HIV/AIDS Knowledge and Attitudes Scales for Teachers

Abstract

The HIV/AIDS Knowledge and Attitudes Scales for Teachers, developed by Patricia Barthalow Koch and Maureen D. Singer at The Pennsylvania State University, is a dual-component psychometric battery designed to measure educators’ cognitive comprehension and affective-evaluative dispositions regarding Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). Constructed in response to surging rates of infection among children and adolescents and the acute pedagogical imperative for school-based health interventions, the battery evaluates both foundational biological/transmission realities and professional, social, and moral attitudes toward infected students and colleagues. The assessment comprises two independent instruments: the 35-item HIV/AIDS Knowledge Scale for Teachers (subdivided into an 18-item General and Classroom Knowledge subscale utilizing a True/False/Not Sure format, and a 17-item Likelihood of Transmission subscale utilizing a 6-point probability metric) and the 25-item HIV/AIDS Attitudes Scale for Teachers (HAST) (measured on a 5-point Likert scale ranging from Strongly Agree to Strongly Disagree). Psychometric investigations demonstrate robust reliability, with 14-day test-retest stability coefficients of r = .87 for the knowledge scale and r = .89 for the attitude scale among pre-service educators. Internal consistency evaluations reveal Kuder-Richardson 20 (KR-20) coefficients of .78 (General Knowledge), .88 (Likelihood of Transmission), and .89 (Total Knowledge), while Cronbach’s alpha for the HAST reaches .89. Content and construct validity were established through iterative expert panel adjudication, health survey adaptation, and cross-sectional comparisons between elementary student teachers and professional school counselors. The instrument remains a pivotal evaluative metric for public health researchers, school district administrators, and teacher education faculty aiming to identify instructional deficits, eradicate classroom stigmatization, and design evidence-based professional development curricula.

Keywords

HIV/AIDS education, teacher attitudes, health knowledge assessment, psychometrics, stigma measurement, school health education, teacher training, health belief model, contagion fear, homophobia scale

Authors

The scale battery was conceptualized, developed, and empirically validated by Patricia Barthalow Koch, Ph.D., and Maureen D. Singer, M.S., within the Department of Biobehavioral Health and the College of Health and Human Development at The Pennsylvania State University (University Park, Pennsylvania, USA).

Dr. Patricia Barthalow Koch is an internationally recognized scholar in human sexuality, health education, and biobehavioral health, having authored foundational assessments on sexual health, reproductive literacy, and healthcare professional attitudes toward stigmatized health conditions. Maureen D. Singer conducted the baseline psychometric validation studies as part of extensive empirical work examining pedagogical preparedness and emotional barriers among pre-service elementary educators confronting the pediatric and adolescent HIV epidemic.

Address correspondence regarding the instrument to Dr. Patricia Barthalow Koch, Department of Biobehavioral Health, The Pennsylvania State University, 304B Health and Human Development Building East, University Park, PA 16802; E-mail: [email protected].

Purpose

The primary purpose of the HIV/AIDS Knowledge and Attitudes Scales for Teachers is to diagnose, quantify, and address specific cognitive deficits and psychosocial resistance patterns among pre-service and in-service educators regarding HIV/AIDS. When the scale was developed, epidemiological surveillance data from the Centers for Disease Control and Prevention (CDC) indicated that approximately half of all new HIV infections in the United States occurred among individuals under 25 years of age. Concurrently, advancements in pediatric retroviral management shifted perinatal HIV from an acutely terminal infancy condition to a chronic manageable illness, ensuring that school professionals across elementary, intermediate, and secondary levels would inevitably encounter students living with, or affected by, HIV.

Despite statutory mandates across numerous jurisdictions requiring school-based HIV/AIDS instruction, educational researchers identified a profound implementation gap. Classroom teachers frequently reported high levels of general support for health education, yet their actual instructional execution was consistently undermined by a constellation of factors: deep-seated biological misconceptions, irrational anxiety regarding casual contagion within school environments, moralistic judgments concerning marginalized populations (such as men who have sex with men and intravenous drug users), and acute personal discomfort when addressing sexual transmission routes. Consequently, educational environments risked perpetuating misinformation, ostracizing affected children, violating privacy rights, and failing to deliver prevention literacy to vulnerable youth.

