URJHS Volume 7

URC

Layers of HIV Stigma: The Influence of High-risk Characteristics on Perceptions

Kerry A. Newness and Lenore Szuchman*
Barry University
Maria R. Lopez*
University of Miami


Abstract

The purpose of the current study was to examine perceptions of single high-risk HIV characteristics and the layering of these characteristics. Participants were 97 (55 women and 42 men, mean age = 21.31, SD = 2.21) undergraduates from Barry University. Vignettes were developed to assess the layering of one (i.e., HIV-positive, gay, and intravenous drug user), two (i.e., HIV-positive/gay, HIV-positive/IV drug user, and gay/IV drug user), and all three high-risk characteristics. After reading vignettes, participants rated items including the likeliness that the target would be verbally or physically assaulted, how well they could cope with their life situation, and how society would accept them. Within-subjects multivariate analysis of variance results suggested that, for many vignette questions, participants’ perceptions of multiple high-risk characteristics were significantly more negative than for single high-risk characteristics, with IV users especially stigmatized in several instances.
Introduction

The life expectancy and physical well-being of individuals living with the Human Immunodeficiency Virus (HIV) has increased in the U.S. as a result of the readily available and more effective antiviral medications (Domek, 2006). The U.S. Department of Disease Control and Prevention (CDC, 2006) estimated that there were between 1 and 1.2 million people living with HIV/AIDS in the U.S. in 2003, with an approximate increase of 40,000 individuals each year. Mental health researchers have examined the importance of self-esteem on physical well-being, the relationship between self-efficacy and adherence to antiviral drugs, the social support of family members and friends, and the perceptions of individuals toward people living with HIV/AIDS (O’Cleirigh, et al., 2003; Simoni, Frick, & Huang, 2006). In addition, the social stigma experienced by these individuals remains an important research question.

The generally accepted definition of stigma proposed by Erving Goffman (1963) is that an individual experiences stigma when he or she exhibits a physical “mark” that causes his or her identity to become “spoiled.” According to the dual-process model for perceived stigma, a stigma reaction can manifest itself in both negative (e.g., avoidance or discrimination) and positive ways (e.g., kindness and sympathy), but research suggests that stigma reactions are predominately negative toward undesirable deviations such as HIV/AIDS (Pryor, Reeder, Yeadon, & Hesson-McInnis, 2004; Weiner, Perry, & Magunusson, 1988). For these reasons, the psychosocial research surrounding the origins and manifestations of stigma may be complex and yield much variation.

People living with HIV/AIDS may experience attributional biases and moral judgments because the general population may perceive the methods for contracting the virus in a negative light. Some of the assumptions that yield stigmatization toward individuals living with HIV/AIDS are sexual promiscuity, marital infidelity, or intravenous drug use (Swendeman, Rotheram-Borus, Comulada, Weiss, & Ramos, 2006). Assumptions that seropositive individuals contracted the virus through irresponsible behavior have, consequently, developed into the stereotypes people living with HIV/AIDS experience today. Unfortunately, research on the methods of HIV contraction has not adequately addressed the implications and severity of discrimination toward seropositive individuals who have many high-risk characteristics or engage in multiple high-risk behaviors. Research on the predictors of HIV-related stigma has addressed the significance of these layers of stigma associated with multiple high-risk behaviors (Swendeman et al., 2006).

With regard to the HIV/AIDS populations, stigma research has generally been conducted on high-risk individuals (e.g., intravenous drug users, gay men, or people perceived as sexually deviant). Besides experiencing social stigma simply for their seropositive status, individuals living with HIV/AIDS may be discriminated against because of race, ethnicity, or economic status. Most HIV-positive individuals experience a degree of stigmatization because of their illness, but studies have shown that those individuals who exhibit characteristics of high-risk behavior may experience a greater amount or severity (Swendeman et al., 2006). It has been documented that seropositive people have been denied job opportunities, deprived of housing contracts, prevented from attending colleges and universities, and have had medical treatment withheld (Yang, Li, Stanton, Fang, Lin, & Naar-King, 2006). People living with HIV/AIDS may additionally experience others’ avoidance when people refuse to stay with them, eat with them, or show affection towards them (Swendeman et al., 2006). Men and women may exhibit this avoidance differentially.

