Gregory M. Herek, Ph.D.

Selected Publications on HIV/AIDS

 
Herek, G.M., & Glunt, E.K. (1988). An epidemic of stigma: Public reactions to AIDS. American Psychologist, 43 (11), 886-891.
  The AIDS epidemic has been accompanied by intensely negative public reactions to persons presumed to be infected by the human immunodeficiency virus (HIV). In this article, we define such reactions as AIDS-related stigma. We discuss two major sources of this stigma: the identification of AIDS as a deadly disease and the association of AIDS in the United States with already stigmatized groups, especially gay men. We describe some of the social and psychological processes that contribute to AIDS-related stigma and offer suggestions for eradicating stigma through public policy and individual education.
 
Herek, G.M. (1990). Illness, stigma, and AIDS. In P. Costa & G.R. VandenBos (Eds.), Psychological aspects of serious illness (pp. 103-150). Washington, DC: American Psychological Association.   This paper describes some of the general cultural, social, and psychological processes through which an illness becomes stigmatized, and the consequences of these processes for individuals with the disease. It applies these concepts to AIDS-related stigma, which refers to all unfavorable attitudes, beliefs, behaviors, and policies directed at persons perceived to be infected with HIV, whether or not they actually are infected and regardless of whether or not they manifest symptoms of AIDS. Individuals' hostility toward people with AIDS can best be understood through psychological and sociological perspectives on stigma, prejudice, and attitudes. Individual manifestations of AIDS-related stigma represent the intersection of psychological processes with the cultural construction of the illness. Five areas of analysis are considered: the biomedical manifestations of AIDS, the cultural construction of AIDS, attitudes of the nonstigmatized, experiences of the stigmatized, and social interactions between the two groups. Note: This chapter is based on a Master Lecture delivered at the meeting of the American Psychological Association in New Orleans, LA.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., & Glunt, E.K. (1991). AIDS-related attitudes in the United States: A preliminary conceptualization. The Journal of Sex Research, 28 (1), 99-123.
  This paper offers a preliminary conceptualization of the psychological structure of AIDS-related attitudes among American adults, and describes some of the social and psychological factors that affect those attitudes. Data were collected first from participants in focus groups in five U.S. cities, and then from respondents in a national telephone survey. Two major psychological dimensions of attitudes were observed consistently. The first dimension, labeled COERCION/COMPASSION, includes judgments about the extent to which AIDS is viewed as highly contagious and requiring containment, through coercion if necessary. It also includes attributions of blame to people with AIDS. The second dimension, PRAGMATISM/MORALISM, includes judgments about the extent to which AIDS is viewed as controllable through research, public education and governmental sponsorship of behavior-change programs. The two attitude dimensions are not highly correlated. Regression analyses suggest that the two dimensions have different social and psychological antecedents, and that these antecedents differ between White and Black Americans. Using the two factors, a tentative typology of responses to the AIDS epidemic is presented. Implications for AIDS education and policy are discussed.
 
Herek, G.M., & Capitanio, J.P. (1993). Public reactions to AIDS in the United States: A second decade of stigma. American Journal of Public Health, 83 (4), 574-577.
  This study measured the pervasiveness of stigmatizing attitudes and beliefs concerning AIDS among the American public. Because African Americans have been disproportionately affected by AIDS, stigma also was assessed in a sample of Black Americans. Telephone interviews were conducted with a general sample of 538 U.S. adults, and a separate sample of 607 African Americans. Individuals were asked about their feelings toward persons with AIDS (PWAs), support for punitive policies, likelihood of avoiding PWAs, and beliefs about HIV transmission. Only 16.5% of Blacks and 22% of Whites did not give any stigmatizing responses. African Americans were more likely than Whites to overestimate the risk of infection through casual contact, but were less likely to hold negative personal feelings toward PWAs. Overall, females were less likely than males to stigmatize PWAs on measures pertaining to punitive policies and avoidant behaviors. Stigma among African Americans appears to focus on AIDS as a disease that threatens the Black community, whereas stigma among Whites appears to reflect attitudes toward the social groups principally affected by the epidemic. The results indicate that stigma reduction should be a central goal of AIDS educational efforts.
(An extended version of the paper is available elsewhere on this site.)
 
