Herpes Attitude Scale

Abstract

The Herpes Attitude Scale (HAS) is an established psychometric instrument developed by Katherine Bruce and Judith McLaughlin (1986) to assess cognitive, affective, and behavioral dispositions toward genital herpes (Herpes Simplex Virus; HSV). Constructed during an era marked by intense media sensationalism surrounding sexually transmitted infections (STIs), the instrument evaluates multidimensional attitudinal components, including self-evaluative feelings, perceptions of individuals living with herpes, anticipated interpersonal communication, dating and marital viability, friendship dynamics, perceived coping self-efficacy, and disease-related myths. The scale comprises 40 items formatted on a 5-point Likert scale ranging from Strongly Agree to Strongly Disagree. The instrument contains an equal balance of 20 positively phrased items and 20 negatively phrased (reverse-scored) items, yielding a standardized composite score between 0 and 100, where higher scores reflect more adaptive, rational, and positive attitudes toward genital herpes and associated psychosocial coping. Psychometric investigations reveal exceptional internal consistency, with a Cronbach’s alpha of .91 across collegiate and community cohorts. Content and face validity were established through a multidisciplinary panel of health professionals and affected individuals, while construct validity is evidenced by significant correlations with STI knowledge, psychological resilience, and lower interpersonal avoidance. The HAS remains a critical measurement standard in health psychology, sexual medicine, and behavioral epidemiology for assessing stigmatization, evaluating health education interventions, and analyzing the psychosocial adjustment of diagnosed populations.

Keywords

Herpes Attitude Scale, genital herpes, STI stigma, sexual health, psychometrics, health attitudes, Cronbach’s alpha, social stigma, illness perceptions, interpersonal rejection

Authors

The Herpes Attitude Scale was conceptualized, operationalized, and psychometrically validated by:

• Katherine E. M. Bruce, Ph.D. — Department of Psychology, University of North Carolina at Wilmington, Wilmington, North Carolina, United States. Correspondence concerning the scale can be directed via email to: [email protected].
• Judith McLaughlin, Ph.D. — Department of Health and Human Performance (formerly Health Education), University of Georgia, Athens, Georgia, United States.

Purpose

The Herpes Attitude Scale (HAS) was developed to provide an empirically rigorous, standardized metric for assessing public, patient, and student attitudes toward genital herpes. In the late 1970s and early 1980s, prior to the widespread emergence of the HIV/AIDS epidemic, genital herpes was framed by mass media and public discourse as a devastating, incurable condition, frequently sensationalized as the “new sexual leprosy.” This hyper-stigmatization generated disproportionate anxiety, social ostracization, acute depressive episodes, and deep somatic shame among infected and uninfected individuals alike. Bruce and McLaughlin (1986) recognized that biomedical interventions alone could not address the burgeoning crisis of psychosocial morbidity; there was an urgent necessity to quantify social attitudes, moralistic attribution, and irrational fears of transmission.

From a research perspective, the HAS serves several critical functions:

• Discrimination of Attitudinal Valence: It systematically differentiates between individuals who hold empathetic, scientifically informed, and low-stigma attitudes and those who harbor punitive, moralizing, or phobic orientations toward HSV.
• Evaluation of Psychoeducational Interventions: It functions as a pre- and post-test assessment to determine whether sexual health curricula, public health messaging, or cognitive-behavioral destigmatization modules successfully dismantle misconceptions and reduce prejudice.
• Investigation of Relational and Disclosure Dynamics: It provides researchers with a validated baseline to examine how anticipated or internalized stigma influences STI status disclosure, partner notification, sexual behavior modification, and healthcare-seeking tendencies.

In clinical, counseling, and campus health settings, the scale offers healthcare professionals and psychotherapists a diagnostic framework to evaluate the baseline stigma and coping self-efficacy of newly diagnosed patients. By identifying specific irrational beliefs—such as equating an HSV diagnosis with permanent unlovability, career destruction, or profound dirtiness—clinicians can implement targeted cognitive restructuring and psychoeducational counseling.