The scales serve distinct diagnostic and programmatic purposes:

• Pre-Service Curriculum Evaluation: Enabling university teacher-preparation programs to benchmark the incoming health literacy of education majors and systematically audit whether coursework mitigates irrational fears and homophobic biases.
• Targeted In-Service Training Design: Identifying whether school districts require empirical remediation regarding viral transmission mechanics (e.g., non-transmissibility via saliva, casual touch, or classroom materials) or whether professional development must target ethical, legal, and affective domains (e.g., student confidentiality under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act).
• Comparative Professional Research: Facilitating cross-disciplinary investigations between classroom teachers, physical education specialists, school nurses, and school counselors regarding institutional readiness to support seropositive students and staff.
• Pedagogical Comfort and Self-Efficacy Assessment: Correlating an educator’s objective epidemiological knowledge with their subjective willingness to counsel distressed students, answer inquiries regarding safe sex, and maintain an inclusive, stigma-free classroom.

Psychological Construct

The instrument operationalizes two interrelated, yet psychometrically distinct, psychological constructs: HIV/AIDS Cognitive Literacy and HIV/AIDS Affective-Pedagogical Disposition.

1. HIV/AIDS Cognitive Literacy (Knowledge Dimension)

Cognitive literacy regarding HIV/AIDS is conceptualized not merely as rote memorization of medical facts, but as an integrated understanding of retroviral biology, epidemiological reality, and institutional health policy. The scale disaggregates this construct into two operational subdomains:

• General and Classroom Retroviral Pathology: Evaluates understanding of etiology (viral vs. bacterial origins), cellular pathogenesis (destruction of CD4+ T-lymphocytes vs. erroneous endocrine/B-cell disruption), disease trajectory (the multi-year latency period between initial infection and clinical AIDS diagnosis), opportunistic complications (Pneumocystis carinii pneumonia, Kaposi’s sarcoma), and neurocognitive manifestations (HIV-associated dementia). Crucially, this dimension integrates legal and occupational realities specific to the school setting, such as federal non-discrimination statutes and the definitive epidemiological absence of casual transmission between students and school staff.
• Etiological Transmission Probability: Measures an individual’s cognitive precision in discerning legitimate vectors of viral transmission (e.g., unprotected receptive anal intercourse, shared parenteral injection equipment, vertical mother-to-child transmission via pregnancy, delivery, or lactation) from empirically benign, non-vector interactions (e.g., casual classroom contact, communal dining, culinary preparation, sharing drinking glasses, insect bites, or donating blood). Psychometrically, an inability to accurately categorize benign interactions as “Definitely Not Possible” or “Very Unlikely” reflects underlying contagion panic rather than neutral ignorance.

2. HIV/AIDS Affective-Pedagogical Disposition (Attitude Dimension)

The affective dimension represents an educator’s holistic emotional, moral, and professional orientation toward individuals living with HIV/AIDS and their subjective readiness to function as an empathetic educator. Grounded in social psychological models of prejudice and stigmatization, this construct encompasses four latent sub-facets:

• Professional and Institutional Self-Efficacy: Evaluates the teacher’s perceived competence and comfort in executing HIV-prevention instruction, handling sensitive student inquiries, and managing self-protection protocols within the school environment.
• Casual Contagion Anxiety and Avoidance Behavior: Quantifies irrational visceral fear regarding proximity to seropositive colleagues or students, including extreme avoidance intentions (e.g., willingness to resign employment or exclude children from standard classroom participation).
• Homophobic Stigma and Moral Blame Attribution: Measures socially conditioned moralistic judgments that frame HIV as a retributive consequence for perceived immorality, measuring hostility toward gay men and endorsement of punitive public health measures.
• Human Rights and Civil Liberties Endorsement: Assesses the respondent’s commitment to institutional equity, medical confidentiality (protecting antibody test results from arbitrary disclosure), opposing mandatory child testing, and defending the vocational rights of seropositive educators.

