Methods: Purposive sampling was used to recruit and draw a sample from 45 HIV/AIDS organizations that receive PEPFAR funding in South Africa. A diverse range of participants (n=502) was included in this study, representing each of South Africa's 9 provinces and 11 official language groups. Participants completed the South African HIV/AIDS Related Indigenous Values (HARIV) scale (28 items) without repeated measures. Principle Component Analysis (PCA) was used to determine the number of factors underlying the construct. Reliability was assessed using Cronbach's Alpha. Construct validity was established both at the item- and scale-level, based upon a series of hypotheses concerning variables expected to have low, moderate and high correlations with the subscales.
Results: Preliminary analyses were conducted to ensure the assumptions were met for the PCA, including KMO's measure of sampling adequacy, Bartlett's test of sphericity, an anti-image correlation matrix, and a correlation matrix to assess multicollinearity. 10 items were removed from the scale during validation procedures. The final PCA solution included 4 factors. Factor 1 (4 items) assessed the use of local spirituality in HIV programs (alpha =.83), factor 2 assessed the incorporation of community focused (rather than individualistic) HIV strategies (alpha =.80), factor 3 (4 items) assessed the HIV program's use of community decision making (alpha =.73), and factor 4 assessed the incorporation of women focused HIV programs (alpha =.84). Scale-level construct validity analyses indicated that each of the index's subscales had moderate to high correlations with program outcome variables such as the relative advantage of the program to the community, program ease of use, employee job satisfaction, and employee organizational commitment.
Conclusions: The HARIV scale represents an important way to assess the use of indigenous values in US foreign HIV programs. Assessment of these values represents an first step in identifying areas in need of further cultural adaptation, in identifying the impact these values have on prioritized outcomes, and in advocating for legislative change in US foreign policy. Future studies are recommended for the expansion of values included in the HARIV scale, and the validation of the scale across diverse African cultural groups. Obama's Global Health Initiative recently prioritized some of the HARIV values as important policy directions for US foreign efforts, indicating that future use of the scale to address other global health needs would be beneficial.