Homosexuality and HIV-related Stigma

With some of the first seropositive individuals being gay men, contraction of the virus within the gay community gave the remaining population a scapegoat (Altman, 1986), which may have been an implicit reaction because of fear. Homosexual orientation, as a result, has been considered a high-risk characteristic. A major factor that influences a person’s reaction toward a group of individuals, such as gay men, is his or her values and morals (Hergovich, Ratky, & Stollreiter, 2003). In a study of homosexual orientation as a high-risk characteristic, Hergovich et al. (2003) assessed perceptions of non-positive individuals toward both heterosexual and homosexual seropositive persons. Although results apparently suggest that moral character influences judgments of the target character, numerous factors involved in the decision-making process may have also contributed to the negative perceptions of homosexual orientation. In addition to greater stigmatization judgments from non-seropositive persons, there is a division within the homosexual community (Courtenay-Quirk, Wolitski, Paresons, Gomez, & Seropositive Urban Man’s Study Team, 2006). The qualitative analysis of interviews conducted in that research suggests that seropositive individuals living in urban areas experience a sense of division and stigma.

The general population’s perceptions of seropositive individuals are typically influenced by characteristics attributed to that individual. One characteristic in particular, homosexual orientation, has been associated with negative and irresponsible behavior. In a study of undergraduate students from a midwestern university, perceptions of high and low-risk onset of the HIV virus were examined through the use of vignettes (Seacat, Hirschman, & Mickelson, 2007). When portrayed as a homosexual male who had contracted the disease through sexual intercourse, participants attributed more responsibility to the target’s behavior. Homosexual orientation was examined as a high-risk characteristic in the current study because of its historical association with experienced HIV-related stigma.

Intravenous Drugs and HIV-related Stigma

Intravenous (IV) drug users who share needles are also a high-risk population for contracting the HIV virus and may experience discrimination regardless of positive serostatus. In a survey of 363 non-drug users, 71 percent responded that they “strongly dislike” heavy drug users (Mateu-Gelabert, Maslow, Flom, Sandoval, Bolyard, & Friedman, 2005). As with the perceptions of homosexuality, the general population in the U.S. regards intravenous drug users as immoral and attributes users’ misfortunes to this deviant behavior (Crandall, 1991). Furthermore, IV-drug users realize this stigmatization and make attempts to conceal the physical characteristics of their injections by puncturing the skin in unnoticeable areas, covering track marks with clothing, and not using drugs within close proximity of their residences (Mateu-Gelabert et al., 2005). Besides the general stigma they experience because of their maladaptive behavior, seropositive IV-drug users are considered to be less “favorable” or “warm” than HIV individuals without a history of drug use and seropositive homosexuals; also, non-drug users’ attitudes toward illegal drug users include ideas of disgust, fear, and anger (Capitaio & Herek, 1999).

Because intravenous drug use is negatively sanctioned in the U. S., and it is considered one of the high-risk behaviors for contraction of the HIV virus, one would expect the general population to have somewhat negative attitudes toward IV-drug users. In fact, Capitanio et al. (1999) found by means of a phone survey that Black and White respondents reported more negative perceptions of IV-drug users than HIV-positive persons and homosexuals. Because perceptions of IV-drug users were significantly more negative than HIV-positive persons, it seems that the stigma experienced is derived from negative reactions toward illegal behavior rather than the stigma of illness. In a quantitative and qualitative analysis of urban drug users and non-drug users, Mateu-Gelabert et al. (2005) reported that the majority of people, including users themselves, have negative judgments toward intravenous use. The current study examined IV-drug use as a high-risk characteristic to determine whether an HIV-positive individual may experience a greater amount of stigmatization as a result of the combination of IV-drug use and seropositive status.

High-risk populations may experience stigma on many levels, but almost all seropositive persons report some form of discrimination or avoidance socially. Therefore, the layers of stigmatization that seropositive individuals with high-risk characteristics suffer from require further attention from researchers. To assess the relationship between high-risk behavior and stigmatization of individuals, hypothetical situations were developed to isolate these high-risk characteristics. Taking into consideration the limitations of previous studies regarding perception of seropositive individuals, the current study was designed to examine high-risk characteristics independent of positive serostatus, high-risk characteristics in addition to positive serostatus, and the layering of high-risk characteristics.

