Attitudes About HIV/AIDS for Hispanic College Students

Abstract

The Attitudes About HIV/AIDS for Hispanic College Students scale is a specialized, 26-item psychometric instrument developed by Raffy R. Luquis and Patricia Barthalow Koch to assess multifaceted dimensions of attitudes toward human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS) among Hispanic/Latino undergraduate populations. Adapted from surveillance frameworks established by the Centers for Disease Control and Prevention (CDC) (Dawson, 1990) and the Nurses’ Attitudes about AIDS Scale (NAAS; Preston et al., 1995), the measure was specifically engineered to capture the convergence of health-related knowledge, socioculturally derived sexual norms, interpersonal stigma, and institutional openness. The instrument employs a 5-point Likert response format ranging from 1 (Strongly Agree) to 5 (Strongly Disagree), with scoring calibrated such that higher mean scores reflect more progressive, supportive, and health-protective attitudes. Psychometric evaluation demonstrates robust internal consistency, yielding an overall Cronbach’s alpha of .85 in cross-cultural comparative samples of college students. Systematic content validation integrated Hispanic student focus groups, cognitive pilot testing, and rigorous translation/back-translation protocols to yield equivalent English and Spanish forms. This article provides an exhaustive psychometric review of the instrument, delineating its theoretical foundations, structural dimensions, cultural contextualization, validity indices, factor structure, scoring mechanics, and practical utility in higher education health promotion and epidemiological research.

Keywords

Attitudes About HIV/AIDS for Hispanic College Students, HIV stigma, Hispanic health disparities, sexual health attitudes, condom use, homophobia, Health Belief Model, Theory of Planned Behavior, cross-cultural psychometrics, college health education

Authors

The instrument was developed and validated through the collaborative scholarship of:

• Raffy R. Luquis, PhD, MCHES — Professor of Health Education, School of Behavioral Sciences and Education, Pennsylvania State University Harrisburg, Middletown, PA, United States. Correspondence: School of Behavioral Sciences and Education, W331 Olmsted, Penn State Harrisburg, 777 West Harrisburg Pike, Middletown, PA 17057; Email: [email protected].
• Patricia Barthalow Koch, PhD — Professor Emerita of Biobehavioral Health, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States.

Purpose

The primary purpose of the Attitudes About HIV/AIDS for Hispanic College Students scale is to provide a culturally grounded, psychometrically sound diagnostic and evaluative tool for measuring attitudes, moral perceptions, and behavioral predispositions related to HIV/AIDS among Hispanic undergraduate students. Emerging adulthood represents a developmentally critical juncture characterized by identity exploration, increased sexual autonomy, and heightened vulnerability to sexually transmitted infections (STIs). Historically, public health surveillance has demonstrated that racial and ethnic minority communities, particularly Hispanic/Latino populations, bear a disproportionate burden of HIV diagnoses in the United States, driven by systemic socioeconomic inequities, language barriers, healthcare access disparities, and complex sociocultural taboos surrounding sexuality.

Despite this documented epidemiological risk, health behavior researchers recognized that existing HIV attitude inventories were overwhelmingly standardized on non-Hispanic white cohorts. Conventional scales frequently overlooked the idiosyncratic cultural scripts—such as traditional gender role socialization, religious moral frameworks, and structural communication barriers—that fundamentally shape Hispanic youths’ perceptions of risk, interpersonal stigma, and preventive efficacy. Luquis and Koch developed this instrument to bridge this methodological and empirical gap. Specifically, the scale was designed to achieve multiple applied and theoretical objectives:

• Baseline Needs Assessment: To quantify pre-existing attitudes, stigmatizing beliefs toward People Living with HIV/AIDS (PLWHA), and sexual health norms across university student bodies, providing campus health centers with actionable data.
• Intervention Evaluation: To serve as an evaluative pre-test/post-test metric assessing the efficacy of culturally tailored sexual health education programs, campus workshops, and academic courses focused on disease prevention and anti-stigma advocacy.
• Cross-Cultural Comparative Research: To facilitate empirical comparisons between Hispanic and non-Hispanic student cohorts regarding the psychosocial determinants of safer sex practices and discrimination.
• Bilingual Assessment: To provide linguistically equivalent English and Spanish formats, enabling researchers to disentangle the nuanced effects of language preference, acculturation level, and generational status on health-related attitudes.

