The Influence of Victim and Respondent
Characteristics on Attitudes Toward AIDS:
A Report to the Nova Scotia Task Force on AIDS
Rudolph Kafer
Cindy JoHotta
Robert Landry
Michael Houlihan
Mount Saint Vincent University
May 12, 1988.
The Influence of Victim and Respondent Characteristics on
Attitudes Toward AIDS:
A Report to the Nova Scotia Task Force on AIDS1
There have been 1,465 cases of acquired immune deficiency syndrome (AIDS)
reported in Canada (National Federation for AIDS (NFA), 1988). Fifty-two percent of
these cases have resulted in death. By the year 1991, the number of cases of AIDS in
Canada is projected to be close to seven thousand (NFA, 1988). In essence the number of
AIDS cases is doubling every thirteen months. Bowen (1987) estimated that 1.5 million
individuals are inflicted with AIDS throughout the world.
In the past few years, the issue of acquired immune deficiency syndrome has
received a great deal of media attention and with the recent increase of AIDS victims
within the heterosexual community, no longer are the high risk groups (homosexuals and
drug users), the only to be fearful of the threat AIDS imposes. Of the reported cases in
Canada 80% are male and 20% female. In addition the highest risk age group of adult
cases falls between 30 and 39 years of age (45.8%). When the age variable is broken
down between genders, there are significant differences between men and women. Men
between the ages of 30 and 39 are categorized as a high risk group constituting 46.6% of
reported cases and women between 20-29 are at high risk constituting 35.2% of reported
cases. Along with age differences there appears to be risk factors that differentiate each
gender. The highest risk factor for men is homosexuality and bisexual activity (86.0%).
However, The high risk factor for women is heterosexual activity originating in an
endemic area (30%) and or sexual contact with a person at high risk (38.0%)(NFA,
1987). According to Bowen (1987), the only way to combat the effect AIDS has had on
the community is through education. Since AIDS has had such an extensive impact, it is
difficult to determine where emphasis should be placed when establishing educational
programs.
AIDS is becoming a widespread medical and behavioral problem. Education
boards, community groups, and government agencies at all levels, each with varying
perspectives, have been addressing the issue of AIDS. Psychological research directly
related to AIDS is scarce. One aspect that has received limited attention is attitudes
toward homosexuals (Lance, 1987).
There has been a backlash of prejudice and discrimination against the groups
considered to be at high risk. This has been openly directed toward homosexuals. A
recent Gallup poll has suggested attitudes toward homosexuals have become more
negative since the onset of AIDS publicity (Morganthau, 1983). It was found that even
1
This study has been supported by a grant from the Nova Scotia Task Force on
AIDS and an internal grant from Mount Saint Vincent University (grant #A06024).
among college students who tend to be a somewhat tolerant segment of the population,
nearly 47.8% approve of legislation banning homosexual relations.
Triplet and Sugarman (1987), demonstrated that AIDS is considered more serious
than genital herpes, serum hepatitis and Legionnaires disease. It was found that
homosexuals were considered more responsible for acquiring the disease than were
heterosexuals (Triplet and Sugarman, 1987). There was also a significant interaction
effect with disease and sexual preference (Triplet and Sugarman, 1987).
Kelly, St. Lawrence, Smith, Hood, and Cook (1987a; 1987b), in two separate
studies, investigated attitudes of physicians and medical students to AIDS victims. In
comparison of reactions to victims of leukemia, medical students rated homosexual AIDS
victims as less appropriate, more offensive, less truthful, less likeable and inferior.
Physicians in the second study did not display prejudicial attitudes towards homosexual
victims but displayed a prejudicial response towards AIDS victims in general. These
studies may not be generalizable due to the subject sample utilized.
The preceding studies have investigated the relation of sexual preference to male
AIDS victims. It would be naive to infer that this relation is the sole determinant of
attitudes towards AIDS victims. Another area that needs consideration is attitudes toward
female AIDS victims. Sexual activity and sharing of infected drug needles are common
methods of acquisition of this disease. These activities may also be a source of
differential attitudes towards victims of this disease.