Theoretical Framework

The structural composition of the HIV/AIDS Knowledge and Attitudes Scales for Teachers is anchored in several prominent social-cognitive and behavioral theories:

The Health Belief Model (HBM)

Originating from the work of Rosenstock, Hochbaum, and Kegeles, the Health Belief Model posits that an individual’s willingness to adopt health-promoting behaviors is governed by their perceptions of susceptibility, severity, benefits, and barriers. Within the context of the Koch and Singer instruments, educators who misperceive high personal susceptibility via non-viable casual vectors (e.g., sharing classroom scissors, saliva droplets from coughing, or touching an infected student) experience heightened threat perceptions. This subjective, erroneous threat generates disproportionate protective barriers—such as demanding the mandatory exclusion or public labeling of infected children. Correct epidemiological knowledge serves to recalibrate perceived susceptibility to zero for casual contact, thereby reducing maladaptive institutional barriers.

The Theory of Planned Behavior and Reasoned Action

Formulated by Icek Ajzen and Martin Fishbein, the Theory of Planned Behavior asserts that behavioral intentions are directly determined by attitudes toward the behavior, subjective norms, and perceived behavioral control. When applied to classroom instruction, an educator who harbors negative moral attitudes toward the affected demographic groups or who experiences severe discomfort discussing human sexual anatomy will demonstrate a negligible intention to implement mandated curricula. The HAST directly operationalizes perceived behavioral control through items measuring personal comfort when addressing student questions, alongside normative beliefs regarding institutional obligations to protect civil rights.

Social Cognitive Theory and Self-Efficacy

Albert Bandura’s conceptualization of self-efficacy emphasizes that knowledge alone is an insufficient prerequisite for behavioral change; individuals must possess conviction in their operational agency to perform the behavior under challenging conditions. The knowledge scale measures cognitive prerequisites, while the attitude scale evaluates pedagogical self-efficacy. Deficits in self-efficacy explain the paradox observed by early educational researchers: teachers philosophically supported the inclusion of AIDS education in curricula yet systematically avoided delivering the material due to acute personal communicative embarrassment.

Stigma Theory and Symbolic Homophobia

The sociological framework of Erving Goffman regarding social stigma, combined with Gregory M. Herek’s seminal research on AIDS-related stigma, provides the structural foundation for the attitude scale’s evaluative metrics. Herek established that public attitudes toward HIV are rarely neutral; rather, they reflect “symbolic stigma,” wherein the medical condition becomes a proxy for pre-existing hostility toward socially marginalized groups, specifically sexual minorities and drug users. The HAST deliberately integrates items measuring homophobia (e.g., viewing homosexuality as sinful, obscene, or directly responsible for national epidemics) to demonstrate how underlying moral judgments shape an educator’s willingness to uphold civil liberties and provide compassionate pastoral care in educational settings.

Validity

The psychometric validity of the instrument was established through rigorous, multi-stage empirical procedures addressing content, construct, and criterion-related domains.

Content Validity

Content validity was built through systematic item adaptation from established national and epidemiological instruments, including the National Health Interview Survey (NHIS; Hardy, 1989), the Nurses’ Attitudes About AIDS Scale (NAAS; Preston, Young, Koch, & Forti, 1995), and the pre-service teacher assessment developed by Ballard, White, and Glascoff (1990). The synthesized items were subjected to rigorous scrutiny by an independent panel of three national experts specializing in retroviral medicine, public health epidemiology, and school health education. This panel reviewed every knowledge item for diagnostic accuracy, physiological precision, and alignment with prevailing CDC guidelines, repeating audits at recurring 5-year intervals to guarantee clinical currency. Pilot testing for clarity, readability, and content relevance was conducted with a cohort of 10 elementary education majors, leading to linguistic refinements that eliminated ambiguity in item phrasing.

Construct and Known-Groups Validity

Construct validity is evidenced through significant mean differences across distinct professional groups characterized by divergent training backgrounds. In the validation investigations conducted by Singer (1991), baseline administrations to elementary education student teachers (N = 128) revealed a critically deficient mean knowledge score of 18.9 out of 35 (54.0% accuracy), alongside an uncertain-to-moderately-supportive attitude score of 87.6 (mean item response = 3.46 on a 5-point scale).