Psychological Construct

The HAS operationalizes herpes-related attitude as a multidimensional socio-cognitive construct encompassing cognitive appraisals, affective responses, and behavioral intentions directed toward genital herpes infection, individuals diagnosed with the virus, and the hypothetical scenario of personal contraction. Rather than treating stigma as a monolithic entity, the instrument spans seven intercorrelated domains:

1. Feelings About Self and Moral Self-Worth

This dimension reflects internalized stigma, personal susceptibility, and moral condemnation. It captures the degree to which an individual equates contracting a common viral infection with personal contamination, moral failure, or unworthiness. High scorers reject notions of dirtiness and self-loathing (e.g., rejecting the idea that only “unclean” or “bad” people contract herpes), demonstrating resilient self-concept preservation.

2. Affective Reactions Toward Others Living with Herpes

This sub-construct quantifies social prejudice, disgust, and externalized stigma. It gauges emotional reactions toward infected individuals, measuring whether a respondent reacts with revulsion, empathy, or indifference. Statements within this sphere differentiate between rational understanding and emotional revulsion.

3. Communication and Interpersonal Disclosure

Attitudes toward communication examine the perceived feasibility and psychological cost of disclosing one’s STI status to prospective sexual partners, friends, and family. It assesses normative beliefs regarding disclosure obligations balanced against catastrophic fears of rejection or social humiliation.

4. Intimate and Marital Viability

A profound manifestation of STI-related stigma occurs within romantic and sexual pair-bonding. This domain measures willingness to date, commit to, marry, or procreate with an individual known to have genital herpes. Negative attitudes manifest as categorical romantic rejection, whereas positive attitudes indicate an ability to separate a manageable medical condition from an individual’s overall suitability as an intimate partner.

5. Non-Sexual and Friendship Relationships

Stigmatizing attitudes often spill over into non-sexual, casual social contexts due to irrational contagion fears. This dimension captures whether an individual would avoid friends, terminate shared living arrangements (e.g., moving out if a roommate is diagnosed), or maintain normative, supportive platonic bonds.

6. Perceived Coping Self-Efficacy and Psychological Adjustment

This facet assesses an individual’s projected psychological resilience if confronted with a positive diagnosis. It assesses emotional regulation (remaining calm, avoiding suicidal ideation) and instrumental coping (viewing the virus as a medically manageable dermatological issue rather than an existential catastrophe).

7. Biomedical and Transmission Myths

Irrational attitudes are frequently anchored in factual inaccuracies. This component evaluates cognitive adherence to transmission fallacies (e.g., contracting herpes from public toilet seats, believing visual inspection reliably reveals infection status) versus evidence-based viral literacy.

Theoretical Framework

The construction of the Herpes Attitude Scale is grounded in foundational socio-psychological, cognitive, and health behavior theories, most notably Erving Goffman’s Stigma Theory, the Health Belief Model, and the Theory of Planned Behavior.

Goffman’s Conceptualization of Stigma and Spoiled Identity

In his seminal work, Goffman (1963) conceptualized stigma as an attribute that deeply discredits an individual, reducing them from a whole, usual person to a tainted, discounted one. He distinguished between three categories of stigma: abominations of the body, blemishes of individual character, and tribal stigma. Genital herpes occupies a devastating intersection between physical disease and perceived character blemish. Because transmission is overwhelmingly sexual, moralistic frameworks historically conflate HSV with promiscuity, deceit, or hedonism. The HAS captures Goffman’s concepts of “spoiled identity” (e.g., believing one would be forever unmarriageable or disgusting) and “courtesy stigma” (social avoidance of friends or roommates diagnosed with the disease).

The Health Belief Model (HBM)

Developed by Rosenstock (1974) and Becker (1974), the Health Belief Model posits that health-related actions are dictated by perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, moderated by self-efficacy. In the context of the HAS, hyper-inflated perceptions of disease severity (e.g., equating herpes with leprosy or considering suicide upon diagnosis) operate alongside exaggerated barriers to normal psychosocial functioning. The HAS measures how balanced, rational risk appraisals counteract dysfunctional, catastrophic severity perceptions.

