\u003cp\u003eThe Vietnamese version of the HSS-12 demonstrated good internal consistency, with a Cronbach’s alpha of 0.85 for the total scale and values ranging from 0.69 to 0.84 across the subscales. These values fall within acceptable thresholds and are consistent with findings from the original study by Reinius et al. [9], as well as validation studies conducted in Brazil [11], Kenya [13], Peru [15], and Iran [14]. Although some previous studies have reported Cronbach’s alpha values below 0.70 for certain subscales, particularly in studies with small sample sizes [12, 14], the results of the present study indicate that the Vietnamese version of the HSS-12 exhibits satisfactory internal consistency within the current study context.\u0026nbsp;In addition, test–retest reliability over a 4-week interval was excellent for the total HSS-12 score (ICC = 0.95), indicating excellent temporal stability. This finding is comparable to, and within the range of, those reported in studies conducted in Kenya (ICC = 0.92) [13] and Iran (ICC = 0.88) [14].\u003c/p\u003e\n\u003cp\u003eConfirmatory factor analysis (CFA) supported the hypothesized four-factor structure of the HSS-12, comprising personalized stigma, disclosure concerns, concerns about public attitudes, and negative self-image. Although the chi-square test was statistically significant, other model fit indices, including the CFI, TLI, RMSEA, and SRMR, indicated acceptable to good model fit, consistent with psychometric research recognizing the sensitivity of the chi-square statistic to sample size [30, 32].\u0026nbsp;After allowing a small number of theoretically and conceptually justified correlations between residuals of selected items within the same factor, the four-factor model demonstrated a substantial improvement in fit indices, providing support for the structural validity of the HSS-12 in the Vietnamese context.\u0026nbsp;Moreover, the poor fit of the one-factor model further supported the multidimensional structure of the HSS-12. In the modified four-factor model, all items exhibited acceptable standardized factor loadings, indicating that each item adequately represented its corresponding latent construct.\u0026nbsp;In addition, moderate to strong inter-factor correlations (r = 0.45–0.89) suggest that these domains are related yet distinct, reinforcing the multidimensional nature of perceived HIV-related stigma. These findings are consistent with previous validation studies conducted in Sweden\u0026nbsp;[9], Brazil\u0026nbsp;[11], Portugal\u0026nbsp;[12], and Peru\u0026nbsp;[15], and further support the structural validity and cross-cultural applicability of the four-factor model of the HSS-12.\u003c/p\u003e\n\u003cp\u003eConvergent validity of the Vietnamese version of the HSS-12 was supported by the expected pattern of associations with external psychological measures. Higher perceived HIV-related stigma was positively associated with depressive symptoms, as measured by the PHQ-9, and negatively associated with perceived social support, as measured by the MSPSS. Although the observed correlations were small to moderate in magnitude, their directions were consistent with theoretical expectations and findings from previous international studies.\u0026nbsp;Prior meta-analyses have consistently demonstrated positive associations between HIV-related stigma and depression or psychological distress, as well as negative associations with social support among people living with HIV [33, 34]. Similar patterns have also been reported in validation studies of the HSS-12 conducted in different cultural contexts, including Portugal [12]. Notably, the weak and non-significant association between disclosure concerns and perceived social support may reflect the use of selective nondisclosure as a coping strategy, whereby individuals limit disclosure to protect themselves from anticipated stigma while maintaining perceived support from close social networks [35]. Overall, these findings support the convergent validity of the Vietnamese HSS-12.\u003c/p\u003e\n\u003cp\u003eThe present findings should be interpreted in light of several limitations. This study used convenience sampling at a single primary healthcare facility, which may limit generalizability. In addition, convergent validity was examined using related psychosocial measures (MSPSS and PHQ-9) and self-report data, which may be subject to social desirability bias. Future studies using stigma-specific external measures and more diverse samples are warranted to further strengthen evidence for validity and generalizability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn conclusion, the findings of this study indicate that the Vietnamese version of the HSS-12 demonstrates good reliability and validity for assessing perceived HIV-related stigma among people living with HIV in Vietnam. The scale exhibited good internal consistency, excellent test–retest reliability, and acceptable evidence of construct and convergent validity. The Vietnamese HSS-12 may be used in research and clinical settings to facilitate standardized stigma assessment and routine stigma monitoring, and to support the development and evaluation of stigma-reduction interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS: Acquired Immunodeficiency Syndrome; ART: Antiretroviral therapy; CFA: Confirmatory factor analysis; CFI: Comparative Fit Index; CI: Confidence interval; HIV: Human immunodeficiency virus; HSS-12: 12-item HIV Stigma Scale; ICC: Intraclass correlation coefficient; MSPSS: Multidimensional Scale of Perceived Social Support; PHQ-9: Patient Health Questionnaire-9; RMSEA: Root Mean Square Error of Approximation; SD: Standard deviation; SRMR: Standardized Root Mean Square Residual; TLI: Tucker–Lewis Index.