It was hypothesized that perceptions of an individual with two high-risk HIV characteristics would be significantly more negative than perceptions of an individual with a single high-risk HIV characteristic, and that the layering of three high-risk HIV characteristics would be significantly more negative than perception of an individual with two high-risk HIV characteristics.

Method

Participants

Ninety-seven undergraduate students from Barry University (42 men and 55 women, mean age = 21.31, SD = 2.21 years) volunteered to participate. Participants identified themselves ethnically as Caucasian/White Non-Hispanic (17.5%), African American/Black (20.6%), Hispanic (17.5%), Afro-Caribbean (14.4%), Asian (3.1%), and other (9.3%). The majority of participants (66%) did not know anyone with HIV, and the minority (33%) knew a friend, family member, or acquaintance with HIV. Participants also reported their political affiliation as Republican (11.3%), Democrat (41.2%), Independent (15.5%), and other (32%).

Materials

Vignettes. Seven vignettes of approximately 70 words in length were developed describing a male character as a Scrabble player involved in a current relationship. Characteristics of the protagonist were manipulated in each vignette based on three independent variables: HIV status, sexual orientation, and IV drug use. Vignettes were designed to assess the layering of one (i.e., HIV-positive, gay, and IV-drug user), two (i.e., HIV-positive/gay, HIV-positive/IV-drug user, and gay/IV-drug user), and all three high-risk characteristics. The independent variables of HIV status and IV-drug use were incorporated into the vignettes in an explicit manner; for example, “His results came back positive and he has been on medication since that time,” and “John occasionally does intravenous drugs with his other friends.” However, the manipulation of sexual orientation as an independent variable was not explicitly stated; rather, sexual orientation was implied through the gender of the target’s partner (John and his girlfriend, Abby, or John and his boyfriend, Charles).

Perception questions. Vignette questions were developed to examine participants’ perceptions of the target in the seven scenarios. Ratings were quantified using a 5-Point Likert-type scale for each individual question: responsibility attributed to the target for his major life events (1 = Very Irresponsible, 5 = Very Responsible), the likeliness that the target would be verbally assaulted or attacked, the likeliness that the target would be physically assaulted (1 = Very Unlikely, 5 = Very Likely), how well the target could cope with his life situation (1 = Not at All, 5 = Very Well), how society would accept the target (1 = Very Unaccepted, 5 = Very Accepted), and how likely the target would be to be in trouble with the law (1 = Very Unlikely, 5 = Very Likely).

Stigma scale. Negative feelings toward people living with HIV were measured by scores on the HIV Stigma and Belief Survey (Herek & Capitanio, 1993). The HIV Stigma and Belief Survey was modified for the purposes of this study in that originally the survey was administered orally, but here it was written, and only four of the five subscales were administered because the fifth (avoidant behaviors) did not lend itself to the Likert format used here. Reliability of the scales was satisfactory with the current sample. The negative feeling subscale measured fear, anger, and disgust on a 4-point Likert scale, with lower ratings indicating more negative feelings (Cronbach's alpha = .69). The support for coercive policies subscale included statements regarding hypothetical public policy (e.g., people with AIDS should be legally separated from others to protect the public health) and responsibility (e.g., people who got AIDS through sex or drug use have gotten what they deserve); a 4-point Likert scale was used with low ratings indicating greater support for coercive policies (Cronbach's alpha = .60). Using a 5-point Likert scale (1 = Very Likely, 5 = Impossible), the casual contact subscale assessed participants’ beliefs regarding the methods of transmission (e.g., kiss on the cheek, sharing a drinking glass, or being bitten by a mosquito or other insect; Cronbach's alpha = .86). Finally, the risk group belief subscale included statements about protected and unprotected homosexual intercourse and intravenous drug users who do not share needles (Cronbach's alpha = .66); ratings were given on a 4-point Likert scale with lower ratings indicating greater likeliness.

