4% #5... Y. Wu... .I'HnAtn . .mmw f.” . $.M....u.wf .3 . a.» E. 1......uafi 1... Lin? a. fiéfifiu. . Mafia ukuwwlfihul’s. . . .. . . .. . .. . . :mfzuaaxzmmp. i . . . i _ . .. . , .. . _ 7,. ., . 5:. f . . ..>.. ..|u vi iii... . . . . 9.- a... Passing . . . . . . . . f‘i I“ j 'J it ,. A? 9' 3935: 1%}. is? $13!, 3 i. i‘ '. T . . at .95.. a . V. D l rho .xI\l:\.1vl»0 ,.. that; HO: 7 nvtlquht ‘ I.\ W»?! ly..%....u....u.....u3 . .rHflWnn n .3ka . . 41.35;»; . , .3... . notu .. .. a5?!hnmu v D . . D : t I. vuIc .“ “xv Wm.uq....v.z.. .1. . an fight: I... .i.’ E} O '3 1» 3 1‘ i9. .IJQ .1571? qt. & *3 fly. “.3 p ‘. 'fl' , I- In. L635: 3. ~U- ‘1‘ I 'I, - . ._. n .13.!3... . "1.197759 . . . . a . _ 1. . .8... h u <. I {fill . . - . . . :76 Q4. . é. .91..)vl; . :2 . Hlxfln..f$. . e..$...«v¢..h.!.:-.n .. . . MID. quiuvnévuzvllrt ....I . kinks. 1.6 ‘ wit-n .. ‘ "“1”":le I". -. ~4~ Lullm‘ vzlolunm ti... WPI‘J.‘ , £511.... 1!.-. l... .ull|.v|hn.ln| . \Wt’b.‘ V . 19163.... .2. .Wm ‘~ .. I Q". lamb... .rv -.$0!Yul§11 I ....vl.1t. .\‘: . b: t. i .lu... .. In. v51 1 IGAN STA m... will" 1w mmlfiu‘i'l'llfi mm mm 0, 31293 01565 0215 LIBRARY Michigan State University This is to certify that the thesis entitled Measuring Associational Stigna Among HIV/AIDS Workers presented by David William Lounsbury has been accepted towards fulfillment of the requirements for Masters.— degree in mores—y WM Major professor Ralph Levine, Ph.D. Date §/§/?¥ 0-7639 MS U is an Aflinnativc Action/Equal Opportunity Institution PLACE IN RETURN BOX to remove this checkout from your record. TO A 0!!) FINES return on or before date due. DATE DUE DATE DUE DATE DUE 'L [‘QJLI i l 1 MSU leeAnNflrmetlv eActIOIVEquelO pportunttylnetltmonm mmwrj MEASURING ASSOCIATIONAL STIGMA AMONG HIV/AIDS WORKERS By David William Lounsbury A THESIS Submitted to Michigan State University in partial fiilfillment of the requirements for the degree of MASTER OF ARTS Department of Psychology 1997 ABSTRACT MEASURING ASSOCIATIONAL STIGMA AMONG HIV/AIDS WORKERS By David William Lounsbury The present study developed a quantitative measure of the degree to which HIV IAIDS workers (N=319) perceive an associational stigma as a result of their close social proximity to persons who have HIV/AIDS. The measure was comprised of two macro-dimensions: depravity (perceiving oneself to be viewed by others as morally bad, corrupt, infectious and perverted because one attends to the needs of persons who have HIV/AIDS) and disempathy (perceiving oneself to be viewed by others as misunderstood, unadmired, and not worthy of compassion because one attends to the needs of persons who have HIV/AIDS). Perceived associational stigma (PAS) tended to be higher when persons who were less familiar to the worker were considered (“Dam-vity = .61; nmm = .49). Depravity was linked to perceptions of being physically avoided by others (r = .55). Disempathy was linked to perceptions of depravity (r = .19) and to perceived social support from HIV/AIDS workers (r = -. l 2). Workers who reported stronger PAS were less likely to exhibit HIV/AIDS-related communication behavior [i.e., informal conversation with others about their HIV/AIDS work] (Wit, = -.29; rpm, = -.O9). To all those whose efforts have pushed the world closer to the end of its epidemics of fear, hate, and intolerance. ACKNOWLEDGMENTS Firstly, I would like to acknowledge my parents, Goody and Bill, and my sisters, Chris and Cindy. Without their love and support I am sure that I would not have found the courage to set off on such a process as graduate school and, hence, would not have this work to share with you today. Secondly, I would like to acknowledge MSU faculty members Ralph Levine, Tom Reischl, John Schweitzer, Brian Mavis, and Galen Bodenhousen. Without their scholarly companionship this work would not have been as strong a catalyst for my personal and professional growth. Thirdly, I would like to acknowledge MSU ecological-community graduate students Holly Angelique, Juliette Mackin, and Hoa Nguyen. This work is validated in a fundamental way by their gracious contribution of genuine regard for me as classmate and friend. Also from MSU, I would like to acknowledge undergraduate assistants Andrea Pasbjerg, Whitney Vollmar, and Callie Bair. Their fresh perspective and authentic curiousity added another dimension of meaning and purpose to this work. lastly, and also most importantly, I would like to acknowledge my friends at the Lansing Area AIDS Network, in particular Patrick Lombardi, Carrie Tarry, and Bill Bathie. Their dedication to improving the quality of life for all people affected by HIV/AIDS is what truly inspired this work. iv TABLE OF CONTENTS LIST OF TABLES ............................................................................................................. viii LIST OF FIGURES ............................................................................................................ xi INTRODUCTION ............................................................................................................... 1 Current Epidemiology of HIV/AIDS .......................................................................... 1 Responding to the HIV/AIDS Epidemic .................................................................... 2 Perceptions of Them ................................................................................................... 4 Searching for a Social Cure ........................................................................................ 6 Goffman’s Conceptual Work on Social Stigma ......................................................... 7 CHAPTER 1 PREVIOUS RESEARCH ON HIV/AIDS STIGMA .......................................................... 9 Associational Stigma .................................................................................................. 9 Studies that Measure Perceptions that Others have of Associates .................... 9 Studies that Measure Perceptions that Associates Have of Others ................... 12 Dimensions of HIV/AIDS Stigma ............................................................................. 18 Judgments of Moral Wrong-doing ................................................................... 18 Judgments of Responsibility/Connollability .................................................... 19 Fear of Contagion ............................................................................................. 20 Lack of Compassion ......................................................................................... 