The purpose of this study was three fold. First, the influence of victim
characteristics (i.e., gender, sexual preference, mode of acquisition) on subjects' attitudes
towards individuals with either AIDS or Hepatitis B were studied. The inclusion of a
virulent disease other than the widely publicized AIDS will allow the examination of the
pervasiveness of prejudice toward victims of highly contagious diseases. Second, the
influence of characteristics of the respondent (eg., gender, education, marital status) on
their attitudes towards AIDS victims will be addressed. Finally, predictors of adoption of
'safe sex' practices by subjects will be identified.
Method
Subjects
The sample utilized in this study consisted of 289 volunteers (faculty and
students) from a regional training facility. Demographic information is summarized in
Table 1. This particular population was selected in order to avoid the educational bias
inherent in using a university population to study public health issues.
Materials
Instruments were developed to assess knowledge of AIDS and Hepatitis B,
attitudes toward disease victims, changes in subjects' sexual behaviour, and demographic
information. These materials are described individually.
Knowledge questionnaires. Two knowledge questionnaires were developed to
assess subjects' level of knowledge of a specific disease (AIDS or Hepatitis B). The two
questionnaires were constructed such that the name of the disease was the only difference
between the two questionnaires (see Appendix A). Each questionnaire consisted of 12
items to which the subject responded true, false or don't know. Items were obtained from
Berkow, 1982; Gerety, 1985; Hopkins, 1987; Lavigne, 1987; Staff, 1985; Staff, 1986;
Department of Health, 1987a, 1987b; Stapleton, 1986; Till, 1987 and Wertz, Sorenson,
Liebling, Kessler, & Heeren, 1987 and the number of correct responses was employed as
an index of the knowledge regarding the disease addressed.
AIDS/Hepatitis B Questionnaires. Vignettes concerning disease victims were
constructed utilizing four independent variables (i.e., disease, gender, preference, and
mode of acquisition) and three control variables (i.e., occupation, marital status and
employment status) that were systematically varied (see Table 2). A similar method was
employed by Kelly et al. (1987a) and proved to be successful. Pilot testing of the
vignettes indicated that eight vignettes was the upper limit for reliable subject response.
Following each vignette a series of six questions required the respondent to
evaluate the subject of the vignette according to three attitudinal dimensions (i.e.,
sympathy, perceived fault, and willingness to socialize with the victim) and three policy
dimensions (i.e., need for isolation, right to anonymity, right to continue working).
Subjects responded on a five point scale (one meaning very sympathetic, totally at fault,
would associate with this victim, should be isolated, should remain anonymous, should
continue in his/her job to five meaning no sympathy, not at fault, would avoid this
person, allowed total freedom, should be publicly identified, must be forced to quit job;
see Appendix B).
The vignettes were grouped in packets of eight so that gender, sexual preference,
and mode of acquisition were fully crossed and disease type was constant. The control
variables (occupation, marital status and employment status) were also fully crossed in
each pack of eight. This arrangement resulted in the factors of gender, sexual preference,
and acquisition mode being treated as within-subject variables and the other variables as
between subject variables.
The order of presentation of the independent variables within the vignettes was
counterbalanced and the presentation of the vignettes were randomized to combat order
effects.
Demographics and sexual behaviour questionnaire. A questionnaire was
developed to identify some of the characteristics of the sample utilized. The information
gathered included age, sex, level of education, marital status, size of home town, and
parents' occupations. Additionally, to assess behavioral change attributable to the threat
of AIDS, six questions were constructed. These were directed towards becoming more
selective of sexual partners, use of and increased purchase of condoms for protection,
decrease in sexual activity, decrease in number of different sexual partners, and general
concern about maintaining a long term relationship due to the threat of AIDS. Procedure
Subjects were solicited by means of a description of the study circulated to
homeroom instructors and read to the students of the facility. Subjects were assured of
anonymity and confidentiality of their responses and of the project's independence of the
facility administration. Lists of volunteers were returned to student services who
scheduled five 20 minute data collection sessions. Volunteer effects were minimized due
to the tendency of classes to participate en masse and the high incentive value of
substituting co-operation in the project for class attendance.
