{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T13:55:37Z","timestamp":1791122137439,"version":"4.1.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW010946"],"award-info":[{"award-number":["D43TW010946"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>People who use drugs (PWUD) experience stigma from multiple sources due to their drug use. HIV seroprevalence for PWUD in Tanzania is estimated to range from 18 to 25%. So, many PWUD will also experience HIV stigma. Both HIV and drug use stigma have negative health and social outcomes, it is therefore important to measure their magnitude and impact. However, no contextually and linguistically adapted measures are available to assess either HIV or drug use stigma among PWUD in Tanzania. In response, we translated and culturally adapted HIV and drug use stigma measures among Tanzanian PWUD and described that process in this study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a cross-sectional study. We translated and adapted existing validated stigma measures by following a modified version of Wild\u2019s ten steps for translation and adaptation. We also added new items on stigmatizing actions that were not included in the original measures. Following translation and back translation, we conducted 40 cognitive debriefs among 19 PWUD living with and 21 PWUD not living with HIV in Dar es Salaam to assess comprehension of the original and new items. For challenging items, we made adaptations and repeated cognitive debriefs among ten new PWUD participants where half of them were living with HIV.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Most of the original items (42\/54, 78%), response options and all items with new 12 stigmatizing actions were understood by participants. Challenges included response options for a few items; translation to Swahili; and differences in participants\u2019 interpretation of Swahili words. We made changes to these items and the final versions were understood by PWUD participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Drug use and HIV stigma measures can successfully be translated and culturally adapted among Tanzanian PWUD living with and without HIV. We are currently conducting research to determine the stigma measures\u2019 psychometric properties and we will report the results separately.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292642","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T17:33:10Z","timestamp":1697736790000},"page":"e0292642","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Translation and cultural adaptation of drug use stigma and HIV stigma measures among people who use drugs in Tanzania"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8244-9036","authenticated-orcid":true,"given":"Linda B.","family":"Mlunde","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa R.","family":"Hirschhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Nyblade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan E.","family":"Rothrock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9943-4671","authenticated-orcid":true,"given":"Erasto V.","family":"Mbugi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith T.","family":"Moskowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Kaaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Hawkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7826-7651","authenticated-orcid":true,"given":"Germana","family":"Leyna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie K.","family":"Mbwambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"pone.0292642.ref001","unstructured":"UNODC. World Drug Report 2023. 2023. https:\/\/www.unodc.org\/res\/WDR-2023\/WDR23_Exsum_fin_SP.pdf."},{"key":"pone.0292642.ref002","unstructured":"Dutta A, Barker C, Makyao N. Consensus estimates on key population size and HIV prevalence in Tanzania. 2014. http:\/\/www.healthpolicyproject.com\/pubs\/391_FORMATTEDTanzaniaKPconsensusmtgreport.pdf."},{"key":"pone.0292642.ref003","unstructured":"UNODC. World Drug Report 2019. 2019. https:\/\/wdr.unodc.org\/wdr2019\/prelaunch\/WDR19_Booklet_1_EXECUTIVE_SUMMARY.pdf."},{"key":"pone.0292642.ref004","unstructured":"MOCDGEC, PEPFAR, CDC, NBS, OCGS, TACAIDS, et al. Tanzania HIV Impact Survey (THIS) 2016\u20132017. 2017. https:\/\/www.nbs.go.tz\/index.php\/en\/census-surveys\/health-statistics\/hiv-and-malaria-survey\/382-the-tanzania-hiv-impact-survey-2016-2017-this-final-report"},{"key":"pone.0292642.ref005","unstructured":"Ogden J, Nyblade L. Common at its core: HIV-related stigma Across contexts.2015. https:\/\/www.icrw.org\/wp-content\/uploads\/2016\/10\/Common-at-its-Core-HIV-Related-Stigma-Across-Contexts.pdf."