21 Assessment of Dependency/Disability ............................................................. 21 Fear of Death .................................................................................................... 22 Other Research on HIV/AIDS Stigma ....................................................................... 23 CHAPTER 2 DEVELOPING AND TESTING A MEASURE OF ASSOCIATIONAL HIV/AIDS STIGMA ............................................................................................................................. 32 Present Study’s Research Questions .......................................................................... 32 Hypotheses ................................................................................................................. 33 CHAPTER 3 METHOD ........................................................................................................................... 42 Procedure ................................................................................................................... 42 Measures .................................................................................................................... 43 Section A. HIV/AIDS Work Background ........................................................ 44 V Section B. Perceptions of Others’ Beliefs ........................................................ 44 Section C. Perceptions of Others’ Negative Behaviors .................................... 45 Section D. Communication with Others ........................................................... 46 Section E. Unexpected Reactions of Others ..................................................... 46 Section F. Personal Background ....................................................................... 47 CHAPTER 4 RESULTS ........................................................................................................................... 48 Use of Confidence Intervals, Inference Probabilities, and Odds Ratios .................... 50 Significance Testing and Confidence Intervals ................................................ 50 Correcting for Attenuation ................................................................................ 51 Inference Probabilities and Odds Ratios for Correlations ................................ 52 Description of Study Sample ..................................................................................... 54 Response Rates ................................................................................................. 54 Respondent Demographics ............................................................................... 55 Types of HIV /AIDS Organizations .................................................................. 56 How Respondents Worked with Persons with HIV/AIDS ............................... 56 Groups Served by HIV/AIDS Workers ............................................................ 59 Dimensionality of Percieved Associational Stigma (Hypotheses 1 - 2) ......................... 62 Exploratory Factory Analysis ........................................................................... 63 First Order Confirmatory Factor Analysis ........................................................ 66 Second Order Confirmatory Factory Analysis .................................................. 68 Pychometrics for Perceived Associational Stigma Scales ................................ 70 Bivariate Correlational Findings ............................................................................... 74 Scale Composition and Psychometrics ............................................................. 75 Correlates of Perceived Associational Stigma (Hypotheses 3 - 10) ...................... 78 Correlates of Perceived Social Distance (Hypotheses Il - I9) .............................. 88 Correlates of HIV/AIDS-related Communication Behavior (Ibipotheses 20 - 29) .............................................................................................. 94 Supplemental Analyses .............................................................................................. 99 Exploratory Cluster Analysis of Study Respondents ........................................ 99 Exploratory Path Analysis of Major Constructs ............................................. 104 CHAPTER 5 DISCUSSION ................................................................................................................... 108 Differentiating Depravity from Disempathy ............................................................ 108 Strength of Association ........................................................................................... 114 Strength of Belief ..................................................................................................... 115 HIV/AIDS Worker Profiles ..................................................................................... 117 Talking is Preventing ............................................................................................... 118 Conclusion ............................................................................................................... 120 APPENDD( A- Participating Organizations ................................................................... 121 APPENDIX B - UCRHIS Approval ................................................................................ 123 vi APPENDIX C - HIV /AIDS Work Experience Survey with Variable Names .................. 124 APPENDD( D - Cover letter to participants .................................................................... 138 APPENDIX E - Informed Consent Sheet ........................................................................ 139 APPENDIX F - Study Results Request Form .................................................................. 140 APPENDIX G - Variable Descriptives ............................................................................ 141 APPENDIX H- Value Labels for Categorical Variables ................................................. 148 APPENDIXI - Variable Compute Statements (SPSS for Windows Syntax) ................. 161 APPENDD( J - Respondent Demographics .................................................................... 165 APPENDIX K- Hunter and Hamilton’s Path Analysis Output ....................................... 169 REFERENCES ................................................................................................................. 