Subjects were assembled in a lecture theatre in groups of varying sizes (8 to 78)
and received written and oral instructions in completion of the instruments. All
participants completed the knowledge and attitudinal instruments in addition to
responding to demographic questions and a series of questions to assess specific
behavioral changes that may have resulted from knowledge of or as a reaction to AIDS.
Results
Results are reported in three sections. The first examines differences in attitudinal
and policy responses due to victim characteristics of gender, sexual preference and mode
of acquisition. Repeated measures analyses of variance were conducted with type of
disease as a between subjects factor and the three other victim characteristics as withinsubject factors for each of the six dependent variables (sympathy, fault, and association;
anonymity, isolation, and job continuance). The second section employs a stepwise
regression to identify respondent characteristics that were predictive of the response to
the vignettes. These analyses were conducted separately for AIDS and Hepatitis B
respondents in order to investigate differences in determinants of attitude by disease type.
The third section uses the same respondent characteristics to investigate self-reported
changes in sexual behaviour.
Victim Characteristics and Attitude
Significant effects were found for disease type, gender, sexual preference and
mode of acquisition as well as several interaction effects (Table 3). A lower score on each
of the six dependent measures is indicative of a more positive attitude (i.e., more
sympathy, less fault, more willing to associate). Significant differences among means for
disease type were observed for sympathy F1,287 = 4.98, p<.0264), fault F1,286 = 8.56,
p<.0037) and anonymity F1,286 =4.05, p<.05). As indicated in Table 4, respondents felt
AIDS victims deserved more sympathy, less anonymity and were rated as less at fault
than were Hepatitis B victims.
Significant gender effects were revealed for association (F1,287 = 16.46, p<.0001),
anonymity F1,286=10.83, p<.0011), and isolation, F1,287 = 11.58, p<.0008) (see Table 3).
In these cases male victims were viewed more negatively than were their female
counterparts (see Table 4).
Differences were found based on sexual preference across all six dependent
variables (sympathy, F1,287 =198.58, p<.0001; fault, F1,287 =135.22, p<.0001; association,
F1,287 =125.38, p<.0001; anonymity, F1,286 =56.32, p<.0001; isolation, F1,287 =117.70,
p<.0001; job continuance, F1,283 =75.86, p<.0001). In all cases homosexual victims were
judged less favorably than were heterosexual victims (see Table 4). Similarly the
response to mode of acquisition of the disease resulted in significant differences between
means on all six dependent variables (sympathy, F1,287 =175.00, p<.0001; fault, F1,287
=250.48, p<.0001; association, F1,287 =75.50, p‹.0001; anonymity, F1,286 =43.50, p<.0001;
isolation, F1,288 =47.37, p‹.0001; job continuance, F1,283=68.09, p<.0001). In all cases
victims that contracted the disease through- the sharing of drug needles were rated less
favorably than those who contracted the disease through sexual activity (see Table 4).
Interaction Effects of Victim Characteristics and Attitude
Many significant interactions were revealed and Scheffe's Test (Keppel, 1982)
was employed to identify the source of these differences. Analysis of the disease by
gender interaction (p<.01). F1,286 =3.99, p<.0468) revealed that male Hepatitis B victims
were judged more at fault than any other group. The disease by sexual preference
interaction F1,286 =5.82, p<.0165) revealed homosexual AIDS victims were least preferred
for association. This same disease by sexual preference interaction revealed that
homosexual Hepatitis B victims were judged to be more at fault for contracting the
disease than were homosexual AIDS victims or heterosexual victims regardless of the
type of disease. Significant gender by sexual preference interaction effects were found for
sympathy (F F1,287 =49.43, p‹.0001), association F F1,287 =19.09,p<.0001), anonymity
(F1,286 =6.70,p<.0101, and isolation (F1,,288 =7.52,p<.0065) (see Table 3). Respondents
indicated that male homosexuals should be isolated and identified more than female
homosexuals or heterosexuals of either sex. In addition, male homosexuals were also
accorded less sympathy and would be associated with less than others (see Table 5).