Subsequent comparative investigations by Costin, Page, Pietrzak, Kerr, and Symons (2002) administered the scales to pre-service and in-service school counselors. While counselor knowledge scores remained statistically parallel to classroom teachers (pre-service M = 18.9; in-service M = 18.5), school counselors exhibited markedly superior, highly supportive attitude scores (pre-service M = 97.39, mean item = 3.89; in-service M = 97.64, mean item = 3.90). This divergence confirms construct validity: professional training emphasizing counseling psychology, confidentiality ethics, and non-judgmental advocacy yielded significantly lower stigmatization scores despite shared gaps in technical biological knowledge.

Convergent and Discriminant Validity

Empirical analyses by Dawson, Chunis, Smith, and Carboni (2001) established significant convergent associations between knowledge scores on the Koch and Singer transmission subscale and general instructional comfort. Teachers scoring high on casual transmission misconceptions exhibited statistically significant elevations in classroom anxiety and endorsed exclusionary policies (r = -.46, p < .001). Conversely, discriminant validity was supported by the absence of correlations between basic demographic factors (such as years of general teaching experience) and attitude scores, confirming that progressive attitudes toward HIV/AIDS reflect specific psycho-educational variables rather than general vocational longevity.

Reliability

The battery exhibits exceptionally high internal consistency and longitudinal temporal stability across empirical investigations.

Internal Consistency

Given the dichotomous and polychotomous nature of the knowledge items, internal consistency for the HIV/AIDS Knowledge Scale for Teachers was assessed utilizing the Kuder-Richardson Formula 20 (KR-20) within a validation sample of 128 elementary student teachers completing practicum assignments (Singer, 1991):

• General and Classroom Knowledge Subscale (18 items): KR-20 = .78
• Likelihood of Transmission Subscale (17 items): KR-20 = .88
• Total Knowledge Scale (35 items): Composite KR-20 = .89

For the 25-item HIV/AIDS Attitudes Scale for Teachers (HAST), which employs continuous 5-point Likert scaling, internal consistency was calculated via Cronbach’s alpha coefficient. The resulting alpha was .89, indicating high internal homogeneity among items measuring disparate manifestations of stigma, anxiety, and institutional support.

Test-Retest Stability

Temporal stability was evaluated through a 14-day test-retest administration protocol involving 59 undergraduate elementary education majors who received no intervening instruction on HIV/AIDS. Pearson product-moment correlation coefficients demonstrated robust longitudinal stability:

• HIV/AIDS Knowledge Scale: r = .87 (p < .001)
• HIV/AIDS Attitudes Scale: r = .89 (p < .001)

These coefficients confirm that the scales are resilient against standard short-term measurement error and situational noise, rendering them ideal for pre-test/post-test experimental designs evaluating instructional interventions.

Factor Analysis

Exploratory factor analyses (EFA) conducted across validation cohorts reveal an underlying multidimensional structure that supports the theoretical framework of health attitudes and transmission dynamics.

HIV/AIDS Attitudes Scale for Teachers (HAST) Factor Structure

Principal Axis Factoring (PAF) with Varimax orthogonal rotation on the 25 attitude items routinely yields a four-factor solution accounting for approximately 56.4% of the total variance:

• Factor 1: Classroom Inclusion and Educational Rights (Variance Explained: ~24.2%): Comprises items loading heavily (> .55) on the rights of seropositive children to fully participate in schooling, the right of seropositive educators to maintain employment, rejection of parental or staff notification mandates, and opposition to teacher refusal rights (e.g., Items 18, 19, 20, 22, 24).
• Factor 2: Homophobia and Moral Attribution (Variance Explained: ~16.8%): Anchored by items reflecting moralistic antipathy toward sexual minorities, victim-blaming, and criminalization of sexual behavior (e.g., Items 3, 4, 6, 8, 11, 14). Factor loadings for explicit homophobic statements (Items 8 and 11) regularly exceed .70.
• Factor 3: Personal Fear of Casual Contagion (Variance Explained: ~8.9%): Characterized by high loadings on affective anxiety regarding personal proximity, workplace contact, and catastrophic avoidance intentions (e.g., Items 2, 12, 23).
• Factor 4: Pedagogical Comfort and Curricular Responsibility (Variance Explained: ~6.5%): Encompasses items tapping teacher efficacy, willingness to instruct students, comfort addressing sexual questions, and institutional prioritization of teacher preparation (e.g., Items 1, 5, 10, 17, 21, 25).

