Attitudes Toward People Living With HIV/AIDS: A Model of Attitudes to Illness.

This study examined attitudes toward people living with HIV/AIDS within a sample of 220 young men and women. As predicted, a multiple regression analysis revealed that the fear of contracting HIV/AIDS through casual contact was a significant predictor of both men's and women's willingness to interact with people living with HIV/AIDS. Attitudes toward homosexuality were also a significant predictor of attitudes toward people living with HIV/AIDS among women, who generally have a low risk of contracting the disease in Western societies. These results indicate that attitudes toward people with a serious illness may be strongly related to the perceived risk of contracting the disease.

This study is designed to examine the psychological bases of attitudes toward people living with HIV/AIDS. Unfavorable attitudes may lead to discrimination in education and employment, and affect public support for health programs. There are two possible explanations for such attitudes that have been explored: fear of contagion and social stigma. Thus, unfavorable attitudes toward people living with HIV/AIDS may result from concern about contracting the disease or the association of HIV/AIDS with homosexuality (Bishop, Alva, Cantu, & Rittiman, 1991; Pryor, Reeder, Vinacco, & Kott, 1989).

Initially, these explanations were seen as competing hypotheses, and early studies found evidence to support both of them. For example, Pryor et al. (1989) concluded that attitudes toward people living with HIV/AIDS were largely a function of its association with homosexuality. In contrast, Bishop et al. (1991) argued that such attitudes are determined primarily by fear of contracting the disease.

More recently, a number of researchers (e.g., Crandall, Glor, & Britt, 1997; Dijker, Kok, & Koomen, 1996; Herek & Glunt, 1993) have proposed that both factors may affect attitudes toward people living with HIV/AIDS. They proposed a general model of attitudes toward people with an illness that may help to reconcile these conflicting findings. In this model, attitudes toward a person with an illness may be based on perceived characteristics of the disease or perceived characteristics of the people who are affected by it.

Some perceived characteristics of the disease that may be important are whether people believe that the disease has serious physical consequences, and whether there is an available treatment for it. Another factor that may influence attitudes toward people with an illness is beliefs about the transmission of the disease. In the case of HIV/AIDS, previous studies have found that many people tend to overestimate the risk of contracting the disease through casual contact (Herek & Glunt, 1993).

Some perceived characteristics of the people who are affected by an illness include whether people appear to be responsible for contracting the disease, and whether they belong to a particular group. For example, people tend to be less sympathetic toward people with an illness if they are believed to have been responsible for its occurrence. In the case of HIV/AIDS, the disease has become associated with homosexuality and sexual promiscuity in Western societies (Pryor et al., 1989).

Crandall et al. (1997) argued that in the case of a serious disease (e.g., HIV/AIDS), attitudes toward people with the illness will be based largely on concerns about the disease, such as the perceived risk of contracting it. With a mild illness, however, the extent to which the disease is associated with deviant social groups will increase negative attitudes toward people with the illness. For example, Bishop et al. (1991) reported that the stated willingness of their study participants to interact with a person with a fictitious illness was related strongly to the perceived contagiousness of the disease. The association of the disease with homosexuality only affected participants' willingness to interact when the disease was described as not being contagious.

The present study aims to investigate whether Crandall et al.'s (1997) model can provide a framework for understanding the psychological bases of attitudes toward people living with HIV/AIDS. On the basis of the model, it is expected that the fear of contracting HIV/AIDS will predict attitudes toward people living with HIV/AIDS more strongly than will attitudes toward homosexuality, because of the serious nature of the disease. As previous studies have found that men tend to report less favorable attitudes than do women toward people living with HIV/AIDS (Heaven, Connors, & Kellehear, 1990), as well as a greater fear of contracting HIV/AIDS (Young, Gallaher, Marriott, & Kelly, 1993) and less favorable attitudes toward homosexuality (Bouton et al., 1987; Kunkel & Temple, 1992; Young et al., 1993), it was decided to test the hypothesis separately among men and women.

Method

Study participants were 220 undergraduate students from a regional university in Australia (43 men, 177 women; M age=22.86 and 21.63 years for men and women, respectively). The students were enrolled in courses in liberal arts (55), nursing (52), radiography (41), social welfare (40), and a range of other programs (32). Each participant was provided with a questionnaire containing the following scales:

Fear of AIDS scale (Bouton et al., 1987). The Fear of AIDS scale was developed to measure fear of the disease. In the present study, a principal‐components analysis with varimax rotation produced five factors with eigenvalues greater than 1. A scree test indicated a two‐factor solution, which differed slightly from Bouton et al.'s initial three‐factor solution. The first factor (fear of contact) contains nine items, such as “If I found out a friend had AIDS, I would be afraid to hug him/her,” and explained 26.0% of the variance. The second factor (public health risk) explained a further 12% of the variance, and includes three items, such as “AIDS will become a severe and widespread epidemic.”

Homophobia scale (Bouton et al., 1987). The seven‐item homophobia scale was developed to measure negative attitudes toward homosexuality (e.g., “Homosexuality is disgusting”). In the present study, the single factor within the scale explained 64.5% of the variance.

Attitudes to People With HIV/AIDS (Heaven et al., 1990). This is a 21‐item measure with three subscales: social distance (e.g., “People who have AIDS should be isolated from the rest of the community”), sympathy (e.g., “People who have AIDS are just innocent victims”), and the view that more research into the disease is necessary (e.g., “We should invest more money in trying to find a cure for AIDS”). In the present study, the three factors explained 29.5%, 10.2%, and 8.3% of the variance, respectively.