Herek, G.M., & Capitanio, J.P. (1994). Conspiracies, contagion, and compassion: Trust and public reactions to AIDS. AIDS Education and Prevention, 6 (4), 367-377.
  AIDS educational programs can be effective only to the extent that they are perceived as credible by their target audiences. In this study, public trust associated with AIDS was assessed in a national telephone survey. African Americans were more likely than Whites to express distrust of doctors and scientists concerning HIV transmission through casual contact, to believe that AIDS is being used as a form of genocide against minority groups, and to believe that information about AIDS is being withheld from the public. Individuals high in distrust did not differ from those low in distrust in their exposure to AIDS information. Higher levels of AIDS-related distrust were not related to self-reported personal risk reduction, but were related to inaccurate beliefs about HIV transmission through casual contact and greater willingness to avoid and stigmatize people with AIDS. The importance of overcoming distrust in AIDS education programs is discussed.
 
Herek, G.M., & Capitanio, J.P. (1997). AIDS stigma and contact with persons with AIDS: Effects of direct and vicarious contact. Journal of Applied Social Psychology, 27 (1), 1-36.
  This paper examines the relationship between AIDS-related stigma and (1) direct, personal contact with people with AIDS (PWAs), and (2) vicarious contact – through mass media – with a public figure with AIDS or HIV. Data are presented from a 2-wave national telephone survey with a probability sample of U.S. adults (ns = 538 at Wave 1; 382 at Wave 2) and an oversample of Black Americans (ns = 607 and 420, respectively). Direct contact with a PWA was associated with less support for coercive AIDS policies, less blame for PWAs, and less avoidance of PWAs. Vicarious contact – operationalized as the self-reported impact of Earvin "Magic" Johnson's disclosure of his HIV infection, which occurred shortly before Wave 2 data collection began – appeared to have its greatest impact among respondents who previously had manifested high levels of stigma. In that group, levels of stigma diminished somewhat to the extent that respondents reported having been strongly influenced by Johnson's announcement. Some differences between the general population sample and the Black oversample were observed in the relative impact of direct and vicarious contact. Although direct contact was negatively correlated with stigma, the best predictors of stigma were respondents' attitudes toward gay men and their beliefs about casual contact. Implications of the findings for reducing AIDS stigma are discussed.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., & Capitanio, J.P. (1998). Symbolic prejudice or fear of infection? A functional analysis of AIDS-related stigma among heterosexual adults. Basic and Applied Social Psychology, 20 (3), 230-241.
  To determine whether attitudes toward a stigmatized group are primarily instrumental or symbolic, multiple aspects of AIDS stigma were assessed in a two-wave telephone survey with a national probability sample of adults (N = 382). Using responses to the Attitude Functions Inventory (AFI), respondents were categorized according to the dominant psychological function served by their attitudes: (1) evaluative (based on instrumental concerns about personal risk for infection), or (2) expressive (based on a need to affirm one's self concept by expressing personal values). Negative affect toward a person who contracted AIDS through homosexual behavior, support for mandatory testing of so-called high-risk groups, and support for other punitive AIDS policies were predicted mainly by attitudes toward gay men for heterosexuals with expressive attitudes but not for those with evaluative attitudes, a pattern labeled functional divergence. Behavioral intentions to avoid persons with AIDS in various hypothetical situations were predicted primarily by beliefs about contagion for heterosexuals with expressive and evaluative attitudes alike, a pattern labeled functional consensus. Implications for AIDS education and for research based on the functional approach to attitudes are discussed.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., Mitnick, L., Burris, S., Chesney, M., Devine, P., Fullilove, M. T., Fullilove, R., Gunther, H. C., Levi, J., Michaels, S., Novick, A., Pryor, J., Snyder, M., & Sweeney, T. (1998). AIDS and stigma: A conceptual framework and research agenda. AIDS and Public Policy Journal, 13 (1), 36-47.
  AIDS-related stigma (or, more simply, AIDS stigma) refers to prejudice, discounting, discrediting, and discrimination directed at people perceived to have AIDS or HIV and at the individuals, groups, and communities with which they are associated. It persists despite passage of protective legislation and disclosures by public figures that they have AIDS or are infected with HIV. Although widely recognized as a problem, AIDS stigma has not been extensively studied by social and behavioral scientists. Empirical research is urgently needed in this area, however. Data are especially needed to inform government leaders, health providers, and the general public as they debate new policies concerning HIV treatment, prevention, and monitoring. This paper represents the final report from a research workshop convened by the Office on AIDS of the National Institute of Mental Health (NIMH) to consider the problem of AIDS-related stigma, its impact on the epidemic, and priorities for empirical research. The workshop, co-chaired by Gregory Herek and Leonard Mitnick of NIMH, was designed to promote consideration of empirical research and theory-building that would have both basic and applied scientific significance, including implications for policymakers and opinion leaders.
(A pre-publication version of the report in PDF format can be downloaded from this site.)
 