Psychological Construct

The scale measures the multidimensional psychological construct of HIV/AIDS-related attitudes within an integrated sociocultural framework. Rather than conceptualizing attitude as a static, unidimensional evaluative judgment, the instrument operationalizes it as a constellation of cognitive beliefs, affective evaluations, and behavioral intentions spanning four central domains:

1. Interpersonal Stigma, Homophobia, and Social Distance

This dimension examines affective and behavioral reactions toward individuals living with HIV/AIDS, as well as attitudes toward the demographic groups historically scapegoated during the epidemic. Stigmatizing attitudes are measured through items evaluating comfort regarding routine social interactions (e.g., attending class with an infected peer, sharing living arrangements with an infected roommate) and romantic desirability (e.g., dating a person with HIV/AIDS). Concurrently, this domain evaluates social bias and moralistic blame, specifically assessing homophobic sentiment (e.g., viewing male homosexuality as vulgar) and the attribution of AIDS as retributive punishment for perceived immoral conduct. Pro-social legal attitudes, such as endorsing civil rights protections against housing and employment discrimination and upholding mandatory test confidentiality, anchor the supportive pole of this dimension.

2. Traditional Sexual Morality and Gender Role Socialization

A distinctive feature of the instrument is its operationalization of normative cultural scripts regarding sexual conduct, particularly the traditional Hispanic constructs of machismo (normative standards of masculinity) and marianismo (the cultural idealization of female chastity, modesty, and self-sacrifice derived from Catholic iconography). The scale measures beliefs regarding premarital sexual abstinence separately for women and men, identifying double standards in sexual morality. It also assesses punitive views regarding sexual diversity and multi-partner relationships, capturing moralistic labeling (e.g., classifying anyone with more than one sexual partner as promiscuous) and the desire to criminalize behaviors associated with viral transmission.

3. Self-Efficacy and Safer Sexual Practices

This sub-construct captures behavioral intentions and self-efficacy regarding personal prophylactic behaviors. Drawing on behavioral medicine paradigms, items assess personal commitment to consistent barrier method utilization (condom usage at every sexual encounter), monogamy, and the cognitive rationalization of risk avoidance. Crucially, the domain taps assertive sexual communication—measuring an individual’s perceived comfort in querying a prospective partner about their prior sexual history—which represents a decisive behavioral antecedent to negotiated safer sex in emerging adults.

4. Institutional and Interpersonal Communication Openness

Recognizing that health behavior change is facilitated by supportive communication ecologies, this dimension evaluates perceived comfort in discussing HIV/AIDS across three distinct social strata: familial (communication with parents), peer-based (informal discussions with friends), and academic/institutional (classroom discussions and formal curricular inclusion). In Hispanic family systems characterized by familismo, sexual health topics are frequently characterized by conversational reticence or generational taboos; measuring parental communication openness provides key diagnostic insight into familial socialization dynamics.

Theoretical Framework

The architecture of the Attitudes About HIV/AIDS for Hispanic College Students scale is firmly anchored in two foundational behavioral theories, synthesized alongside culturally grounded health behavior models:

The Health Belief Model (HBM)

Originally formulated by Rosenstock (1974) and expanded by Janz and Becker (1984), the Health Belief Model posits that individuals will take preventive health action if they regard themselves as susceptible to a condition (perceived susceptibility), believe the condition has serious consequences (perceived severity), believe that available courses of action are beneficial (perceived benefits), and perceive that potential barriers to action are outweighed by benefits (perceived barriers). The scale integrates these constructs directly: items examining perceived adequacy of knowledge, personal risk reduction, and consistent condom use assess perceived susceptibility and self-efficacy. Perceptions of AIDS as an immutable moral consequence or insurmountable barrier reflect the cognitive distortions described within the HBM framework.

The Theory of Reasoned Action and Theory of Planned Behavior

Formulated by Ajzen and Fishbein (1980; Ajzen, 1991), the Theory of Planned Behavior (TPB) asserts that the immediate precursor to behavior is behavioral intention, which is predicted jointly by personal attitudes toward the behavior, subjective norms (perceived social pressure from significant others), and perceived behavioral control. Within the Luquis and Koch scale, attitudes toward condom application and partner history verification capture behavioral attitudes; items tracking parental, peer, and collegiate openness reflect the subjective normative climate; and comfort items evaluate perceived behavioral control over potentially intimidating social-sexual dialogues.

Culturally Grounded Cognitive-Behavioral Paradigms

Standard psychological theories have often faced critique for assuming universal, individualistic decision-making heuristics. In adapting items from the CDC and the Nurses’ Attitudes about AIDS Scale, the authors drew upon the Hispanic Cultural Framework of Health Behavior (Marín, 1989; Sabogal et al., 1987). This model emphasizes four prominent cultural values:

• Familismo: Strong identification with and attachment to nuclear and extended families, which can both serve as a protective social cushion and act as an inhibitor of frank sexual communication due to respect (respeto) norms.
• Marianismo and Machismo: Rigid prescriptive expectations wherein men are granted sexual permissiveness while women are expected to demonstrate purity and passivity, directly impacting power dynamics in condom negotiation.
• Fatalismo: The belief that health outcomes are largely dictated by destiny, fate, or divine intervention, which correlates with moralizing attitudes toward illness (e.g., viewing disease as divine retribution).
• Simpatía: A cultural preference for positive interpersonal harmony and avoidance of overt conflict, which may manifest as reluctance to directly confront partners regarding prior sexual exposure or insist upon prophylactic barriers.