Procedure. Participants read all seven vignettes in a semi-counterbalanced sequence (i.e., no two participants read vignettes in the same order). After reading each individual vignette, participants answered the questions regarding perceptions of the target, for a total of seven question sets. Then, participants completed the HIV Stigma and Belief Survey. After filling out the questions and survey, participants reported their demographic information by completing a questionnaire.

Results

A repeated measures multivariate analysis of variance (MANOVA) was conducted to determine the within-subject difference for each of the seven vignette conditions and six vignette questions. There was a significant multivariate effect for all six vignette questions, F(6,36) = 10.76, p < .001. All of the univariate analyses were significant. (See Table 1 for these results and see Table 2 for all means and standard deviations).

Table 1. Within-Subject Analysis of Variance for Vignette Questions

Vignette Question

M

SE

F

df, error

η2

Responsibility

3.17

.10

41.13*

6, 576

.30

Verbal Assault

3.30

.07

16.39*

6, 576

.15

Physical Assault

3.04

.07

21.68*

6, 576

.18

Coping Ability

2.30

.06

62.92*

6, 576

.40

Society Acceptance

2.95

.08

24.28*

6, 576

.20

Trouble with Law

3.11

.06

130.72*

6, 576

.58

* p < .001

Table 2. Means and Standard Deviations for All Vignette Conditions and Questions

Vignette Questions

Responsible

Verbal

Physical

Coping

Society

Law

Condition

M

SD

M

SD

M

SM

M

SD

M

SD

M

SD

HIV+

3.86a

1.18

3.02a

1.13

2.53a

1.07

3.53b

1.06

3.46a

1.04

2.11a

1.04

Gay

4.07a

1.18

2.94a

1.27

2.73a

1.17

4.07a

0.97

3.58a

1.14

1.91a

1.06

Drug User

2.78b

1.54

2.74a

1.15

2.60a

1.05

2.91c

1.17

3.18a

1.14

3.73b

1.10

HIV+/Gay

3.82a

1.23

3.46b

1.18

3.14b

1.08

3.47b

1.10

2.80b

1.18

2.01a

1.06

HIV+/Drug

2.47b

1.65

3.49b

1.06

3.29b

1.03

2.09d

0.99

2.61c

1.15

4.03b

0.96

Gay/Drug

2.75b

1.50

3.49b

1.06

3.28b

1.03

2.81c

1.21

2.74b

1.19

3.82b

0.98

HIV+/Gay/Drug

2.45b

1.61

3.90c

1.06

3.69c

0.99

2.01d

0.91

2.29c

1.20

4.16c

0.81

Note. Within columns, identical superscripted letters indicate means that are not significantly different from each other.

A Tukey post hoc analysis was conducted for each of the six vignette questions to determine whether the layering of high-risk HIV characteristics was perceived significantly more negatively than single high-risk characteristics and whether the combination of all three high-risk characteristics was perceived to be significantly more negative than the combination of two high-risk characteristics.

The post hoc analysis for the responsibility vignette question indicated no significant difference between responses for two of the three single high-risk conditions (i.e., gay and HIV+) and the gay/HIV+ condition; however, the remaining four conditions, all of which included the drug user characteristic (i.e., drug user, gay/drug user, HIV+/drug user, and HIV+/gay/drug user), were perceived as significantly more negative.

The Tukey post hoc analysis for the verbal assault and physical assault vignette questions, as hypothesized, indicated no significant difference in response among the single, high-risk characteristic conditions; the targets with the layering of two high-risk characteristics were perceived to be significantly more negative, and the target with all three high-risk characteristics was perceived to be significantly more negative than the other six targets.

The Tukey post hoc analysis for the coping vignette question suggested that the targets in the HIV+ and HIV+/gay conditions were perceived as less able to cope than in the gay condition. The targets in the gay/drug user and drug user conditions were perceived to be significantly less able to cope than the characters in the HIV+ and HIV+/gay condition, and the target in the HIV+/gay/drug user and HIV+/drug user conditions were perceived to be less able to cope than the other five targets.

The post hoc analysis for the societal acceptance vignette questions suggested no significant difference in the conditions with single high-risk characteristics (i.e., HIV+, gay, and drug user). The HIV+/gay and gay/drug user targets were perceived to be significantly less accepted by society than the single, high-risk targets, and the HIV+/drug user and HIV+/gay/drug user targets were perceived to be significantly less accepted by society than the other five targets.