Herek, G.M., Gillis, J. R., Glunt, E. K., Lewis, J., Welton, D., & Capitanio, J. P. (1998). Culturally sensitive AIDS educational videos for African American audiences: Effects of source, message, receiver, and context. American Journal of Community Psychology, 26(5), 705-743.
  The importance of using culturally sensitive educational materials in HIV-related interventions with racial and ethnic minority groups is widely recognized. However, little empirical research has been conducted to assess the relative effectiveness of different techniques for creating culturally sensitive AIDS educational videos. Two field experiments with three samples of African American adults (Ns = 174, 173, and 143) were conducted to assess how source characteristics (race of communicator), message characteristics (multicultural message versus culturally specific message), and audience characteristics (racial distrust and AIDS-related distrust) influence proximate (perceptions of the message's credibility and attractiveness) and distal (AIDS-related attitudes, beliefs, and behavioral intentions) output variables for AIDS educational videos. In Study 1, an AIDS video with a culturally-specific message was rated as more credible, more attractive, and of higher quality than was a video with a multicultural message. The multicultural message was rated less favorably when delivered by a White announcer than when the announcer was Black. In Study 2, the same pattern was replicated with a second community sample and a campus-based sample. Study 2 also indicated that a multicultural message might be more effective if delivered in a culturally-specific context, namely, after audience members watch a culturally specific video. Minimal changes were observed in distal outcome variables. It is argued that influencing proximate output variables is necessary, though not sufficient, for effecting long-term change in AIDS-related attitudes, beliefs, and behaviors.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., (1999). AIDS and stigma. American Behavioral Scientist, 42, 1102-1112.
  This paper briefly reviews current knowledge about AIDS-related stigma, defined as prejudice, discounting, discrediting, and discrimination directed at people perceived to have AIDS or HIV, and the individuals, groups, and communities with which they are associated. AIDS stigma has been manifested in discrimination, violence, and personal rejection of people with AIDS (PWAs). Whereas the characteristics of AIDS as an illness probably make some degree of stigma inevitable, AIDS has also been used as a symbol for expressing negative attitudes toward groups disproportionately affected by the epidemic, especially gay men and injecting drug users (IDUs). AIDS stigma affects the well-being of PWAs and influences their personal choices about disclosing their serostatus to others. It also affects PWAs' loved ones and their caregivers, both volunteers and professionals. Stigma has hindered society's response to the epidemic, and may continue to have an impact as policies providing special protection to people with HIV face renewed scrutiny.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., & Capitanio, J.P. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1126-1143.
  This paper presents national survey data to assess the extent to which AIDS-related stigma remains linked to public attitudes toward homosexuality in the United States. Most heterosexuals continue to associate AIDS primarily with homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice (antigay attitudes). Although all people who contract AIDS sexually are assigned blame for their infection, such blame is greater for a gay or bisexual man than for a heterosexual man or woman. A sizable minority of the public equates all male-male sexual behavior with AIDS, even sex between two HIV-negative men. A substantial portion also expresses discomfort about touching an article of clothing or drinking from a sterilized glass used by a PWA. These misconceptions and discomfort are correlated with sexual prejudice. It is argued that the link between AIDS attitudes and sexual prejudice impedes HIV prevention efforts and threatens civil rights.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Capitanio, J.P., & Herek, G.M. (1999). AIDS-related stigma and attitudes toward injecting drug users among Black and White Americans. American Behavioral Scientist, 42, 1144-1157.
  Research has indicated that stigmatizing AIDS attitudes are associated with negative attitudes toward gay men. Because injecting drug users (IDUs) are also stigmatized and because injecting drug use is an important exposure category for HIV infection, we hypothesized that AIDS stigma might also be related to attitudes toward IDUs. We further hypothesized that the proportionately higher level of HIV transmission related to injecting drug use in the African American community would produce different patterns of stigma between Blacks and Whites. National probability samples of U.S. adults were interviewed by telephone. Respondents with more negative attitudes toward IDUs held more stigmatizing AIDS attitudes. Among Blacks, such attitudes explained more variance than did attitudes toward gay men, a pattern opposite to that found among Whites. Moreover, knowing someone who injected illegal drugs was associated with less AIDS stigma for Blacks, but not for Whites. The results suggest that Blacks' and Whites' attitudes toward people with AIDS are informed by their different experiences of the AIDS epidemic.
 