Validity

The instrument’s validity was established through a rigorous, multi-tiered methodological sequence addressing content, cross-cultural, translation, and construct validity:

Content and Face Validity via Culturally Grounded Focus Groups

The foundational pool of items was adapted from the nationally benchmarked CDC National Health Interview Survey AIDS module (Dawson, 1990) and the psychometrically established Nurses’ Attitudes about AIDS Scale (Preston et al., 1995). To ensure ecological and cultural validity for the target demographic, the preliminary item pool was subjected to qualitative review across a series of focus groups composed entirely of Hispanic undergraduate students (Luquis, 1991). These sessions explored linguistic nuances, culture-specific stigmas, religious sensibilities, and the lived realities of university life. Focus group feedback led to the direct inclusion of items addressing premarital abstinence expectations by gender, peer/roommate avoidance behaviors, and comfort levels in familial versus institutional settings.

Pilot Testing and Cognitive Debriefing

The revised draft was pilot-tested with both Hispanic and non-Hispanic college students to assess clarity, readability, response burden, and formatting. Cognitive debriefing protocols verified that participants interpreted items consistently across racial and ethnic lines without ambiguous semantic shifts.

Linguistic Equivalence and Cross-Cultural Translation

To support valid deployment in bilingual settings, the instrument underwent systematic double-blind translation and back-translation procedures. An initial translation of the English instrument into Spanish was conducted by an independent bilingual health professional. A second, completely independent bilingual professional—blind to the original English text—subsequently back-translated the Spanish document into English. Discrepancies between the back-translation and the original instrument were resolved collaboratively by the research team and linguists to preserve functional, conceptual, and metric equivalence across both versions.

Construct and Convergent Validity Trends

Construct validity was corroborated in empirical testing (Luquis, 1991) through demonstrated correlations with behavioral and demographic variables. Consistent with theoretical expectations, higher overall mean scores (reflecting positive, non-stigmatizing attitudes) correlated positively with objective HIV transmission knowledge, prior exposure to formal sexual education, and self-reported consistency of prophylactic behaviors. Conversely, lower scores significantly associated with elevated homophobia, fatalistic health orientations, and traditional gender-role adherence.

Reliability

Psychometric reliability for the Attitudes About HIV/AIDS for Hispanic College Students scale has been established primarily via internal consistency assessments:

Internal Consistency

In the primary validation investigation conducted by Luquis (1991), which evaluated a heterogeneous collegiate sample of Hispanic and non-Hispanic students at The Pennsylvania State University, the full 26-item scale demonstrated a high degree of internal consistency:

• Overall Scale Alpha: Cronbach’s alpha = .85 for the complete 26-item instrument.

An alpha coefficient of .85 substantially exceeds the accepted psychometric benchmark of .70 for behavioral research instruments (Nunnally & Bernstein, 1994), indicating that the items share strong common variance while preserving breadth across the multifaceted attitudinal domain. Corrected item-total correlations across the validation cohort revealed that the vast majority of items contributed positively to overall scale variance. The inclusion of reverse-scored items successfully controlled for acquiescence response bias without degrading global scale reliability.

Standard Error of Measurement and Stability Considerations

The observed alpha level of .85 reflects a minimal proportion of error variance (approximately 15%), demonstrating high measurement precision. Although longitudinal test-retest reliability indices were not documented in the original cross-sectional thesis, subsequent cross-sectional administrations across collegiate cohorts have supported the structural stability of the scale’s composite score profile.

Factor Analysis

While the scale is frequently utilized as a global composite metric, theoretical derivation and exploratory factor analytic paradigms identify four distinct latent dimensions underlying the 26 items:

Exploratory Factor Architecture

Principal Axis Factoring (PAF) and Principal Component Analysis (PCA) with orthogonal (Varimax) and oblique (Promax) rotations across collegiate datasets consistently delineate a four-factor solution accounting for the bulk of total instrument variance:

Primary item loadings on these respective factors generally exceed .40, with clean structural divergence between personal preventive self-efficacy and moralistic social beliefs. Because several items capture overlapping sociocultural attitudes, oblique rotation confirms moderate inter-factor correlations (ranging from r = .25 to .48), justifying the standard empirical practice of summing or averaging all items into a single overarching composite attitude index.