Significant gender by mode of acquisition interaction effects were found on sympathy F
F1,287 =8.33,p<.0042), fault (F1,286 =8.49,p<.0039), anonymity (F1,286 =6.07, p<.0144),
isolation F1,288 =14.76,p<.0002, and job continuance F1,283 =6.20,p<.0133). In all
instances females whom acquired the disease sexually were perceived more positively
than any others (see Table 5).
Sexual preference by mode of acquisition interaction effects were found for
sympathy F1,287 =92.53,p<.0001), fault F1,286 =154.32,p<.0001), association F1,287
=15.85,p<.0001), isolation F1,288=15.47,p<.0001), and job continuance
F1,283=5.86,p<.0161). Heterosexuals acquiring the disease via sexual activity were
perceived more favorably than heterosexuals contracting the disease using drug needles
and homosexuals getting the disease either through sexual activity or drug use. (see Table
5).
There was one significant three-way interaction reported. A disease by sexual
preference by mode of acquisition interaction for anonymity F1,286 =12.68, p<.0004)
revealed that heterosexual, Hepatitis B victims acquiring the disease sexually were rated
more positively than homosexuals regardless of disease or mode of acquisition, AIDS
victims regardless of sexual preference or mode of acquisition or those acquiring the
disease by sharing drug needles, regardless of sexual preference or disease type.
Respondent Characteristics and Attitude
Due to the orthogonal nature of the design, it was possible to total scores across
all eight vignettes to arrive at a valid score for each of the six dependant variables for
each respondent. Stepwise regressions were conducted using the total scores for
sympathy, fault, association, anonymity, isolation, and job continuance as criterion
variables and subject characteristics as predictors. Subject characteristics were age,
gender, level of education, home town, parental occupation, and marital status. These
analyses were conducted separately for each disease type. Significant predictors22, partial
correlations, and R2 values are listed in Table 6. Since all of the predictors are negatively
correlated with the criterion variable, high predictor scores (ex. more education) are
2
All reported predictors were significant at p<.05.
related to more positive ratings on the dependant variables whereas low predictor scores
are indicative of less favorable responses.
As seen in Table 6, total sympathy score is best predicted by the sex of the
respondent for both AIDS and Hepatitis B. In this instance female respondents rate
victims more positively. In addition, marital status emerged as a significant predictor of
sympathy towards AIDS victims. The direction of the results indicates that married
individuals rate these victims more positively than do respondents who are single.
The only predictor identified for total score on perceived fault for Hepatitis B was
marital status. There were no significant predictors of percieved fault for AIDS victims.
Sex of the respondent and knowledge of AIDS were predictive of total association
ratings for AIDS victims. Mother's occupation and respondent's sex best predicted total
association scores for Hepatitis B. Mother's occupation is rated on a one (professional) to
nine (unskilled) scale. The results indicate that more unskilled roles of the mother on
lower status occupations are predictive of willingness to associate with Hepatitis B
victims.
For both disease types, sex of the respondent was the single predictor of total
anonymity (see Table 6).
Sex of the respondent was predictive of need for isolation ratings for both
diseases with females again being more positive. In addition, the level of knowledge was
a significant predictor in response to the AIDS Victims' need for isolation. Higher
knowledge led to more favorable ratings for each of the dependent variables for which it
was as a significant predictor.
The predictors which emerged for total job continuance score for AIDS were sex
of the respondent and knowledge. Those for Hepatitis B were the sex of the respondent
and mothers occupation.
Stepwise Regression on Summated Sexual Behaviour
Sexual behaviour scores were obtained by summating the responses to questions
addressing: partner selectivity, condom use, condom purchasing, increase in promiscuity,
decreases in sexual activity, and expressed interest in long-term relationships. The
summation of these responses resulted in a score that indicated the amount of change
toward safe sexual practices as a result of awareness of AIDS. The same respondent
characteristics utilized in the preceding analyses were employed as predictor variables.