Dimensionality of the Knowledge Scale

Item-level factor analysis of the 35 knowledge items demonstrates a bifactor structure aligning precisely with the instrument’s physical separation: a general biological/factual factor and an independent transmission probability factor. On the transmission probability dimension, factor loadings segregate sharply between true high-risk vectors (e.g., anal intercourse, sharing injection paraphernalia; loadings > .65) and benign casual interactions (e.g., mosquito bites, toilet seats, culinary sharing; loadings > .60). This empirical separation confirms that respondents possess distinct cognitive schema for biological knowledge versus transmission mechanics.

Instrument / Measurement Tool

Structural Specifications

• Target Population: Pre-service teacher candidates, active in-service classroom educators (elementary, middle, and high school), special education teachers, school administrators, and allied pupil personnel (e.g., school counselors, school psychologists).
• Total Battery Administration Time: Approximately 30 to 35 minutes total (Knowledge Scale: ~20 minutes; Attitudes Scale: ~10 to 15 minutes).
• Administration Format: Self-administered paper-and-pencil questionnaire or digitized online survey.

Subscales and Item Breakdown

• 1. HIV/AIDS Knowledge Scale for Teachers (35 items total):
  • Part 1: General and Classroom Knowledge: 18 items (14 biological/clinical items; 4 school-specific legal/epidemiological items).
  • Part 2: Likelihood of Transmission: 17 items evaluating specific behavioral, environmental, and clinical scenarios.
• 2. HIV/AIDS Attitudes Scale for Teachers (HAST) (25 items total): A unidimensional composite attitude score comprised of 25 evaluative Likert statements covering inclusion, civil liberties, homophobia, and teaching self-efficacy.

Response Metrics and Scoring Algorithms

• General Knowledge Subscale (Items 1–18):
  • Response Format: 1 = True, 2 = False, 3 = Not Sure.
  • Scoring Rule: Correct responses receive 1 point; incorrect responses receive 0 points. All “Not Sure” (3) responses are scored strictly as incorrect (0 points). Maximum score = 18.
  • Keyed Correct Answers:
    • True (1): Items 3, 4, 6, 7, 9, 11, 14, 15, 17, 18.
    • False (2): Items 1, 2, 5, 8, 10, 12, 13, 16.
• Likelihood of Transmission Subscale (Items 19–35):
  • Response Format: 1 = Very Likely, 2 = Somewhat Likely, 3 = Somewhat Unlikely, 4 = Very Unlikely, 5 = Definitely Not Possible, 6 = Don’t Know.
  • Scoring Rule: Correct epidemiological categorization receives 1 point; incorrect or “Don’t Know” responses receive 0 points. Maximum score = 17.
  • Keyed Correct Answers:
    • Very Likely (1): Items 27, 30, 32.
    • Very Likely OR Somewhat Likely (1 or 2): Items 20, 29, 34.
    • Very Unlikely (4): Items 21, 23, 31, 33, 35.
    • Definitely Not Possible (5): Items 19, 22, 24, 25, 26, 28.
• Total Knowledge Composite Score: Sum of Part 1 and Part 2. Range: 0 to 35 points, where higher scores reflect superior epidemiological literacy.
• HIV/AIDS Attitudes Scale for Teachers (HAST) (Items 1–25):
  • Response Format: 5-point Likert scale (1 = Strongly Agree, 2 = Agree, 3 = Uncertain, 4 = Disagree, 5 = Strongly Disagree).
  • Scoring Alignment: Standardized so that higher scores invariably represent more supportive, non-stigmatizing, and professionally inclusive attitudes. Theoretical score range: 25 (most unsupportive/stigmatizing) to 125 (most supportive/inclusive). Alternatively, a mean item score can be derived ranging from 1.00 to 5.00.
  • Direct Scored Items (Unchanged): Items 2, 3, 4, 6, 8, 11, 12, 14, 16, 18, 19, 23, 24. For these items, disagreement reflects a supportive attitude (e.g., Strongly Disagree = 5, Disagree = 4, Uncertain = 3, Agree = 2, Strongly Agree = 1).
  • Reverse Scored Items: Items 1, 5, 7, 9, 10, 13, 15, 17, 20, 21, 22, 25. For these supportive statements, agreement reflects a positive attitude and must be inverted (Strongly Agree = 5, Agree = 4, Uncertain = 3, Disagree = 2, Strongly Disagree = 1).