Herek, G. M. (2000). The social construction of attitudes: Functional consensus and divergence in the US public's reactions to AIDS. In G.R. Maio & J.M. Olson (Eds.), Why we evaluate: Functions of attitudes (pp. 325-364). Mahwah, NJ: Lawrence Erlbaum.
  This chapter offers some observations about attitude functions based on research in the area of AIDS and stigma. A conceptual framework is presented for thinking about how the functions served by attitudes can vary across domains and among the specific attitude objects that compose those domains. Some attitude objects are socially constructed in such a way that they elicit the same function from virtually all members of a population (a pattern labeled functional consensus), whereas others are constructed such that they elicit a variety of functions (/i>functional divergence). Data are presented from a series of opinion surveys about AIDS conducted between 1990-97 with national probability samples of US adults. Depending on the function served generally by their attitudes in the AIDS domain, respondents' specific AIDS attitudes were differentially correlated with their beliefs about HIV transmission and attitudes toward gay men. However, some specific AIDS attitudes elicited functional consensus: Regardless of which function their AIDS attitudes generally served at the domain level, most respondents' attitudes toward these specific aspects of AIDS manifested a similar pattern of relationships to their transmission beliefs and attitudes toward gay men.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., Gonzalez-Rivera, M., Fead, F., & Welton, D. (2001). AIDS educational videos for gay and bisexual men: A content analysis. Journal of the Gay and Lesbian Medical Association, 5 (4), 143-153.
  Objective: To systematically describe the content of AIDS educational videos targeting gay and bisexual men, and to compare it to the content of videos for heterosexual African American and Latino audiences. Design: AIDS videos targeting gay/bisexual men (n = 35), heterosexual African Americans (n = 14), and heterosexual Latinos (n = 25) were coded for the presence or absence of messages identified by various theoretical models as relevant to HIV education and risk reduction. Results and Conclusions: Videos targeting gay and bisexual men typically emphasized sexual risk reduction techniques whereas videos for heterosexual minority viewers were more likely to provide information about HIV transmission and audience members' vulnerability to AIDS. Despite their focus on reducing personal risk, most gay/bisexual videos did not depict partner negotiation for safer sex, reinforce the perception that social norms favor sexual risk reduction, or eroticize safer sex practices. Suggestions are offered for future research and for production of AIDS educational videos.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
Herek, G.M., Capitanio, J.P., & Widaman, K.F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991-1999. American Journal of Public Health, 92(3), 371-377.
  Objectives. This study assessed the prevalence of AIDS stigma and misinformation about HIV transmission in 1997 and 1999 and examined trends in stigma in the United States during the 1990s. Methods. Telephone surveys with national probability samples of English-speaking adults were conducted in 1996-97 (N = 1309) and 1998-1999 (N = 669). Findings were compared to results from a similar 1991 survey. Results. Overt expressions of stigma declined throughout the 1990s, with support for its most extreme and coercive forms (e.g., quarantine) at very low levels by 1999. However, inaccurate beliefs about the risks posed by casual social contact increased, as did the belief that people with AIDS (PWAs) deserve their illness. In 1999, approximately one-third of respondents expressed discomfort and negative feelings toward PWAs. Conclusions. Although support for extremely punitive policies toward PWAs has declined, AIDS remains a stigmatized condition in the United States. The persistence of discomfort with PWAs, blame directed at PWAs for their condition, and misapprehensions about casual social contact are cause for continuing concern and should be addressed in HIV prevention and education programs.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
 
