US prejudice against people with HIV has grown in past decade

Research published in the March edition of the American Journal of Public Health shows that approximately 50 per cent of Americans still believe that they can acquire HIV through everyday contact with a person infected with the virus, and support the mandatory testing of groups most at risk of HIV infection. The study authors believe that such misunderstanding and prejudice is compromising HIV prevention initiatives.

In 1991, 1997 and 1999, researchers at the University of California, Berkeley, conducted telephone interviews with over 1,300 randomly selected English-speaking Americans to assess the extent of prejudice towards people with HIV and misinformation about how HIV is transmitted.

The sample were asked questions falling into three broad areas:

• The first set of questions assessed support for coercive AIDS related policies, as well as negative feelings towards people with AIDS and the extent to which people with AIDS were blamed for having their illness.
• The second set of questions looked at popular beliefs about how HIV is transmitted
• the final tranche assessed the sample's intention to avoid contact with those infected with HIV, feelings of discomfort towards them and fear of symbolic contact.

Describing their findings as "both hopeful and disturbing" the Berkeley researchers found that support for coercive policies such as the mandatory quarantining of people with HIV, falling from over a third in 1991 to 12 per cent in 1999. Similarly the number of people advocating the public naming of people with HIV fell from over 28 per cent in 1991 to just over 16 per cent at the end of the decade. However, at over 80 per cent, there was little change in the numbers supporting the compulsory testing of pregnant women and the belief that there should be the forced testing of high risk groups fell only only slightly from nearly three quarters to a little under two thirds.

The number believing that "people who got AIDS through sex or drugs have gotten what they deserve" increased from a fifth to a quarter in the 1990s, and in 1999 over 48 per cent of Americans believed that "most people with AIDS are responsible for having their illness." The University of California researchers believe that in part this may be due to "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."

Although there was a clear understanding amongst the people interviewed that HIV was most likely to be spread through unprotected sex or sharing needles, the numbers believing that they could be infected with HIV through casual contact actually increased in the 1990s, with over 50 per cent of Americans agreeing that they could acquire HIV from drinking out of the same glass as a person with HIV, or being "coughed or sneezed on by someone who has the AIDS virus." The percentage believing that HIV could be acquired from using a public toilet also increased, from 34 per cent in 1991 to almost 41 per cent in 1999.

Throughout the 1990s the proportion of those believing that donating blood could lead to becoming infected with HIV remained steady at just below a third. The researchers described these findings as particularly worrying, because "those who believe that HIV can be spread through social contact are probably more likely to fear such contact with [people with HIV] and may be more willing to advocate punitive policies that violate [people with HIV] human rights under the guise of protecting public health." Clear information about how HIV is not spread, the researchers suggest, should be included in future HIV prevention campaigns.

The Berkeley study also showed that many Americans still felt discomfort about contact with HIV-positive people, with 30 per cent saying they would be uncomfortable if their child attended the same school as somebody with HIV, an increase of almost four per cent since 1997, and almost 30 per cent said they would avoid using their neighbourhood grocer if the owner had HIV.

A quarter of Americans, a figure unchanged across the 1990s also feared "symbolic contact" with HIV, such as wearing a sweater, once worn by a person with AIDS which had been cleaned and cellophane-wrapped, or drinking from a sterilised glass in a restaurant which a person with HIV had once used.

The Berkeley researchers conclude that, not only will such a widespread misunderstanding and prejudice impact on the lives of people with HIV, but "also affect the success of programs and policies intended to prevent HIV transmission' and conclude "eradicating AIDS stigma remains an important public health goal for effectively combating HIV."