Participants were asked to complete the questionnaire without discussing their answers with anyone else. They were assured that their responses would be confidential and that they could withdraw from the study at any time.

Results

Table 1 presents the means and standard deviations for various measures. Comparisons of the means with the midpoints of the subscales indicate that both men and women considered HIV/AIDS a major health risk, but they reported relatively little fear of contracting it through causal contact. Both men and women also expressed sympathetic attitudes toward people living with HIV/AIDS, a willingness to have social contact with them, and strong support for research into the disease.

Table 1


 Means on Measures of Fear of AIDS, Homophobia, and Attitudes Toward People Living With AIDS

	Men		Women		Scale midpoint	α
	M	SD	M	SD
Fear of AIDS
Fear of contact	19.09	6.24	16.61	4.61	27	.77
Public health risk	11.72	2.49	11.99	1.95	9	.57
Homophobia	19.44	7.86	14.43	5.67	21	.90
Attitudes
Social distance	17.60	6.50	14.43	4.20	30	.84
Sympathy	25.56	3.87	28.56	3.86	21	.77
Research and care	12.28	2.95	12.70	2.18	9	.81

A MANOVA reveals significant gender differences on many of the scales. Men reported a greater fear of contracting HIV/AIDS through casual contact, F(1, 213)=8.77, p<.05, partial η2=.04; and less favorable attitudes toward homosexuality than women, F(1, 213)=23.77, p<.01, partial η2=.10. Men were also less willing to have social contact with people living with HIV/AIDS, F(1, 213)=15.75, p<.01, partial η2=.07; while women expressed more sympathetic attitudes toward them, F(1, 213)=20.43, p<.01, partial η2=.09. A Bonferroni adjustment was used to determine the levels of significance.

Finally, separate multiple regression analyses were performed on the data to determine the unique predictors of attitudes toward people living with HIV/AIDS among men and women. A summary of the significant predictors of these attitudes is presented in Table 2. Fear of contracting HIV/AIDS through casual contact was a significant predictor of both men's and women's willingness to interact with people living with HIV/AIDS. The fear that HIV/AIDS represents a major health risk was also a significant predictor of support for research into the disease among men and women. Among women, attitudes toward homosexuality were a significant predictor of their willingness to have social contact with people living with HIV/AIDS, as well as their feelings of sympathy toward them and support for research into HIV/AIDS.

Table 2


 Summary of Simultaneous Multiple Regression of Predictor Variables on Attitudes Toward People Living With AIDS

Variable	B	SE B	β	t	p
Social distance
Fear of AIDS, fear of contact (men)	.84	.10	.80	8.59	.00
Fear of AIDS, fear of contact (women)	.53	.06	.58	8.50	.00
Homophobia (women)	.14	.05	.19	2.73	.01
Sympathy
Fear of AIDS, fear of contact (women)	−.29	.07	−.35	−4.45	.00
Homophobia (women)	−.21	.05	−.31	−3.98	.00
Research and care
Fear of AIDS, public health risk (men)	.65	.16	.55	4.15	.00
Fear of AIDS, public health risk (women)	.28	.08	.25	3.51	.00
Homophobia (women)	−.08	.03	−.20	−2.27	.02

Discussion

As predicted, the fear of contracting HIV/AIDS through casual contact was a significant predictor of both men's and women's willingness to interact with people living with HIV/AIDS. The fear that HIV/AIDS poses a major health risk was also a significant predictor of support for research into the disease among both men and women. In contrast, attitudes toward homosexuality were a significant predictor of these two attitudes toward people living with HIV/AIDS only among women, who generally have a lower risk of contracting the disease in Western societies. Attitudes toward homosexuality also were a significant predictor among women of their feelings of sympathy for people living with HIV/AIDS.

These results are consistent with Crandall et al.'s (1997) hypothesis that attitudes toward people with a serious illness will be strongly related to the perceived risk of contracting the disease. But their model further proposed that the characteristics of the people affected by the disease would only influence attitudes toward them in the case of mild illnesses. The results of the present study suggest that attitudes toward people with a serious illness also may be linked to their perceived characteristics, when the risk of contracting the disease is low. Both these sets of results are consistent with the findings of Bishop et al.'s (1991) earlier study of the willingness of participants to interact with a person with a fictitious illness.

In line with previous studies that have used the same measures, men reported a greater fear of contracting HIV/AIDS and less favorable attitudes toward homosexuality than did women (Bouton et al., 1987; Kunkel & Temple, 1992; Young et al., 1993). Men also expressed less favorable attitudes toward people living with HIV/AIDS in terms of expressions of sympathy and their willingness to have social contact with them (Heaven et al., 1990). These findings are consistent with the perception that men face a greater risk of contracting HIV/AIDS than do women. However, it should be noted that the effect sizes of these differences were small (.04–.10).

In summary, the results of the present study indicate that attitudes toward people with a serious illness may be strongly related to the perceived risk of contracting the disease. If the risk of contracting the disease is regarded as high, attitudes toward people with the illness may be based largely on fear of contracting it. When the disease does not appear to be contagious, the characteristics of the people who are affected by the illness may influence attitudes toward them. These findings represent a refinement of Crandall et al.'s (1997) model, which may provide a more comprehensive framework for understanding public attitudes toward people with a serious illness (e.g., those affected by the 2003 outbreak of the SARS virus) and allow health professionals to develop intervention programs that are appropriate to the perceived risk of contracting a disease within the community. At the same time, support for the model would be strengthened by a replication of this study with a sample of the population that was based more broadly, particularly in terms of age and educational background.