173 vii LIST OF TABLES Table 1 - Interpretation of Inference Probabilities and Odds Ratios for Correlations ..... 53 Table 2 - Respondents’ City of and County of Residence by Regional HIV Prevention Planning Group (RPPG) ................................................................. 54 Table 3 - Cumulative Incidence of AIDS by Regional HIV Prevention Planning Group (RPPG) ................................................................................... 55 Table 4 - How Respondents Worked with Persons with HIV /AIDS ............................... 60 Table 5 - Groups Served by HIV/AIDS Workers ............................................................ 61 Table 6 - Hypotheses for Research Question 1 ................................................................ 62 Table 7 - Factor Loadings and Uniqueness for Exploratory Factor Analyses of Dimensions of Perceived Associational Stigma ............................................... 65 Table 8 - Percentage of Variance Explained for Exploratory Factor Analyses of Dimensions of Perceived Associational Stigma ............................................... 66 Table 9 - First Order Correlation Matrix and Item-F actor Loadings for Confirmatory Factor Model of Perceived Associational Stigma ............................................ 67 Table] 0 - Second Order Correlation Matrix and Item-Factor Loadings for Confirmatory Factor Model of Perceived Associational Stigma ...................... 69 Table 11 - Standard Score Coefficient Alpha and Average Correlation for Perceived Associational Stigma Scales ............................................................................. 70 Table 12 - Univariate Repeated Measures Analysis for Perceived Associational Dimensions of Perceived Associational Stigma ............................................... 73 Table 13 - Summary of Results for Research Question 1 .................................................. 74 Table 14 - First Order Correlation Matrix and Item-Factor Loadings for Confirmatory Factor Model of Five Multi-Item Scales .......................................................... 77 viii Table 15 - Standard Score Coefficient Alpha and Average Correlation for Multi-item Scales ................................................................................................................ 78 Table 16 - Hypotheses for Research Question 2 ................................................................ 79 Table 17 - Correlational Analysis for Perceived Associational Stigma and Satisfaction with Work Experience .................................................................. 80 Table 18 - Correlational Analysis for Perceived Associational Stigma and Basis of HIV/AIDS Work (Volunteer vs. Paid) ............................................................. 80 Table 19 - Correlational Analysis for Perceived Associational Stigma and the Number of Otherwise Stigrnatized Groups of PWAs with whom Respondents Work ..82 Table 20 - Correlational Analysis for Perceived Associational Stigma and Frequency of Face-to-face Contact with PWAs ................................................................. 82 Table 21 - Correlational Analysis for Perceived Associational Stigma and Duration of Work Experience .......................................................................................... 84 Table 22 - Correlational Analysis for Perceived Associational Stigma and Perceived Social Support from Peer HIV/AIDS Workers ................................................ 84 Table 23 - Correlational Analysis for Perceived Associational Stigma and Perceived Risk of HIV Infection ....................................................................................... 86 Table 24 - Correlational Analysis for Perceived Associational Stigma and the Proportion of Persons who know about Respondent’s HIV/AIDS Work ........ 86 Table 25 - Summary of Results for Research Question 2 .................................................. 87 Table 26 - Hypotheses for Research Question 3 ................................................................ 89 Table 27 - Correlational Analysis for Perceived Associational Stigma and Perceived Social Distance ................................................................................................. 90 Table 28 - Correlational Analysis for Perceived Social Distance and Selected Variables ........................................................................................................... 91 Table 29 - Summary of Results for Research Question 3 .................................................. 93 Table 30 - Hypotheses for Research Question 4 ................................................................ 94 Table 31 - Correlational Analysis for HIV/AIDS-related Communication Behavior and Perceived Associational Stigma ................................................................. 96 Table 32 - Conclational Analysis for HIV/AIDS-related Communication Behavior and Selected Variables ...................................................................................... 96 Table 33 - Summary of Results for Research Question 4 .................................................. 99 Table 34 - Validation of Group Membership by Selected External Criteria ................... 102 Table 35 - Nonlinear Correlational Analysis for Selected External Criteria and Respondent Group .......................................................................................... 104 Table 36 - List of Results Tables for Path Analytic Model’s Direct Links ..................... 107 LIST OF FIGURES Figure l - Types of HIV/AIDS Organizations ................................................................. 57 Figure 2 - Types of HIV/AIDS Work .............................................................................. 58 Figure 3 - Confirmatory Factor Model for Perceived Associational Stigma ................... 71 Figure 4 - Standardized Respondent Group Centers ...................................................... 101 Figure 5 - Respondent Group Profiles ........................................................................... 103 Figure 6 - Path Analysis of the Effect of Perceived Associational Stigma on HIV IAIDS-related Communication Behavior ............................................... 