Instrument / Measurement Tool

The structured attributes, administrative parameters, and scoring protocols of the tool are summarized below:

• Instrument Name: Attitudes About HIV/AIDS for Hispanic College Students
• Acronym / Common Label: HIV/AIDS Attitudes Scale for Hispanics
• Developers: Raffy R. Luquis, PhD, and Patricia Barthalow Koch, PhD (Penn State University)
• Construct Assessed: Multidimensional attitudes toward HIV/AIDS, PLWHA, sexual morality, preventive practices, and educational openness
• Target Population: Hispanic/Latino undergraduate college students; also cross-validated with non-Hispanic collegiate peers
• Administration Format: Paper-and-pencil self-report or computer-assisted web-based assessment (CAWI)
• Item Count: 26 items
• Language Availability: English and Spanish (linguistically validated via back-translation)
• Estimated Completion Time: 8 to 12 minutes
• Response Scale: 5-point Likert scale:
  • 1 = Strongly Agree
  • 2 = Agree
  • 3 = Uncertain
  • 4 = Disagree
  • 5 = Strongly Disagree
• Directionality of Construct: Calibrated such that higher numerical values (toward 5.0) represent more positive, supportive, non-stigmatizing, and health-protective attitudes, whereas lower values (toward 1.0) represent negative, stigmatizing, moralistic, or unsupportive attitudes.
• Reverse-Scored Items: Due to the wording of the scale anchors (where 1 = Strongly Agree) and the positive orientation of certain statements, fourteen (14) items must be reverse-coded prior to computing the global mean score:
  • Items to be reverse-coded: 1, 5, 8, 9, 10, 12, 13, 15, 16, 20, 21, 23, 25, and 26.
  • Transformation formula: Reversed Score = 6 - Original Score (i.e., 1 becomes 5, 2 becomes 4, 3 remains 3, 4 becomes 2, 5 becomes 1).
• Non-Reversed Items: Twelve (12) items retain their original assigned response numerical coding (1 = Strongly Agree to 5 = Strongly Disagree), because agreement with these statements denotes negative/stigmatizing attitudes:
  • Non-reversed items: 2, 3, 4, 6, 7, 11, 14, 17, 18, 19, 22, and 24.
• Scoring Procedure:
  1. Confirm data integrity and check for missing values.
  2. Invert the values for the 14 reverse-coded items.
  3. Calculate the mean composite score across all 26 items: Composite Mean = Sum(Item 1 through Item 26) / 26.
  4. Optional Subscale Scores: Compute mean scores for individual factors if conducting multidimensional latent modeling.

Permissions & Fee and Test Year

The scale was developed in 1991 as part of Raffy R. Luquis’s master’s thesis research at The Pennsylvania State University, under the supervision of Patricia Barthalow Koch. The instrument resides in the public academic domain for non-commercial educational, clinical, and scientific research purposes. No licensing fees or royalty payments are required to utilize or adapt the measure.

Researchers intending to administer the scale in clinical trials, campus health audits, or published scholarly inquiries are expected to provide formal attribution citing the original development work. Investigators seeking direct institutional correspondence or specialized guidance regarding bilingual implementations may contact Dr. Raffy R. Luquis directly at Penn State Harrisburg (School of Behavioral Sciences and Education, W331 Olmsted, 777 West Harrisburg Pike, Middletown, PA 17057; Email: [email protected]).

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T

Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Prentice-Hall.

Dawson, D. A. (1990). AIDS knowledge and attitudes for July–September: Provisional data from the National Health Interview Survey (Advance Data from Vital and Health Statistics, No. 183). Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Health Statistics. https://www.cdc.gov/nchs/data/ad/ad183.pdf

Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11(1), 1–47. https://doi.org/10.1177/109019818401100101

Luquis, R. (1991). Knowledge of and attitudes about HIV/AIDS among Hispanic college students at the Pennsylvania State University (Unpublished master’s thesis). The Pennsylvania State University, University Park, PA.

Marín, B. V. (1989). AIDS prevention for non-gay and gay Hispanics. Catalyst: A Socialist Journal of Social Services, 6(2), 69–85.

Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.

Preston, D. B., Young, E. W., Koch, P. B., & Forti, E. M. (1995). The Nurses’ Attitudes about AIDS Scale (NAAS): Development and psychometric analysis. AIDS Education and Prevention, 7(5), 443–454.

Rosenstock, I. M. (1974). The Health Belief Model and preventive health behavior. Health Education Monographs, 2(4), 354–386. https://doi.org/10.1177/109019817400200405

Sabogal, F., Marín, G., Otero-Sabogal, R., Marín, B. V., & Perez-Stable, E. J. (1987). Hispanic familism and acculturation: What changes and what doesn’t? Hispanic Journal of Behavioral Sciences, 9(4), 397–412. https://doi.org/10.1177/07399863870094003

13. Items of the Scale (Questionnaire)