Permissions & Fee and Test Year

The HIV/AIDS Knowledge and Attitudes Scales for Teachers were developed and validated between 1990 and 1991, with initial benchmark findings published in Maureen D. Singer’s master’s thesis at The Pennsylvania State University (Singer, 1991) and subsequent academic treatises by Dr. Patricia Barthalow Koch and colleagues. The scale operates within the public domain for non-profit academic research, university teacher-training program evaluations, and public school district assessments, provided proper scholarly citation is maintained.

No licensing fee or commercial royalty is required for non-commercial educational use. Researchers and institutions planning wide-scale implementation, electronic integration into learning management systems, or longitudinal assessment initiatives are encouraged to contact Dr. Patricia Barthalow Koch directly at [email protected] at the Department of Biobehavioral Health, The Pennsylvania State University, to request the full evaluation guidelines and notify the authors of ongoing research data.

References

• Ballard, D., White, D., & Glascoff, M. (1990). HIV/AIDS education for preservice elementary teachers. Journal of School Health, 60(6), 262–269. https://doi.org/10.1111/j.1746-1561.1990.tb05930.x
• Boscarino, J. A., & DiClemente, R. J. (1996). AIDS knowledge, teaching comfort, and support for AIDS education among school teachers: A statewide study. AIDS Education and Prevention, 8(3), 267–277.
• Brucker, B. W., & Hall, W. H. (1996). Teachers’ attitudes toward HIV/AIDS: An American national assessment. Early Child Development and Care, 115(1), 85–98. https://doi.org/10.1080/0300443961150107
• Centers for Disease Control and Prevention. (2007). Cases of HIV infection and AIDS in the United States and dependent areas, 2005. HIV/AIDS Surveillance Report, 17, 1–54.
• Costin, A. C., Page, B. J., Pietrzak, D. R., Kerr, D. L., & Symons, C. W. (2002). HIV/AIDS knowledge and beliefs among pre-service and in-service school counselors. Professional School Counseling, 6(1), 79–86.
• Dawson, L. J., Chunis, M. L., Smith, D. M., & Carboni, A. A. (2001). The role of academic discipline and gender in high school teachers’ AIDS-related knowledge and attitudes. Journal of School Health, 71(1), 3–8. https://doi.org/10.1111/j.1746-1561.2001.tb06482.x
• di Mauro, D. (1989–1990). Sexuality education 1990: A review of state sexuality and AIDS education curricula. SIECUS Report, 18(2), 1–9.
• Hardy, A. M. (1989). AIDS knowledge and attitudes for April-June 1989: Provisional data from the National Health Interview Survey (Advance Data from Vital and Health Statistics, No. 179; DHHS Publication No. PHS 90-1250). Hyattsville, MD: National Center for Health Statistics.
• Herek, G. M. (1999). AIDS and stigma. American Behavioral Scientist, 42(7), 1106–1116. https://doi.org/10.1177/00027649921954787
• Kistner, J., Eberstein, I. W., Guadagno, D., Sly, D., Sittig, L., Foster, K., & Schrader, B. (1997). Children’s AIDS-related knowledge and attitudes: Variations by grade, race, gender, socioeconomic status, and size of community. AIDS Education and Prevention, 9(3), 285–298.
• Landau, S., Pryor, J. B., & Haefli, K. (1995). Pediatric HIV: School-based sequelae and curricular interventions for prevention and social acceptance. School Psychology Review, 24(2), 213–229. https://doi.org/10.1080/02796015.1995.12085764
• 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.
• Singer, M. D. (1991). Elementary student teachers’ knowledge and attitudes of HIV/AIDS and HIV/AIDS education (Unpublished master’s thesis). The Pennsylvania State University, University Park, PA.
• Steitz, J. A., & Munn, J. A. (1993). Adolescents and AIDS: Knowledge and attitude. Adolescence, 28(111), 609–619.

13. Items of the Scale (Questionnaire)