106 xi INTRODUCTION Current Epidemiology of HIV/AIDS Sixteen years have now passed since the Centers for Disease Control and Prevention (CDC) reported the unsettling news of five deaths in Los Angeles from Pneumocystis carinii pneumonia (PCP) (CDC, 1981; US. Public Health Service, 1986), an opportunistic infection now commonly associated with Acquired Immunodeficiency Syndrome (AIDS). Since then the United States has seen more than 548,102 cases of AIDS, approximately 63% of which have already ended in death (Michigan Department of Community Health [MDCH], 1996). By 1993 AIDS was, and continues to be, the number one cause of death among American men between the ages of 25 and 44 (CDC, 1993; CDC, 1995a). In the United States alone at least 1,000,000 people are currently infected with Human Immunodeficiency Virus (HIV), the virus that causes AIDS (CDC, l995a). Moreover, up to 80,000 new cases of HIV-infection are expected to be reported in the United States alone each year (CDC, 1995a). Recent reports indicate that the prevalence of AIDS in the United States and other western industrialized countries will stabilize gradually over the next few years (CDC, 1995a). Although somewhat encouraging, health officials consider the number of cases at which the epidemic appears to be leveling off to be unacceptably high. Other parts of the world, Asia in particular, are experiencing rapidly worsening rates of HIV infection and more virulent forms of I-HV (World Health Organization [WHO], 1995). WHO reported 1 2 that more than 18 million adults and 1.5 million children have been infected with HIV worldwide, which has already resulted in approximately 4.5 million cases of AIDS in 17 8 countries. These epidemiological data Show how the HIV /AIDS epidemic continues directly to affect the health and general well-being of people throughout the globe. Assessment of the larger social impact of HIV /AIDS, however, is a far more complex task. In an attempt to communicate the character of the social impact that HIV/AIDS has had in the United States in just one decade, Cadwell (1991) wrote: AIDS has threatened the social order of [this country]. Norms about expectable life spans have contracted by 50% for some groups. Stereotypes have cracked. Macho movie idols topple as their disease reveals them as ‘faggots.’ The fundamental taboos of sex and death have reared in full public view spread across newspaper headlines and on the nightly television news. Different groups have heralded the demise of their more crucial social values. For spokespersons of Middle America, the family is at stake. For some gay liberationists, freedom of sexual expression is in jeopardy. Formerly disguised prejudice is exposed in the lack of finding for education and prevention of AIDS. Gays [among other groups] already stigmatized as deviant are further stigmatized as lethally contagious (p. 236). In short, HIV/AIDS presents society with a complex array of social problems that simultaneously challenge our technology, knowledge, and values. Responding to the HIV/AIDS Epidemic Society’s response to the problem of HIV/AIDS may be best characterized as unwieldy and polarized. Some have used HIV/AIDS to justify draconian policies that they claim will stamp out moral decay and promiscuity in society (Buchanan, 1987; Cohen, 1987). Others have used it to justify the need for innovative and progressive initiatives in medicine, law, public policy, and social science (Stryker et al., 1995). For instance, the fight against HIV /AIDS has led to the discovery of new treatments for a number of other 3 diseases and health problems (Lemp, Payne, Neal, Temelso, & Rutherford, 1990); has forced revision of legal code so that potentially life-sustaining drugs are made more available (Hansen, Ranelli, & Ried, 1995); has produced an empowered advocacy for the promotion of nationwide health-enhancement programs (Kelly, Murphy, Sikkema, & Kalichman, 1993); and has assembled an enlightened new literature on human sexualityhincluding homosexuality and adolescent/teenage sexualityhand drug-using behaviors (Adib & Ostrow, 1991). Also out of the problem of HIV /AIDS has emerged a proliferation of community- based HIV/AIDS organizations, which can be found in cities, towns, and rural areas alike (U .8. Conference of Mayors, 1990). Most of these organizations are set up expressly to serve persons with HIV/AIDS, but many have expanded to provide other services such as HIV-antibody testing, prevention education, and community-based advocacy and referrals. Volunteers typically comprise most of the personnel in these organizations¢so much so that the phenomenon of community-based HIV/AIDS service development has come to be referred to as AIDS Volunteerism (Omoto & Crain, 1995a; Omoto & Synder,1995). Although medicine, law, public policy, social science, and grassroots initiatives have each made an undeniable contribution to the fight against HIV/AIDS, these gains can be more directly credited to the efforts of a select (i.e., particularly affected) segment of the population (Omoto & Snyder, 1995; Williams, 1988). Although some research shows a gradual increase in attention to issues related to HIV /AIDS and compassion for persons who have HIV/AIDS (Weiner, 1988), the general public appears to have remained relatively aloof (Maticka-Tyndale, 1996). 4 Perceptions of Them Gilmore and Somerville (1994) note that a threat to a person’s well-being, such as HIV/AIDS, instigates an arguably adaptive human proclivity to divide ourselves quickly into self-serving categories of us and them. This differentiation may account for much of the indifference found among the general public regarding persons with HIV/AIDS. They further write that: When people, as individuals, a group, or society, are confronted with a frightening or intolerable situation, their response can be to attempt to flee or escape from it; to control it by activating or destroying it, or its cause; to deny it; or to displace the fear it engenders such that its impact is eliminated or minimized (p. 1339). Aspects of this general phenomenon have often been observed during previous epidemics of disease, in particular those of Black Plague, cholera, polio, and syphilis (e.g.,Brandt, 1988; Risse, 1988; Rosenberg, 1987). With respect to HIV/AIDS in the United States, American society was quick to label exactly who comprised them. Analysis of media reporting about HIV/AIDS during the first half of the 19808 underscored, often with high melodrama, that the disease affected particular “high risk groups” and that it was “lethal,” “exotic,” and “mysterious” (Kinsella, 1988). These early characterizations of the disease established a basis upon which social perceptions of persons with HIV/AIDS would be formed. First known here as “the gay cancer,” Gay Related Immune Disorder (GRID), or “the gay plague,” HIV/AIDS has always been considered a disease that affects men who have sex with men (e.g., Adib & Ostrow, 1991). Besides men who have sex with men, it was also associated with hemophiliacs, Haitians, and heroin-users. HIV/AIDS, in fact, came to be known to many people as the disease of the ‘four Hs.’ Indeed, these groups 5 comprised approximately 94% of all AIDS cases in the United States by the summer of 1983. Male-to-male sex accounted for 63% of all cases, followed by intravenous (IV) drug use (25%), Haitian (5%), contaminated blood products (1%), and undetermined (6%) (Foege, 1983). Although the statistics are organized somewhat differently now, the current proportions of AIDS cases remain similar. Male-to-male sex accounts for 50% of all AIDS cases, followed by IV drug use (25%), male-to-male sex and IV drug use (6%), contaminated blood products (2%), heterosexual sex (8%), perinatal infection (1%), and undetermined (7%) (MDCH, 1996). The fact that HIV/AIDS continues to disproportionately afflict gay men and IV drug users, however, can be presumed to maintain the public’s perception that this disease is not a great threat to members of mainstream society. Yet the face of the epidemic is changing. Since the early 19803, the incidence of HIV/AIDS has been increasing in persons who are neither gay nor IV drug users (Choi & Coates, 1994; Lindhorst & Mancoske, 1993). Through October 1995, 51% of reported cases of AIDS were among blacks and Hispanics, even though these populations represent an estimated 13% and 10%, respectively, of the United States population (CDC, 1995a). Cun'ent statistics show that African-Americans now account for the highest prevalence of AIDS (646.9 per 100,000 people) among all racial groups in the United States (MDCH, 1996). This reality is explained by some researchers as a result of social problems such as higher drug abuse and worsening economic opportunity for the majority of the black community (F ullilove, Fullilove, Haynes & Gross, 1990). Links to worsening economic opportunity were also underscored by Haverkos and Edelrnan (1988), who 6 concluded that persons who are unemployed or under-employed were more likely to test HIV-positive. Regardless of why or why not HIV/AIDS continues to spread in this country, epidemiologists agree that national data continue to Show a yearly increase in the proportion of AIDS cases that are due to heterosexual transmission (CDC, 1995a). Searching for a Social Cure Because prospects for a biomedical cure for AIDS or a vaccine for HIV remain limited, primary prevention initiatives continue to be an essential component of any strategy that would bring about an end to the epidemic (Lifson, 1994; Kelly, et al., 1993; Mascola, McNeil, & Burke, 1994). Although never 100% guaranteed, HIV/AIDS prevention programs have had measurable positive impact (Cates & Hinman, 1992; Maticka-Tyndale, 1996). A number of such initiatives in the United States have demonstrated remarkable success, most notably within communities of gay men (Adib & Ostrow, 1991; Dilley, 1994; Kelly, et al., 1993). Success, however, has come on too small a scale. There is an urgent need to implement prevention programs that have a community-wide scope and that strengthen collaboration between community-based advocates, social scientists, and public health agents (Choi & Coates, 1994; Kelly et al., 1993). Although the most concrete explanations for not yet meeting this need are budgetary crises and poorly designed mechanisms for program dissemination (Choi and Coates, 1994; Philipson, Posner, & Wright, 1994), the effect of a pervasive social stigma that continues to surround the disease and those persons who are seen as somehow linked to it may be more at fault (Batchelor, 1988; Herek & Capitanio, 1993). Even if a biomedical cure were discovered in the near future, the blame, discrimination, and denial that characterize the social 7 dynamics of this epidemic would be likely to remain. Although there is broad consensus that the quality of life for persons with HIV/AIDS is often decreased because they are ofien highly stigmatized (e.g.,Herek and Capitanio, 1993; Herek & Glunt, 1988), community interventions tend not to directly address this problem (Bean, Keller, Newburg, & Brown, 1989). Prevention strategies must begin to take a more active role in destigrnatizing the epidemic. To the degree that this can be accomplished, suffering of persons with HIV/AIDS can be reduced, community-wide awareness and involvement can be increased, and more effective social policy can be enacted. Goffman’s Conceptual Work on Social Stigma Much of the research on the topic of stigma and associational stigma has been motivated by the work of sociologist Erving Goffman. Goffman (1963) defined stigma as the situation of the individual who is disqualified fiom fitll social acceptance. By his definition, the state of being stigmatized is understood to arise out of interactions between two types of persons, those who are normal [i.e., Goffman’s reference to a person who does not “depart negatively from the particular expectations at issue” ( Goffrnan, 1963, p. 5)], and those who possess a stigma. Stigrnatization, therefore, is a situation-specific event that generates an awareness of an individual’s possession of an unappreciated or devalued state of difference. In other words, one’s possession of this sort of dtfiizrentness (or at minimum an observer’s assumption of another’s differentness) is necessary, but not sufficient, for one to be stigmatized. Sometimes the social situation is such that the disqualifying mark possessed by an individual is not noticeable. In such cases persons typically employ some method of 8 information management (i.e., Goffrnan’s notion of “passing”), which keeps the individual merely discreditable. The state of being discredited is one in which the situation has not allowed the disqualifying mark to remain concealed. Here some manner of tension management is ofien employed (i.e., Goffman’s notion of “covering”) in order to diminish the social harm that stigmatized persons might otherwise be forced to endure. Goffrnan’s (1963) concept of a courtesy stigma, recoined here as associational stigma, refers to a state of being ‘indirectly’ devalued solely because of one’s close social proximity to others who are perceived to be ‘directly’ stigmatized (i.e., to actually own, or possess, the