The post hoc analysis for the vignette question addressing the character’s likelihood for being in trouble with the law indicated no significant difference between responses for two of the three single high-risk conditions (i.e., gay and HIV+) and the gay/HIV+ condition. The drug user, gay/drug user, and HIV+/drug user targets were perceived to be significantly more likely to be in trouble with the law, and the target in the condition with the layering of all three high-risk characteristics was perceived to be significantly more likely to be in trouble with the law than the other six conditions.

A between-subjects MANOVA was conducted to determine gender differences in perceptions of responsibility and social acceptance for the HIV+ condition, F(2, 94) = 772.10, p < .001. Both univariate ANOVAs were significant. Women (M = 4.09, SD = 1.02) perceived the target from the HIV+ vignette to be significantly more responsible than men (M = 3.55, SD = 1.07), F(2, 94) = 5.26, p < .05. Women perceived the character from the HIV+ vignette to be significantly more accepted by society than men, F(2, 94) = 7.52, p < .01.

A between-subjects MANOVA was conducted to determine gender differences on the Stigma and Belief survey scales, F(4, 92) = 4.84, p < .01. The univariate ANOVA for coercive public policies indicated that women (M = 3.56, SD = .54) disagreed with the policies significantly more than men (M = 3.16, SD = .63), F(1, 95) = 11.58, p < .01. There were no significant gender differences in casual contact beliefs or in negative feelings toward people living with HIV, and high-risk group beliefs.

To determine what factors may have contributed to gender differences in perception of societal acceptance and responsibility in the HIV-positive vignette, separate multiple regressions were conducted for women and men using as independent variables the four Stigma and Belief Survey scales and whether or not the participants knew someone with HIV. For women, the prediction for societal acceptance was significant, adjusted R 2 = .21, p = .004. Significant predictors were low reports of negative feelings, low support for coercive public policy, and knowledge of how the virus can and cannot be contracted through casual contact. (See Table 3 for analysis summary). For men, the prediction for societal acceptance was not significant. The prediction for responsibility was significant for women, adjusted R 2 = .12, p = .05. Responses on the casual contact belief scale were a significant predictor of responsibility for women (See Table 4 for analysis summary). The prediction for responsibility was not significant for men.

Table 3. Regression Analysis Summary for Societal Acceptance

   

Women

 

Men

Predictor

B

SEM

β

t

p

B

SEM

β

t

p

Negative Feelings

.61

.23

.45

2.70

.01

.78

.38

.41

2.05

.05

Public Policy

-.68

.28

-.39

-2.42

.02

-.16

.34

-.09

-.47

.64

Casual Contact

.30

.15

.27

1.99

.05

-.27

.22

-.24

-1.25

.22

High Risk Group

-.04

.22

-.03

-.20

.85

.24

.31

.12

.77

.44

Know HIV

.05

.25

.03

.21

.84

.24

.41

.10

.60

.55

Note. The regression was not significant for men, adjusted R2= .02, p = .33

Table 4. Regression Analysis Summary for Responsibility

   

Women

 

Men

Predictor

B

SEM

β

t

p

B

SEM

β

t

p

Negative Feelings

-.11

.26

-.07

-.42

.68

.94

.46

.40

2.05

.05

Public Policy

-.33

.32

-.17

-1.03

.31

-.10

.40

-.05

-.24

.81

Casual Contact

.45

.17

.37

2.59

.01

-.60

.26

-.43

-2.30

.03

High Risk Group

.31

.25

.18

1.27

.21

.13

.37

.05

.35

.73

Know HIV

.42

.28

.21

1.51

.14

.09

.49

.03

.18

.86

Note. The regression was not significant for men, adjusted R2= .06, p = .22

Of the participants who knew someone living with HIV, 24 were women (72.7%) and 9 were men (27.3%). These frequencies were significantly different from chance, χ 2 = (1, N = 97) = 5.23, p < .05. Women’s responses on the coercive public policy scale (M = 3.56, SD = .54) were significantly correlated with whether they knew someone living with HIV, r(53) = .31, p < .05. Men’s responses on the coercive public policy scale (M = 3.16, SD = .63) were not significantly correlated with whether they knew someone with HIV, r(40) = .60, p = .08. Negative feelings toward people living with HIV were significantly correlated with responses on coercive public policies for women (M = 3.32, SD = .70), r(53) = .39, p < .01, and men (M = 3.33, SD = .57), r(40) = .52, p < .001. Additionally, men’s responses on the casual contact belief scale (M = 3.90, SD = .94) were significantly correlated with responses on the coercive public policy scale, r(40) = .49, p < .01.

