HIV-Related Stigma and Knowledge
in the U.S., 1991-1999


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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