The Factorial Structure, Reliability, and Validity of a Coping Measure Among Women with HIV and Sexual Trauma in Cape Town, South Africa

The dual epidemics of HIV and sexual violence against women complicate HIV care engagement in South Africa. In settings with limited mental health treatment, robust measures to enhance screening and intervention for mental health specific to people with HIV are needed. The current study developed a 42-item assessment for coping with HIV and trauma in isiXhosa. In a randomized controlled trial, 350 participants completed measures of coping, anxiety, traumatic stress, and depression at their baseline assessments. Participants were women with HIV residing in Khayelitsha, South Africa, initiating or re-initiating antiretroviral therapy (ART) and histories of sexual abuse and trauma symptoms. We performed exploratory factor analysis with oblique rotation using parallel analysis and calculated Cronbach's alpha for each coping factor to assess internal consistency. Finally, we evaluated convergent and discriminant validity among the subsequently identified factors and assessments of depression, traumatic stress, and anxiety. The parallel analysis suggested the retention of three factors: active, avoidant, and social/spiritual coping. The final measure included 39 items with an overall Cronbach's Alpha of 0.825. The factor structure demonstrated robust goodness of fit. Convergent validity was demonstrated through significant positive correlations between active and social/spiritual coping, and between avoidant coping and the depression, anxiety, and traumatic stress. Significant negative correlations of active and social/spiritual coping with depression, anxiety, and traumatic stress scores also supported the discriminant validity between subscales.We conclude that the Coping with HIV measure provides a strong and validated measure of coping for use in populations in South Africa living with HIV.Clinical Trial Number: NCT04793217.