disqualifying mark) by their social situation. According to Goffman, “associates” most often derive from one or more sets of potentially supportive persons: (1) those who “own” the same stigma (i.e., Goffrnan’s reference to a person who has a particular stigma in common; such as a person who is also HIV-positive), (2) those who are ‘Vvise” (i.e., Goffman’s reference to a normal who is privy to the perspective of a stigmatized group, such as a person who has experience as a caregiver to persons with HIV/AIDS), and (3) those who are related by social structure (i.e., family members, such as a sibling, parent, or spouse of a person with HIV /AIDS). For the purposes of this study an associate will be any person who works with persons who have HIV/AIDS. A review of the literature about HIV IAIDS stigma follows in the next chapter. Chapter 1 PREVIOUS RESEARCH ON HIV/AIDS STIGMA Associational Stigma The concept of associational stigma has most often been used to explain particular kinds of coping strategies within the context of the family. It has also been used to study less compulsory relationships, such as relationships among roommates or among casual friends. Most studies of associational stigma have based their results on qualitative data from relatively small sample sizes. In a number of studies, associational stigma has been applied to the topic of HIV IAIDS, typically highlighting how it affects family members of someone who is discovered to be HIV-positive. In general, research about associational stigma may be sorted into the following two broad approaches: (1) studies that measure perceptions that potential stigrnatizers (i.e., persons who become aware of the respondent’s relationship with a person or group that is known to be stigmatized) have of associates and (2) studies that measure perceptions that associates have of potential Studies that Measure Perceptions that Others have of Associates Five studies measured perceptions that potential stigrnatizers have of associates. One of them is directly applied to persons who work with persons who have HIV/AIDS. The first of these studies, by Weyand (1984), asked 90 male students to evaluate attitudes toward descriptions of sons of fathers who were either alcoholic, mentally ill, or 9 10 non-stigmatized, and who were from either upper middle class or working class backgrounds. Content analysis of voice recordings of messages the subjects believed would be played for the target sons was also conducted. Results supported the existence of an associational stigma. The sons of such fathers were perceived to be generally acceptable persons, but were rated as likely to have a large number of problems in family situations, especially those that involved the father. In addition, a father’s alcoholism, relative to the mental illness, was found to elicit particularly stigrnatizing reactions for sons fiom a working class background. Signal] and Landy (1973) demonstrated that the male partner of an attractive woman was viewed more positively than the male partner of an unattractive woman. The study randomly assigned subjects (28 males and 28 females from an undergraduate psychology course) to observe one of four experimental conditions. Observations were of the male partner with either (1) an associated, attractive female (i.e., a girlfriend); (2) an associated, unattractive female; (3) an unassociated, attractive female; or (4) an unassociated, unattractive female. Perceptions of the stimulus male were lowest when he was associated with an unattractive female, highest when he was associated with an attractive female. Sigelrnan, Howell, Cornell, Cutright, and Dewey (1991) asked 120 men to evaluate four scenarios about two male roommates who shared a university dormitory room. In the scenarios, one of the males was identified as gay and the other was not. Respondents were then told that the non-gay roommate was either voluntarily or involuntarily living in the dorm room with the gay-identified male. Results supported that although involuntary association was not enough to register stigrnatization of the non-gay-identified male, ll voluntary association was, albeit only by those respondents with more intolerant attitudes toward gays. Sack, Seidler, and Thomas (1976) asked persons who were presumed to be stigmatized by others how they believed their stigma affected members of their social networks. The study analyzed qualitative data from 31 imprisoned parents who reported on the degree to which they perceived their children and spouses to suffer stigmatization and other social trauma as a result of their incarceration. The authors found that the imprisoned persons perceived that their children and spouses experienced decreased levels of social support and higher levels of harassment from the peers in their community. The fifth of these studies measured perceptions of potential volunteers and examined whether others devalued persons who volunteered to work with persons who have HIV/AIDS (Omoto & Synder, 1995b). To explore this possibility, evaluations of target AIDS volunteers were compared to evaluations of non-AIDS volunteers. It was hypothesized that target AIDS volunteers might be evaluated negatively because they were viewed as either (1) closely associated with a highly stigmatized group, (2) willing to be altruistic (i.e., “too perfect”), or (3) guilt-arousing (i.e., subjects feel guilty because they do not have the composure to do such work). Results showed that subjects in this study viewed AIDS volunteerism in a positive way. Volunteerism that assisted the poor (#755) or persons with HIV/AIDS (M=7 .49) was rated more favorably than volunteerism that assisted the Communist Party (M=5.85; F(2,122)=14.25, p<.05). Moreover, there was no support for either the hypothesis that HIV/AIDS volunteers were “too perfect” or that they were guilt-arousing. 