Discussion

Evidence supporting the layering theory of high-risk HIV characteristics suggests that multiple high-risk behaviors are associated with increased experience of social stigmatization. Results from the univariate analysis regarding the character’s responsibility suggest that participants perceived IV drug use to be significantly more irresponsible than the behaviors depicted in the vignette conditions without IV drug use. The results also suggest that perceptions of responsibility are not dependent on the layering of high-risk behaviors; instead, perceptions may have been influenced by the legal constraints. More negative perceptions of drug use than for positive serostatus are consistent with results from Capitanio et al. (1999). Perhaps the characters in the vignettes who used intravenous drugs were thought to be significantly more irresponsible because the act of using hard drugs is life-threatening. Furthermore, taking part in recreational drug use is a personal choice, whereas being gay has many biological components and contracting HIV can occur through other means than direct sexual contact.

An individual’s ability to cope with his or her life situation in response to the diagnosis of a terminal disease is critical for physical well-being. The post hoc test used to examine the vignette question about the character’s ability to cope with his life situation yielded more variation than the other vignette questions. The character portrayed in the gay vignette condition was thought to be more able to cope than the characters in the other vignette conditions, which may suggest that participants did not see homosexual orientation as a significant life stressor. The characters in the vignette conditions that included IV-drug use were thought to be the least able to cope with their life situation. Intravenous drug use, therefore, could have been perceived by participants as a negative means for coping with life situations. Moreover, participants thought the characters in the vignette conditions with the combination of IV-drug use and positive HIV status would be able to cope even less than vignette conditions with just IV-drug use. These results provide partial support for the layering of stigma hypothesis.

In general terms, stigma is experienced by various individuals because society is not accepting of a physical attribute. Results from the Tukey post hoc test for the societal acceptance vignette question provide partial support for the layering of stigma hypothesis. Specifically, the targets with only one high-risk characteristic were perceived to be significantly more accepted. This suggests that participants did not perceive any difference between the gay, HIV-positive, or IV-drug use high-risk characteristics, but that the combination of characteristics would have a negative influence on acceptance. Of the vignette conditions with two or all three high-risk characteristics, participants thought an individual with the combination of IV-drug use and HIV-positive status would experience the least societal acceptance.

Verbal assault and physical assault are two specific manifestations of social stigmatization. The results from the Tukey post hoc tests for verbal and physical abuse vignette conditions provide evidence to support the hypothesis that participants would perceive the multiple high-risk characteristics as significantly more negative than single high-risk characteristics. Compared with the character described as having only one high-risk characteristic, participants thought the character depicted as having the combination of two high-risk characteristics was significantly more likely to be verbally and physically assaulted by individuals in society. Moreover, the character with all three high-risk characteristics was thought to be significantly more likely to be verbally and physically assaulted than the characters with two high-risk characteristics.

Although the likelihood of being in trouble with the law should be perceived as independent from HIV-positive status and homosexual orientation, results suggest otherwise. The character from the vignette condition with the layering of all three high-risk characteristics was thought to be the most likely in trouble with the law. Characters in vignette conditions without the IV-drug use variable were perceived to be the least likely in trouble with the law; participants’ perceptions, therefore, were influenced by the negative sanctions associated with IV-drug use. These results suggest that the severity of stigma experienced by individuals living with HIV may vary based on both the layering and type of high-risk characteristic. If there are legal implications associated with the high-risk characteristic, such as IV-drug use, then the HIV-positive individual may experience greater stigmatization.