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e Ethical approval was obtained from the Research Ethics Committee of Pham Ngoc Thach University of Medicine (Decision No. 1357/TDHYKPNT-HDDD, April 21, 2025). All participants provided written informed consent prior to participation. Participation was voluntary, and confidentiality was ensured through data anonymization and restricted access.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received no specific funding from any public, commercial, or not-for-profit funding agencies.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nguyen Vu Anh Thu, Bui Hong Cam, Le Minh Nhan, and Cao Nguyen Hoai Thuong. Project administration and supervision were performed by Ho Nguyen Anh Tuan and Cao Nguyen Hoai Thuong. The first draft of the manuscript was written by Cao Nguyen Hoai Thuong and Nguyen Vu Anh Thu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e We would like to thank the staff of the Substance Use and HIV/AIDS Counseling and Treatment Department of District 10 Medical Center for their support in participant recruitment and data collection. We also sincerely thank all study participants for their time and valuable contributions.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are not publicly available due to concerns regarding participant confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. HIV data and statistics Geneva: World Health Organization. 2025 [cited 2025 14 January]. 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Psychol Bull. 2010;136(2):236\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/a0018193\u003c/span\u003e\u003cspan address=\"10.1037/a0018193\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV stigma, HIV Stigma Scale, HSS-12, reliability, validity","lastPublishedDoi":"10.21203/rs.3.rs-8830973/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8830973/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHIV-related stigma remains a major psychosocial challenge affecting mental health, healthcare engagement, and quality of life among people living with HIV. Reliable and culturally appropriate brief instruments are essential for stigma assessment in both research and clinical practice; however, validated Vietnamese measures remain limited. This study aimed to evaluate the psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS-12).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among 245 people living with HIV receiving antiretroviral therapy at a primary healthcare facility in Ho Chi Minh City, Vietnam. Internal consistency was assessed using Cronbach’s alpha. Test–retest reliability was evaluated in a subsample of 56 participants over a 4-week interval using the intraclass correlation coefficient (ICC). Construct validity was examined using confirmatory factor analysis (CFA), comparing a hypothesized four-factor model with a one-factor alternative model. Convergent validity was assessed through correlations with depressive symptoms (Patient Health Questionnaire-9; PHQ-9) and perceived social support (Multidimensional Scale of Perceived Social Support; MSPSS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Vietnamese HSS-12 demonstrated good internal consistency (Cronbach’s alpha = 0.85) and excellent test–retest reliability (ICC = 0.95). CFA supported a modified four-factor structure with acceptable model fit indices (CFI = 0.962; TLI = 0.945; RMSEA = 0.064; SRMR = 0.050), whereas the one-factor model showed poor fit. Convergent validity was supported by positive correlations between HSS-12 scores and PHQ-9 scores, and negative correlations with MSPSS scores, except for the disclosure concerns subscale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Vietnamese version of the HSS-12 is a reliable and valid instrument for assessing perceived HIV-related stigma among people living with HIV in Vietnam. This brief measure may facilitate standardized stigma assessment in psychological research and routine care settings.\u003c/p\u003e","manuscriptTitle":"Psychometric properties of the Vietnamese version of the 12-item HIV Stigma Scale (HSS- 12) among people living with HIV in Vietnam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 09:31:03","doi":"10.21203/rs.3.rs-8830973/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T03:04:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T15:27:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50979554730511148966712040097025586595","date":"2026-02-26T19:44:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T20:15:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68000248253416690680438847405357798039","date":"2026-02-23T16:20:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327883179561185501179383243425338201923","date":"2026-02-17T15:32:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T12:31:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-12T10:52:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T01:30:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-11T01:29:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2026-02-09T13:11:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"912707b9-bb5f-405c-bd85-7798e8697f85","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T06:25:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 09:31:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8830973","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8830973","identity":"rs-8830973","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}