12 Studies that Measure Perceptions that Associates Have of Others Eleven studies measure perceptions that associates have of potential stigmatizers. Half of them are directly applicable to persons who work with persons who have HIV/AIDS. In the first of these studies, Bennett, Kelaher, and Ross (1994) developed a 24-item scale that measured AIDS impact on health care professionals. Data fi'om 84 respondents generated an exploratory factor analysis solution with five factors. Results showed that items that loaded highly on a factor entitled Discrimination and Stigma Due to Work with AIDS accounted for more variance than any other factor (R2 = .13; scale reliability (or) = .72). Relating these results to other aspects of their study, the authors noted that HIV/AIDS workers may be more selective about whom they seek out for social support than other health care workers who do not work with persons who have HIV/AIDS. Three years of qualitative observations and data from a series of in-depth interviews with nine intimate parhrers of persons who succumbed to AIDS revealed that persons who lost their partners to AIDS suffered stigrnatization—which was sometimes blatant, sometimes subtle—from the medical community, friends, family, and religious organizations (Geis, Fuller & Rush, 1986). Their impressions of the difficult circumstance of participants in their small, non-random sample compelled them to generalize that “the degree of stress [surviving intimate partners] experience as a stigmatized and isolated group cannot be overestimated by anyone involved in counseling with these men” ( p. 43). In another study of caregiving partners of men with AIDS, Folkman, Chesney, and Richards (1994) found that caregivers often faced stigrnatization from fear of contagion. 13 They were typically assumed to be HIV -positive because they were known to be the intimate partner of a person with AIDS. Respondents were 86 HIV-positive men, plus 167 HIV -negative men in the caregiving group, and an additional 61 HIV-positive men in the comparison group. In general, stress among caregivers was greater than among non- caregivers, especially among those who were HIV-positive. In addition, caregivers reported longer durations and higher levels of negative moods, particularly anger and guilt. Anger was most often directed at either the disease itself, their AIDS-stricken partner, or the health care system. Guilt often resulted from either hostility towards their dying partner, inability to stop their partner’s pain and suffering, or from self-perceived betrayal when difficult decisions needed to be made concerning their dying partner’s fate. Calling attention to both the public and the private ways in which AIDS elicits fears of contagion, disability, death, and moral judgment, Powell-Cope and Brown (1992) explore how family caregivers are affected by HIV/AIDS. Their qualitative study content analyzed interview data from 53 family caregivers to explore the process of going public about a family member’s AIDS diagnosis. They classified caregivers into two broad groups: (1) those who became assertive advocates for persons with HIV/AIDS and (2) those who did not. The first group of caregivers found that their advocacy on behalf of persons with HIV/AIDS helped them cope with the pervasive social stigma that is linked to HIV/AIDS. In contrast, the second group of caregivers feared social rejection as a result of telling someone about a family member with AIDS. This “uncertainty” about whether or not to tell others was frequently cited as the reason that many caregivers maintained a situation of relative isolation and secrecy. Data analyses also revealed a particular emphasis on the phenomenon of guilt by association. The authors observed that 14 because of caregivers’ close relationship to a person with AIDS, they were “obligated to share the stigma of AIDS and were likewise discredit ” (p. 571), but that the majority of caregivers who participated in the study lived with neither complete openness nor complete secrecy. Powell-Cope and Brown (1992) suggest that these kinds of interpersonal pressures appear to affect communication about HIV/AIDS-related topics. Not communicating openly about HIV/AIDS issues may be an important barrier to overcome for community- based prevention programs. By transferring the first-hand knowledge that HIV/AIDS workers are naturally accumulating to persons in their social network, like friends and family members, they would be fimctioning as HIV/AIDS preventionists. In a case study of a 30-year-old gay man, McDonnell, Abel], and Miller (1991) assessed family members’ willingness to care for a person with AIDS. They deduced that although the family network is a logical source of support, many families of HIV-positive gay men are reluctant, if not unwilling, to care for them. Their reluctance is typically linked to stigrnatizing attitudes aimed directly at the HIV-positive family member as well as fear of an associational stigma from friends and co-workers. The authors suggested ways that social workers can help diminish such attitudes and facilitate effective family support for persons with HIV/AIDS. The sixth and final HIV/AIDS-related study on associational stigma, which focused specifically on AIDS volunteerism, researched the degree to which people tend to devalue HIV/AIDS-volunteers relative to other types of volunteers (Omoto & Crain, 1995b). Subjects were asked to imagine volunteering to care for one of three different persons: (1) a man living with AIDS, (2) a boy living with AIDS, or (3) a man living with 15 Alzheimer’s. Subjects were then asked to rate how they thought different members of their social network would respond to their volunteer work. Members of their social network included family members, close friends and co-workers. Omoto and Crain (1995b) reported that subjects believed that AIDS volunteerism is stigrnatizing, although in different ways among different members of their social network. Co-workers were viewed as the most stigmatizing (M=4.l3), followed next by close friends (W363), and then family members (M=3.09). The authors also noted that subjects who imagined working with the man with AIDS did not expect support from others. Outside of the context of HIV/AIDS, a study by Gochros (1985) found that wives of men who declared their bisexuality perceived themselves to be stigmatized by others. Through interviews with 103 women whose husbands had revealed their bisexuality to them, the consequences of disclosure and the factors that influenced them were explored by the author. At the time of the study, approximately two-thirds of the marriages had dissolved. Findings suggest that wives struggled less with their husbands’ bisexuality than with problems of isolation, stigma, and loss. Similarly, in a book about adjusting to a variety of types of social deviance, Pfuhl and Henry (1986) noted that parents of gay and lesbian children often encountered social rejection when members of their social network heard that their son or daughter was not heterosexual. Birenbaum (1970, 1992) and Levinson and Starling (1981) both found higher