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Development and Validation of a Provider-Specific Anticipated Stigma Scale for People Who Inject Drugs.

Roman Ivasiy^1,2,3, Valerie A Earnshaw⁴, Jimi Huh⁵

¹Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.

AIDS and Behavior

|March 14, 2026

Summary

A new scale, the Substance Use Anticipated Provider Stigma Scale (SU-APSS), effectively measures anticipated stigma among people who inject drugs (PWID). This tool helps identify provider-specific stigma to improve HIV prevention and care engagement.

Keywords:

Anticipated stigma Healthcare discrimination Intersectional stigma People who inject drugs (PWID)Scale validation Stigma Stigma measurement

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Area of Science:

Public Health
Health Psychology
Sociology

Background:

Stigma in healthcare settings is a significant barrier to HIV prevention and treatment for people who inject drugs (PWID).
Existing stigma measurement tools often fail to capture the intersectional and provider-specific experiences of PWID, particularly from syringe service programs (SSPs).

Purpose of the Study:

To develop and validate the Substance Use Anticipated Provider Stigma Scale (SU-APSS).
To assess anticipated stigma from four distinct provider types: healthcare workers, substance use treatment staff, pharmacists, and SSP personnel among PWID.

Main Methods:

A cross-sectional survey was administered to 264 PWID meeting specific inclusion criteria.
Confirmatory factor analysis (CFA) was used on data from 218 participants to evaluate the scale's structural validity.
Cronbach's alpha was calculated to assess the internal consistency of the SU-APSS subscales and the overall scale.

Main Results:

The CFA confirmed a robust four-factor structure for the SU-APSS with excellent model fit indices.
All scale items demonstrated significant factor loadings, indicating strong construct validity.
High internal consistency was observed for all subscales (α = 0.85–0.96) and the total scale (α = 0.87).
Attribution analysis identified drug use, physical appearance, and income level as primary perceived reasons for anticipated stigma.

Conclusions:

The SU-APSS is a validated, multidimensional instrument for measuring anticipated provider-specific stigma among PWID.
This scale can guide the development of targeted stigma-reduction interventions.
The SU-APSS can be used to evaluate strategies aimed at enhancing HIV prevention and care engagement for PWID.