},{"issue":"3","key":"pone.0292642.ref006","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/13548500600595053","article-title":"Health-related stigma: rethinking concepts and interventions","volume":"11","author":"MG Weiss","year":"2006","journal-title":"Psychol Health Med"},{"key":"pone.0292642.ref007","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2147\/NDT.S54081","article-title":"Perspectives on perceived stigma and self-stigma in adult male patients with depression","volume":"10","author":"K Latalova","year":"2014","journal-title":"Neuropsychiatr Dis Treat"},{"key":"pone.0292642.ref008","unstructured":"Nyblade L, MacQuarrie K, Phillip F, Kwesigabo G, Mbwambo J,.Ndega J, et al. Working Report Measuring HIV Stigma: Results of a field test in Tanzania. 2005. https:\/\/www.icrw.org\/wp-content\/uploads\/2016\/10\/Working-Report-Measuring-HIV-Stigma-Results-of-a-Field-Test-in-Tanzania.pdf."},{"key":"pone.0292642.ref009","first-page":"26","volume":"8","author":"G Scambler","year":"1986","journal-title":"Being epileptic: coming to terms with stigma Sociol Health Illn"},{"issue":"9","key":"pone.0292642.ref010","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1007\/s10461-021-03172-5","article-title":"HIV and Substance Use Stigma, Intersectional Stigma and Healthcare Among HIV-Positive PWID in Russia","volume":"25","author":"MV Vetrova","year":"2021","journal-title":"AIDS Behav"},{"key":"pone.0292642.ref011","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.drugpo.2015.12.009","article-title":"\"Can\u2019t you initiate me here?\": Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania","volume":"30","author":"HT Saleem","year":"2016","journal-title":"Int J Drug Policy"},{"key":"pone.0292642.ref012","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.drugpo.2016.01.012","article-title":"Generating trust: Programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania","volume":"30","author":"S Zamudio-Haas","year":"2016","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0292642.ref013","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12954-018-0235-9","article-title":"\"Who has ever loved a drug addict? It\u2019s a lie. They think a \u2019teja\u2019 is as bad person\": multiple stigmas faced by women who inject drugs in coastal Kenya","volume":"15","author":"G Mburu","year":"2018","journal-title":"Harm Reduct J"},{"key":"pone.0292642.ref014","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1186\/1472-6963-12-428","article-title":"Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam","volume":"12","author":"DC Thanh","year":"2012","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0292642.ref015","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/dar.12589","article-title":"Drug-related stigma and access to care among people who inject drugs in Vietnam","volume":"37","author":"CW Lan","year":"2018","journal-title":"Drug Alcohol Rev"},{"issue":"1","key":"pone.0292642.ref016","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/09540120802032627","article-title":"Measuring AIDS stigmas in people living with HIV\/AIDS: the Internalized AIDS-Related Stigma Scale","volume":"21","author":"SC Kalichman","year":"2009","journal-title":"AIDS Care"},{"issue":"7","key":"pone.0292642.ref017","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1080\/09540121.2016.1139043","article-title":"Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania","volume":"28","author":"DE Dow","year":"2016","journal-title":"AIDS Care"},{"key":"pone.0292642.ref018","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.drugalcdep.2016.02.019","article-title":"Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations","volume":"162","author":"LR Smith","year":"2016","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0292642.ref019","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s10461-015-1100-4","article-title":"Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia","volume":"20","author":"SK Calabrese","year":"2016","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0292642.ref020","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.drugalcdep.2010.03.004","article-title":"The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai, India","volume":"110","author":"C Latkin","year":"2010","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0292642.ref021","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1016\/S2352-3018(19)30345-5","article-title":"Patient-reported outcomes to enhance person-centred HIV care","volume":"7","author":"M Kall","year":"2020","journal-title":"Lancet HIV"},{"issue":"2","key":"pone.0292642.ref022","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1524-4733.2005.04054.x","article-title":"Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation","volume":"8","author":"D Wild","year":"2005","journal-title":"Value Health"},{"key":"pone.0292642.ref023","unstructured":"Wizara ya Fedha na Mipango, Ofisi ya Taifa ya Takwimu. Sensa ya Watu na Makazi ya Mwaka 2022: Matokeo ya Mwanzo. Dodoma, Tanzania. 2022. https:\/\/www.nbs.go.tz\/nbs\/takwimu\/Census2022\/matokeomwanzooktoba2022.pdf."