The results of the gender analysis suggest that women perceived the character in the HIV only vignette to be more responsible for things that happen to him than did the men. Casual contact beliefs and knowledge of the means of transmission, according to the regression analysis, significantly predicted this perceived responsibility for women. The direction of this regression was positive for women (i.e., the more informed on causal contact, the more responsible the participant perceived the target). Unfortunately, this particular question was ambiguous, for the vignette included both responsible and irresponsible behaviors. Contracting the HIV virus may be interpreted as irresponsible behavior; whereas, being tested may be seen as responsible behavior. Women who were informed concerning types of casual contact, therefore, may have thought the target was responsible for being tested. The target’s romantic partner in the HIV-positive only (i.e., not gay) condition was a woman, so women many have been able to relate to the vignettes more than the men. Furthermore, men and women were equally knowledgeable about the means of HIV transmission and did not differ in their beliefs on the casual contact scale. In the current sample, more women knew someone with HIV than men; as a result, contact theory (Allport, 1954) may explain women’s more positive attributions.

In addition to having significantly more positive responses on the responsibility vignette question, women perceived the HIV-positive character to be significantly more accepted by society than men. The negative feelings toward people living with HIV responses were significant predictors of societal acceptance for women; therefore, they may have been projecting their personal feelings for societal acceptance. Additionally, men were more likely to favor the coercive public policies than women, and they thought society would be less accepting overall. Ratings on the level of societal acceptance, therefore, may suggest that women are more likely to be compassionate or empathetic toward individuals living with HIV.

More women in this sample knew someone living with HIV than men, and there was a significant difference in beliefs of coercive public policies. Women’s responses on public policy issues correlated with their knowing someone with HIV, but men’s responses did not correlate with their knowing someone with HIV. For men, the knowledge of how the virus may be transmitted and contracted correlated with their responses on the coercive public policy items. Whether women agreed with negative public policies, therefore, may have been decided based on feelings and emotions, whereas men’s responses for public policy may have been based on knowledge of transmission. Stigma, in the form of social avoidance and discrimination, may be related to the lack of knowing someone with HIV or being able to relate to seropositive individuals on a personal level. Interventional programs designed to reduce the stigma associated with HIV may consider combining an informational component with an emotional component that allows participants to interact with and get to know someone with HIV.

The current study had several limitations. First, the college sample may be especially aware of the means of contraction of HIV. However, stigma associated with the HIV virus is driven by fear and lack of knowledge about the means of contraction. Results may not, therefore, be representative of the general U.S. population. Additionally, the participants were students living in South Florida, where the number of individuals living with HIV is greater than in some other parts of the country. Participants’ perceptions of the layering of stigma may have been influenced by greater exposure to people living with HIV. Furthermore, the demographic information collected in the current study did not include a question regarding participants’ sexual orientation. The manipulation of homosexual orientation as a high-risk characteristic within the vignettes could have been perceived differently by participants identifying themselves as heterosexual, bisexual, or homosexual. The methodology of the current study manipulated variables using vignettes; however, there are certain limitations associated with this method (Hughes, & Huby, 2004). Results, consequently, provide insight into the perceptions of the layering of stigma, but cannot determine actual levels of stigma experienced by individuals living with the HIV virus.

The current study examined the layering of HIV stigma through the manipulation of HIV status, homosexual orientation, and intravenous drug use as high-risk characteristics, but there may be other characteristics that influence perceptions of individuals living with HIV. For example, marital infidelity or sexual promiscuity may influence perceptions of HIV-positive individuals. The vignettes in the current study only included a male character; however, HIV-positive females may experience different types or severity of stigmatization. Future studies examining the layering of HIV stigma would benefit from including both genders and more high-risk characteristics. Additional research on the factors that contribute to the stigmatizing behavior toward individuals living with HIV is necessary.

The stigmatization experienced by people living with HIV is a pervasive problem despite the general population’s conception that the severity of stigmatization has decreased over the past 20 years (Samuels, 2008). In fact, an HIV-positive homeless man from Texas was charged and sentenced in 2008 to 35 years in prison for assault with a deadly weapon when he spat on a police officer (Kovach, 2008). This incident exemplifies how an individual may stigmatize because he or she fears contraction, even knowing the means of transmission. In this recent case, the man was homeless, effectively layering his HIV stigma with another highly stigmatized characteristic. Thus the implications for work on the layering of stigma are very real and worthy of further study.


References

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