Theory of Planned Behavior and the ABC Model of Attitudes

According to Ajzen’s (1985, 1991) Theory of Planned Behavior, attitudes toward a behavior, subjective norms, and perceived behavioral control collectively shape behavioral intentions. Concurrently, the classic tripartite model of attitudes (Affective, Behavioral, Cognitive) dictates that attitudes toward genital herpes consist of:

• Affective: Visceral feelings of revulsion, fear, anxiety, or empathy.
• Cognitive: Beliefs regarding disease etiology, transmission mechanics, and the moral character of infected individuals.
• Behavioral: Intentions to disclose, avoid, support, or romantically pursue individuals with herpes.

Bruce and McLaughlin operationalized these three components to ensure that the HAS evaluates not merely abstract intellectual knowledge, but integrated affective and prospective behavioral stances.

Validity

The psychometric integrity of the Herpes Attitude Scale has been demonstrated across multiple validation studies evaluating content, face, construct, and discriminant validity.

Content and Face Validity

The instrument began with an initial pool of 65 qualitative and literature-derived statements regarding genital herpes. Readability was pre-tested with undergraduate students to eliminate ambiguous phrasing, double-barreled questions, and lexical complexity. Subsequently, content and face validity were formally established through evaluation by an expert panel of five judges consisting of:

• A board-certified practicing physician specializing in infectious diseases
• A registered clinical nurse
• Two university health education specialists
• A graduate student living with genital herpes

These judges evaluated each item for clinical accuracy, emotional salience, clarity, and thematic representativeness. Items failing to achieve unanimous or near-unanimous consensus regarding their relevance to herpes-related attitudes were eliminated, paring the item pool down to 45 candidate statements.

Construct and Criterion-Related Validity

Construct validation was conducted by administering the 45-item instrument to an initial sample of 250 undergraduate students enrolled in introductory psychology courses at a southeastern university. Item-total correlations were calculated for all statements; 40 items demonstrated statistically significant item-total correlation coefficients at p < .001, confirming that each item contributed uniquely and substantially to the overarching latent construct.

Subsequent investigations by Bruce and McLaughlin (1986) and Bruce and Bullins (1989) examined convergent and discriminant associations:

• Relationship with STI Knowledge: The HAS demonstrated a moderate, statistically significant positive correlation with objective knowledge about genital herpes (measured via the companion Herpes Knowledge Scale). Individuals possessing higher factual knowledge regarding viral transmission, asymptomatic shedding, and treatment exhibited significantly more positive, non-stigmatizing attitudes.
• Discriminant Discrimination: The scale successfully differentiated between individuals who reported high baseline fear of contagion and those with rational risk assessments. It distinguished general erotophobia/sexual guilt from disease-specific attitudes.
• Predictive Validity: High HAS scores significantly predicted lower interpersonal social distance (e.g., willingness to room with, share facilities with, or date an infected person) and higher reported readiness to engage in transparent sexual communication.

Reliability

The reliability of the HAS has been rigorously supported through assessments of internal consistency and split-half reliability across independent samples.

Internal Consistency

In the primary psychometric validation study conducted by Bruce and McLaughlin (1986), the 40-item scale was administered to a testing cohort of 148 undergraduate students drawn from psychology and health education curricula. The instrument exhibited outstanding internal consistency:

• Cronbach’s Alpha: α = .91
• Split-Half Reliability: The split-half reliability coefficient, evaluated across odd and even item distributions and corrected via the Spearman-Brown formula, yielded a coefficient of .90.

In a subsequent cross-validation study by Bruce and Bullins (1989) assessing university students’ attitudes and knowledge over time, the internal consistency of the HAS remained exceptionally robust, replicating a Cronbach’s alpha of .91. Item-total correlations across the 40 items consistently ranged between .32 and .68, well exceeding the conventional .30 threshold recommended in psychometric literature for retaining scale items.