 
Herek, G.M. (2002). Thinking about AIDS and stigma: A psychologistís perspective. Journal of Law, Medicine, and Ethics, 30, 594-607.
  This article provides a brief introduction to social psychological theory and research concerning AIDS-related stigma. After defining stigma and distinguishing it from the related constructs of prejudice and discrimination, the article briefly describes the contours of contemporary AIDS stigma in the United States, using findings from the author's own empirical research to illustrate key patterns. Reasons why HIV is stigmatized are considered and the ways that stigma is enacted in social encounters are discussed. Instrumental stigma (which is based mainly on fear of HIV-transmission) is distinguished from symbolic stigma (based mainly on preexisting attitudes toward the groups disproportionately affected by HIV). Various strategies for reducing AIDS stigma are considered.
 
 
 
Herek, G.M., Capitanio, J.P., & Widaman, K.F. (2002). Stigma, social risk, and health policy: Public attitudes toward HIV surveillance policies and the social construction of illness. Health Psychology, 22 (5), 533-540.
  This study examined how illness-related stigma is symbolically expressed through public attitudes toward health policies. Data from a 1999 national telephone survey with a probability sample of English-speaking US adults (N = 1,335) were used to assess how support for HIV surveillance policies is related to AIDS stigma and negative attitudes toward groups disproportionately affected by the epidemic. Anonymous reporting of HIV results to the government was supported by a margin of approximately 2-to-1, but name-based reporting was opposed 3-to-1. Compared to opponents of name-based reporting, supporters expressed significantly more negative feelings toward people with AIDS, gay men, lesbians, and injecting drug users, and were significantly more likely to overestimate the risks of HIV transmission through casual contact. More than one third of all respondents reported that concerns about AIDS stigma would affect their own decision to be tested for HIV in the future. Implications for understanding the social construction of illness and for implementing effective HIV surveillance programs are discussed.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)
 
 
 
Herek, G.M., Widaman, K.F., & Capitanio, J.P. (2005). When sex equals AIDS: Symbolic stigma and heterosexual adultsí inaccurate beliefs about sexual transmission of AIDS. Social Problems, 52 (1), 15-37.
  Data from an experiment embedded in a national telephone survey of heterosexual, English-speaking US adults (N = 1,283) were used to examine the relationship between sexual prejudice and erroneous beliefs about AIDS transmission. Respondents were presented with three scenarios, each describing a single sexual encounter between a different healthy (i.e., HIV-negative) protagonist and another person. The scenarios varied in the sexual partnerís HIV status (positive in one, negative in the others) and the use of condoms (condoms used in one scenario, not used in the others). The protagonistís sex and sexual orientation as well as the sex of her or his partner were experimentally manipulated. Nearly all respondents correctly stated that the protagonist could contract AIDS through unprotected sex with a person with AIDS. A substantial minority erroneously believed the protagonist could contract AIDS through sex with an uninfected partner, and significantly more respondents believed that a homosexual or bisexual man who had sex with another (uninfected) man risked AIDS compared to respondents who were asked about a heterosexual encounter. Across experimental manipulations, inaccurate beliefs about HIV transmission through unprotected sex were predicted by lower educational level, lower income, being female, being Black, high religiosity, a high degree of personal concern about contracting AIDS, and lack of knowledge about HIV transmission through casual contact. With other relevant variables statistically controlled, sexual prejudice was not a significant predictor of inaccurate beliefs about HIV transmission through unprotected sex but did predict erroneous beliefs about transmission through protected sex.
(A pre-publication version of the paper in PDF format can be downloaded from this site.)

 

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