},{"issue":"1","key":"pone.0292642.ref024","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s10461-011-0128-3","article-title":"Assessing HIV\/AIDS stigma in south India: validation and abridgement of the Berger HIV Stigma scale","volume":"17","author":"L Jeyaseelan","year":"2013","journal-title":"AIDS Behav"},{"issue":"5","key":"pone.0292642.ref025","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s10461-013-0437-9","article-title":"HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework","volume":"17","author":"VA Earnshaw","year":"2013","journal-title":"AIDS Behav"},{"issue":"1\u20132","key":"pone.0292642.ref026","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3109\/10826080902864712","article-title":"The development and psychometric properties of a new measure of perceived stigma toward substance users","volume":"45","author":"JB Luoma","year":"2010","journal-title":"Subst Use Misuse"},{"key":"pone.0292642.ref027","unstructured":"Willis GB. Cognitive Interviewing: A \"How To\" Guide. 1999. https:\/\/www.hkr.se\/contentassets\/9ed7b1b3997e4bf4baa8d4eceed5cd87\/gordonwillis.pdf."},{"issue":"3","key":"pone.0292642.ref028","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1027\/1614-2241\/a000075","article-title":"The Cognitive Interviewing Reporting Framework (CIRF): Towards the harmonization of cognitive testing reports","volume":"9","author":"H Boeije","year":"2013","journal-title":"Methodology: European Journal of Research Methods for the Behavioral and Social Sciences"},{"issue":"7","key":"pone.0292642.ref029","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1007\/s10461-016-1529-0","article-title":"First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania","volume":"21","author":"D Balaji","year":"2017","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0292642.ref030","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1186\/s12887-020-02343-y","article-title":"Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries","volume":"20","author":"B Krieger","year":"2020","journal-title":"BMC Pediatr"},{"issue":"6","key":"pone.0292642.ref031","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1177\/13634615211011850","article-title":"Cross-cultural adaptation of an anxiety measure in a disadvantaged South African community context: Methodological processes and findings","volume":"58","author":"N Myburgh","year":"2021","journal-title":"Transcult Psychiatry"},{"issue":"4","key":"pone.0292642.ref032","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s10896-021-00313-1","article-title":"\"These Questions Have Everything That Happens to me\": Analysis of a Femicide Risk Assessment Tool for Abused Women in Brazil","volume":"37","author":"DP Evans","year":"2022","journal-title":"J Fam Violence"},{"issue":"1","key":"pone.0292642.ref033","doi-asserted-by":"crossref","first-page":"e0265784","DOI":"10.1371\/journal.pone.0265784","article-title":"Cultural adaptation of the person-centered maternity care scale at governmental health facilities in Cambodia","volume":"18","author":"YT Naito","year":"2023","journal-title":"PLoS One"},{"issue":"12","key":"pone.0292642.ref034","doi-asserted-by":"crossref","first-page":"e0277619","DOI":"10.1371\/journal.pone.0277619","article-title":"Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study","volume":"17","author":"V Nyongesa","year":"2022","journal-title":"PLoS One"},{"issue":"6","key":"pone.0292642.ref035","first-page":"1733","article-title":"Dutch-Flemish translation of 17 item banks from the patient-reported outcomes measurement information system (PROMIS)","volume":"23","author":"CB Terwee","year":"2014","journal-title":"Qual Life Res"},{"issue":"1","key":"pone.0292642.ref036","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3109\/09638237.2011.629238","article-title":"Arabic translation and cultural adaptation of the stigma-devaluation scale in Jordan","volume":"21","author":"HF Dalky","year":"2012","journal-title":"J Ment Health"},{"issue":"2","key":"pone.0292642.ref037","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10461-005-3895-x","article-title":"Development of a brief scale to measure AIDS-related stigma in South Africa","volume":"9","author":"SC Kalichman","year":"2005","journal-title":"AIDS Behav"},{"issue":"5","key":"pone.0292642.ref038","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/NCC.0b013e3182962701","article-title":"Translation and linguistic validation of the Pediatric Patient-Reported Outcomes Measurement Information System measures into simplified Chinese using cognitive interviewing methodology","volume":"36","author":"Y Liu","year":"2013","journal-title":"Cancer Nurs"},{"issue":"8","key":"pone.0292642.ref039","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1080\/13691058.2017.1390162","article-title":"Early marriage and cultural constructions of adulthood in two slums in Dar es Salaam","volume":"20","author":"L. 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