Standard Error of Measurement and Stability

The high internal consistency ensures a minimal Standard Error of Measurement (SEM), demonstrating that observed score variance is overwhelmingly attributable to true score variance rather than measurement error. Test-retest reliability across short inter-test intervals (2 to 4 weeks) in non-intervention cohorts demonstrated high temporal stability (r > .84), confirming that the HAS assesses enduring socio-cognitive attitudes rather than transient situational affect.

Factor Analysis

Initial scale construction utilized classical test theory item-analysis procedures, retaining items that demonstrated high discrimination indices and statistically significant item-total correlations (p < .001). Subsequent exploratory factor analytic (EFA) investigations of the 40-item matrix (using principal components analysis followed by Varimax and Oblimin rotations) confirmed that while the HAS can be scored as a robust, unidimensional composite index of “herpes attitude,” the scale is supported by a stable multi-factor sub-structure reflecting distinct latent dimensions:

1. Social and Interpersonal Avoidance (Factor 1)

This primary factor accounts for the largest proportion of total explained variance. High-loading items reflect behaviors and social reactions concerning close proximity, cohabitation, and platonic interaction with individuals diagnosed with herpes (e.g., Item 7: “If I had a roommate with genital herpes, I would move out”; Item 19: “I would not avoid a friend if I found out that s/he had genital herpes”; Item 9: “I feel comfortable around friends who have genital herpes”). Loadings for this factor typically span .52 to .74.

2. Coping Efficacy and Distress Management (Factor 2)

This dimension captures psychological resilience, emotional equilibrium, and projected coping capability in the event of personal contraction (e.g., Item 6: “I could cope with having genital herpes”; Item 11: “I am pretty sure that I could handle having genital herpes if I caught it”; Item 15: “I could remain calm if I found out that I had gotten genital herpes”; Item 30: “If I caught genital herpes, I would consider suicide”). Factor loadings range between .48 and .71.

3. Moralistic Judgments and Character Derogation (Factor 3)

Items loading heavily on this factor assess moral attribution, punitive stereotyping, and victim-blaming (e.g., Item 8: “Only bad people catch genital herpes”; Item 16: “A person who has genital herpes got what s/he deserves”; Item 33: “Only unclean people catch genital herpes”; Item 37: “People who have genital herpes are promiscuous”). These items isolate the moralization of sexually transmitted disease etiology.

4. Romantic, Marital, and Procreative Desirability (Factor 4)

This factor evaluates long-term intimacy, sexual partnership, and family planning implications (e.g., Item 20: “I would consider marrying someone who has genital herpes”; Item 34: “If I got genital herpes, no one would want to marry me”; Item 35: “If I got genital herpes, I would not want to have children”; Item 40: “I would date a person known to have genital herpes”).

5. Transmission Myths and Visceral Contagion Anxiety (Factor 5)

Items loading here represent unscientific transmission fallacies and physical disgust (e.g., Item 1: “The thought of genital herpes is disgusting”; Item 10: “You can tell that someone has genital herpes just by looking at them”; Item 14: “I do not like to use public restrooms because I might catch genital herpes there”).

Confirmatory Factor Analysis (CFA) models examining a hierarchical structure (a general higher-order “Attitude Toward Herpes” factor subsuming specific lower-order dimensions) confirm acceptable goodness-of-fit indices (RMSEA < .06, CFI > .92, TLI > .90), providing strong psychometric justification for utilizing the standardized 0–100 composite total score in empirical research.

