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The survey trends yield both hopeful and disturbing
findings about AIDS stigma among the US adult public.
On the hopeful side, overt expressions of
stigma appear to have declined over the 1990s. The most
punitive aspects of AIDS stigma – support for quarantine
and public identification of PWAs – diminished considerably,
with fewer than 1 in 5 adults still supporting such measures
by 1999. A similar pattern was evident for negative feelings
toward PWAs. And, by the decade's end, relatively few respondents
said that they would avoid a male coworker or a schoolchild
with AIDS.
Nevertheless, it is disturbing that in 1999 – nearly
two decades after the beginning of the AIDS epidemic
in the United States – one fifth of those surveyed still
feared PWAs and one sixth expressed disgust or supported
public naming of PWAs.
In addition, the surveys revealed that more
covert forms of stigma persist. Even in 1999, roughly one
fourth of respondents felt uncomfortable having contact
with a PWA. Such feelings might well translate into avoidance
or discrimination in some real-world interactions. Indeed,
nearly one third of respondents said they would avoid shopping
at a neighborhood grocery store whose owner had AIDS.
The surveys also revealed troubling signs
that the sorts of beliefs and opinions that provide a foundation
for AIDS stigma continue to be widespread. The proportion
of adults believing that a person infected with HIV through
sex or drug use deserves to have AIDS increased over the
decade, peaking in 1997. When the question was framed in
less harsh terms, approximately one half of respondents
perceived PWAs to be responsible for their illness. This
pattern is worrisome because individuals with an undesirable
condition are generally subjected to greater stigma when
they are perceived to be personally responsible for their
situation.
In the case of AIDS, such perceptions may
be an unintended consequence of public education campaigns
that stress the importance of personal decision making in
HIV prevention. If so, health educators face the challenge
of communicating the importance of protecting oneself from
AIDS without promoting increased blame for individuals who
become infected.
Of further concern is the fact that although
respondents understood how HIV is transmitted, they were
much less clear about how it is not transmitted. Indeed,
the proportions overestimating the risks posed by some forms
of casual social contact were higher in 1997 and 1999 than
in 1991. Those who believe that HIV can be spread through
casual social contact are probably more likely to fear such
contact with PWAs and may be more willing in the future
to support punitive policies that violate PWAs' human rights
under the guise of protecting public health.
Such fears may partly account for the widespread
support for mandatory testing of various groups. Although
such support declined to some extent between 1997 and 1999,
mandatory testing continued to be favored by most respondents.
The survey results have at least two important
implications for public health. First, they suggest that
AIDS educational efforts have effectively communicated how
HIV is transmitted but have been less successful in convincing
the public that AIDS is not spread through casual social
contact. Some respondents who doubted the safety of casual
contact were skeptical of scientists, but most reported
that they believe scientists who say that AIDS is not transmitted
through casual contact. Thus, AIDS educators and public
health workers may be able to counter misperceptions about
HIV transmission simply by ensuring that AIDS education
messages include clear information about how HIV is not
transmitted, a practice that was common in the 1980s.
Second, public health policy should recognize
that AIDS stigma persists in the United States. One fifth
of respondents gave three or more stigmatizing responses
on the 9-item index in 1999. Still more indicated some degree
of discomfort in social interactions with PWAs. These respondents
represent a sufficiently large number of adults that many
PWAs justifiably fear the consequences of stigma when their
diagnosis becomes known to others. Such fears are likely
to have detrimental effects on PWAs and persons at risk
for HIV. They will also affect the success of programs and
policies intended to prevent HIV transmission. Thus, eradicating
AIDS stigma remains an important public health goal for
effectively combating HIV.
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