Level of education was predictive of response to the sexual behaviour questions for those
who replied to the vignettes pertaining to AIDS victims. Higher education was indicative
of less conservative behavioral responses. Response to the Hepatitis B questionnaires was
best predicted by the division of staff versus students. Membership in the staff group was
predictive of more conservative practices. Table 7 presents the frequency of responses to
the individual sexual behaviour questions. As can be seen, the majority of subjects
reported an increased selectivity of sexual partners, increased interest in a long-term
relationship, and a decrease in the number of sexual partners. The validity of these
responses should be investigated by more detailed methods which focus more specifically
on sexual practices than did the present study. However, results found are congruent with
previous studies (Triplet & Sugarman, 1987; Kelly et al, 1987a; Kelly et al, 1987b).
Discussion
The results of this study illuminate various factors that influence public attitudes
toward victims of contagious diseases (i.e. AIDS and Hepatitis B). Results indicate that
attitudes toward victims of contagious diseases are differentially influenced by gender of
the victim, mode of acquisition and sexual preference of the victim.
Presently, the primary goal of AIDS education is the reduction of future incidence
of the disease and to increase public awareness of the medical and precautionary aspects
of this disease. Obviously educational programs must address these combined factors and
not the disease alone. As can be seen from the results, sexual preference, especially
homosexuality is a major factor contributing toward discrimination against victims with
infectious diseases.
One method that has been shown to reduce negative attitudes and fears associated
with homosexuality is linked exposure to the risk group involved. Lance (1987)
administered the Hudson and Ricketts Homophobia Scale to two groups. The first group
completed the questionnaire prior to a three hour exposure session and the second group
completed the scale after the session. Results indicated that exposure to a homosexual
reduces levels of homophobia. This line of reasoning appears to follow the theory of
cognitive dissonance, which is: an individual's attitude can be altered if the occurrence of
specific events are inconsistent with the established attitudes. In essence, we may alter
our attitudes to make them consistent with our overt actions.
The analysis of respondent characteristics revealed that gender regularly predicts
attitudes. It must be pointed out that only a small portion of the variance in attitude was
explained by the respondent characteristics measured in this study. The strength of the
main effect of sexual preference in the victim characteristic analysis suggests that more
variation could be explained by measures of homophobia or possibly prejudice. Other
possible factors that could be involved would be religiosity and sensation seeking or risk
taking behaviour. The main effect of mode of acquisition indicates that other social
factors may be implicated in relation to the attitude toward the victims of these diseases.
Subjects' attitudes toward promiscuity and alternatively drug usage may play substantial
roles in prediction of attitudinal differences. Further research should attempt to address
some of these areas.
Our results have indicated that attitudes towards AIDS victims are complicated by
a multitude of factors. The attitudes displayed by these respondents indicated that in
addition to sexual preference influencing attitudes, the gender of the victim and the way
in which the disease was acquired also influence the attitude.
References
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Kelly, J.A., St. Lawrence, J.S., Smith, S., Hood, H.V., & Cook, D.A. (1987a).
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Triplet, R.G., & Sugarman, D.B. (1987). Reactions to AIDS victims:Ambiguity breeds
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APPENDIX A
AIDS QUESTIONNAIRE
Please circle the correct response. All questions must
be answered. If you are not sure of the correct answer, do not
guess, circle DK (don't know).
T
=
true
F
=
false
DK =
don't know
1.
AIDS attacks the reproductive system.
2.
AIDS is more infectious than Hepatitis B.
3.
AIDS can be spread by using dirty needles during drug use.
4.
AIDS is responsible for causing chronic liver disease.
5.
Blood can be tested to see if the AIDS virus is present.
6.
AIDS can be spread by heterosexual intercourse.
7.
You can get AIDS by living with someone who is infected.
8.
Babies can get AIDS from breast feeding from their infected mothers.
9.
You can get AIDS from dishes that were used by an AIDS victim.
10. The AIDS virus can get through your skin if you are cut.
11. AIDS patients die because they can't successfully fight infections.
12. There is a vaccine for the AIDS virus which can prevent infection.
T
T
T
T
T
T
T
T
T
T
T
T
F
F
F
F
F
F
F
F
F
F
F
F
DK
DK
DK
DK
DK
DK
DK
DK
DK
DK
DK
DK