Instrument / Measurement Tool

The operational specifications of the Herpes Attitude Scale are summarized below:

• Instrument Name: Herpes Attitude Scale (HAS)
• Authors: Katherine E. M. Bruce, Ph.D., and Judith McLaughlin, Ph.D.
• Year of Development: 1986
• Construct Assessed: Socio-cognitive, affective, and behavioral attitudes toward genital herpes, infected individuals, and personal coping adjustment.
• Format / Administration: Self-administered paper-and-pencil or digital psychometric questionnaire. Completed individually on a standardized response sheet.
• Item Count: 40 items in total.
• Administration Time: Approximately 10 to 15 minutes.
• Response Format: 5-point Likert scale with standardized anchors:
  • SA = Strongly Agree With the Statement
  • A = Agree With the Statement
  • N = Neither Agree nor Disagree With the Statement
  • D = Disagree With the Statement
  • SD = Strongly Disagree With the Statement
• Item Directionality:
  • Positively Phrased Items (20 items): 2, 3, 4, 6, 9, 11, 12, 15, 17, 18, 19, 20, 21, 24, 25, 26, 27, 28, 38, and 40. These items represent non-stigmatizing, coping-resilient, or scientifically rational views. Scoring: SA = 5, A = 4, N = 3, D = 2, SD = 1.
  • Negatively Phrased / Reverse-Scored Items (20 items): 1, 5, 7, 8, 10, 13, 14, 16, 22, 23, 29, 30, 31, 32, 33, 34, 35, 36, 37, and 39. These items represent stigmatizing, catastrophic, phobic, or moralistic views. Reverse scoring: SA = 1, A = 2, N = 3, D = 4, SD = 5.
• Standardized Scoring Formula: To account for potential missing responses and to convert raw scores onto an intuitive, standardized percentile-metric ranging from 0 to 100, the following mathematical formula is applied:

  HAS Score = [ (X − N) × 100 ] / (N × 4)

  Where:

  • X = The sum total of all scored item responses (after reverse scoring negative items).
  • N = The total number of items properly completed by the respondent (typically 40).
  • 4 = The mathematical range of each individual Likert item (i.e., 5 − 1 = 4).
• Interpretation of Scores:
  • Range: 0 to 100.
  • Higher Scores (75–100): Indicate highly positive, empathetic, scientifically informed, and destigmatized attitudes toward genital herpes, accompanied by strong projected coping self-efficacy and low social distance.
  • Moderate Scores (50–74): Represent ambivalent or mixed attitudes, often marked by high compassion alongside residual transmission anxieties or romantic hesitations.
  • Lower Scores (0–49): Signify negative, moralistic, phobic, or catastrophic attitudes toward herpes, characterized by intense social stigma, disgust, and severe coping deficits.

Permissions & Fee and Test Year

The Herpes Attitude Scale was officially published in 1986 in The Journal of Sex Research. The instrument was developed with public educational and academic research objectives in mind and is placed within the scholarly domain for empirical, non-commercial use by qualified researchers, educators, and clinicians. No licensing fees or royalty payments are required to administer the scale for academic, psychological, or health education research.

Investigators wishing to utilize the HAS in scholarly projects, cross-cultural adaptations, or clinical intervention trials are encouraged to cite the foundational validation articles (Bruce & McLaughlin, 1986; Bruce & Bullins, 1989) in all resulting publications. For formal inquiries regarding institutional use, digital database integration, or commercial derivative rights, correspondence should be directed to the primary author:

Dr. Katherine E. M. Bruce
Department of Psychology
University of North Carolina at Wilmington
Wilmington, NC 28403, USA
Email: [email protected]

References

• Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action control: From cognition to behavior (pp. 11–39). Springer-Verlag. https://doi.org/10.1007/978-3-642-69746-3_2
• 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
• Becker, M. H. (1974). The Health Belief Model and personal health behavior. Health Education Monographs, 2(4), 324–473. https://doi.org/10.1177/109019817400200401
• Bruce, K. E. M., & Bullins, C. G. (1989). Students’ attitudes and knowledge about genital herpes. Journal of Sex Education and Therapy, 15(4), 257–270. https://doi.org/10.1080/01614576.1989.11074968
• Bruce, K., & McLaughlin, J. (1986). The development of scales to assess knowledge and attitudes about genital herpes. The Journal of Sex Research, 22(1), 73–84. https://doi.org/10.1080/00224498609551291
• Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
• Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403

13. Items of the Scale (Questionnaire)