The level of stigmatization associated with HIV and AIDS has been declining within the United States, but the proportion of the public who hold misperceptions about how HIV is transmitted is rising. A national telephone survey of adults has shown that the odds of supporting the quarantine of people with AIDS decreased by 15% per year between 1991 and 1999.1 Likewise, the odds that respondents would avoid contact with people who have AIDS or harbored negative feelings toward them decreased annually by about 10%. During the same period, however, the odds of believing that HIV infection could be contracted by being sneezed or coughed on rose significantly.
By interviewing nationally representative samples of adults in 1997 and 1999, researchers were able to estimate the prevalence of stigmatizing opinions and wrongly held beliefs about HIV and AIDS among the American public. They also compared the results with those from a similar survey they conducted in 1991 to examine trends in the public's attitudes toward HIV and AIDS during the decade. Of the 1,309 interviewees in 1997 and 669 interviewees in 1999, 55% were female and about 80% were non-Hispanic white; the average age was 44-45, and the median educational level was some college or other postsecondary schooling.
The prevalence of extreme attitudes toward people with AIDS decreased significantly throughout the decade: Some 29-34% of respondents endorsed the segregation or public naming of people with AIDS in 1991, whereas 12-16% did so in 1999. The odds of supporting these punitive policies, as estimated by logistic regression analysis, decreased by 15% and 9%, respectively, each year. The prevalence of anger, fear or disgust toward people with AIDS also fell during the decade: The proportions of respondents harboring these negative feelings decreased from 27-35% in 1991 to 15-20% in 1999, corresponding to reductions in odds of 8-10% per year. From 1997 to 1999, the proportions supporting the mandatory testing of immigrants and of people at risk of getting AIDS decreased significantly--from 78% to 74% and from 74% to 64%, respectively. In addition, the odds of agreeing that most people with AIDS are responsible for having their illness decreased by 9% each year from 1997 (54% of respondents) to 1999 (48%). However, between 1991 and 1999, the proportion of respondents agreeing that people with AIDS have gotten what they deserve grew from 20% to 25%.
From 1991 to 1997, the proportion of those interviewed who believed that HIV could be spread by kissing an infected person on the cheek decreased significantly, from 17% to 13%. In contrast, respondents commonly answered incorrectly about the risk of HIV infection from other types of contact: From 1991 to 1999, the proportion of those believing that infection could be contracted by sharing a glass remained at about one-half, and the proportion believing that infection could be acquired by donating blood was roughly one-third. Moreover, the likelihood of wrongly replying that HIV could be transmitted by using public toilets or through coughing and sneezing was significantly higher at the end of the decade (41% and 50%, respectively) than at the beginning (34% and 46%); the odds of giving these responses increased annually by 4% and 15%, respectively. The researchers show that the high level of misperception about HIV transmission is not due to public mistrust of scientists and doctors: At the end of the decade, the majority of respondents trusted these professionals to tell the truth about AIDS (70%) and believed them when they said that AIDS is not spread by casual contact (87%).
In 1997 and 1999, roughly one-quarter of those surveyed said they would feel uncomfortable if they worked in the same office or if their child attended the same school as someone with AIDS, or if they shopped in a local grocery store knowing that the owner had AIDS. Although the odds of avoiding people with AIDS in these three hypothetical situations decreased during the decade by 8-10% each year, three in 10 respondents in 1999 still would avoid shopping in a store if the owner had AIDS. The researchers comment that discomfort toward people with AIDS "might well translate into avoidance or discrimination in some real-world interactions."
The investigators note that although "overt expressions of stigma" seem to have decreased during the past decade, more covert forms remain. They warn that fear of people with AIDS and public support for punitive policies persist, calling these trends "disturbing." According to the researchers, the findings have at least two implications for public health. First, AIDS educational efforts need to communicate more effectively how HIV is not transmitted. Second, public health policy should address the persistence of stigma to reduce its harmful effects on people with AIDS and to improve the success of programs and policies aimed at preventing HIV transmission. The authors conclude that "eradicating AIDS stigma remains an important public health goal for effectively combating HIV."--T. Lane
1. Herek GM, Capitanio JP and Widaman KF, HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999, American Journal of Public Health, 2002, 92(3):371-377.