levels of social exclusion and Strained rapport among parents who care for mentally retarded children. Birenbaum’s (1970) qualitative study focused on techniques that parents used to manage information (or to manage tension, as it were) in such a way that decreased stigmatization for both themselves and for their child. The author searched for patterns of l6 adaptation among the 103 mothers of mentally retarded children in the sample. Focusing on these mothers’ relationships with other family members, friends, and parents of other retarded children, the author noted that parents tended to either “embrace the stigmatized or seek to dissociate [herself/)himself from [her/]his affiliation” (p. 197). It was further observed that those parents who limited their participation with organizations that served families with mentally retarded children were generally more successful at maintaining mainstream community membership. In Levinson and Starling’s (1981) study, data from 319 mothers of severely retarded children was used to explore the following three hypotheses: (1) Level of associational stigma is positively related to social status, (2) associational stigma is greater among parents of males than females, and (3) associational stigma is inversely related to the visibility of the child’s disability. The first and second hypotheses were not supported. However, Analysis of Variance (AN OVA) showed that lower-class parents reported greater stigma when the child’s disability was more visible than when it was not, whereas middle-class parents reported lower stigma scores that did not appear related to visibility. In an ethnographic study of associational stigma among family caregivers, Blum (1991) studied 34 primary caregivers to spouses who had been diagnosed with Alzheimer’s disease for three years. She documented techniques by which caregivers learned to cover up embarrassing social circumstances that could increase stigmatizing attitudes or behaviors towards the afflicted person and his or her family. She explained that such efforts may be understood as attempts to maintain both the diseased person’s and the caregiver’s dignity. 17 Blum (1991) also deduced that stigma management may be viewed in terms of two phases that follow the degenerative nature of the disease process. The first phase of stigma management involves development of a simple relationship of collusion between the stigmatized individual and the caregiver, which is possible as long as the Alzheimer’s patient is in control of his or her faculties. Awareness of stigrnatization is, at this point, often a primary concern of the person who directly bears the stigma and a secondary concern of the caregiver. Practices such as “covering” and “passing” when the two are in public situations is found to be common. The second phase of stigma management begins when the severity of the disease leaves the work of stigma management wholly to the caregiver. Here, increasing responsibility for the patient as well as more pronounced symptoms of the disease call for strategies of stigma management that were found to involve a broader circle of family members and other “wise” associates. To summarize, the literature on associational stigma suggests that people who are situationally connected to a stigmatized person typically shoulder some degree of stigrnatization. The degree to which they are stigmatized (or perceive themselves to be stigmatized) appears to be a frmction of a third person’s perception, or awareness, of (l) the associate’s relationship to the directly stigmatized person and (2) the perceived severity of this person’s stigma. Moreover, associates, like their directly stigmatized counterparts, are likely to employ particular strategies to keep themselves from being discredited. With respect to degenerative diseases such as HIV /AIDS, managing information to minimize associational stigma is likely to become increasingly diffith and of greater concern to caregivers as the disease progresses. 18 Dimensions of HIV/AIDS Stigma In order to understand how an associate of a person with HIV/AIDS is potentially stigmatized, it is important first to understand how persons who have HIV /AIDS are potentially stigmatized. Although the source of an associate’s stigma is, by definition, the same as that of the directly stigmatized other’ 5, it may or may not follow that the associate will be stigmatized in the same way or to the same degree. However, understanding how persons with HIV /AIDS are stigmatized provides a logical point of departure against which an associational stigma may be measured. Previous researchers have conceptualized HIV /AIDS stigma as being comprised of a variety of dimensions. The present review considers six such dimensions that are measured in various combinations among 20 articles that purportedly measured HIV/AIDS stigma. Ranking the frequency with which each of these dimensions were measured, fi'om most common to least common, are the following: (1) judgment of moral wrong-doing, (2) judgment of responsibility/conuollability, (3) fear of contagion, (4) lack of compassion, (5) assessment of dependency/disability, and (6) fear of death. The following sections provide an overview of the meaning of these dimensions as they were presented in these studies. Judgments of Moral Wrong-doing Among the articles reviewed, judgments of immorality or moral wrong-doing were found to be the most frequently reported dimension of HIV/AIDS stigma. Sixteen of the 20 articles (80%) found some degree of moral judgment toward persons with HIV/AIDS (Bean et al., 1989; Bishop, Alva, Cantu, & Rittiman, 1991; Crandall, 1991; Dooley, 1995; Herek & Capitanio, 1993; LePoire, 1994; Lewis & Range, 1992; Peters, Boer, Kok, 19 & Schaalma, 1994; Range & Starling, 1991; St. Lawrence, Husfeldt, Kelly, Hood, & Smith, 1990:]; St. Lawrence, Kelly, Owen, Hogan & Wilson, 1990:2; Strasser & Damrosch, 1992; Trezza, 1994; Young, Gallaher, Belasco, Barr, & Webber, 1991; Young, Gallaher, Marriott, & Kelly, 1993). In these studies, moral judgments arose from strong identification with particular religious and cultural systems of belief. According to some religions, homosexuals, IV drug users, and commercial sex workers who become HIV-positive are thought to be in receipt of their due—properly punished by God and condemned to suffering—with the infection serving as a mark of their immorality. According to more general Western cultural beliefs, which tend to desexualize human interaction, the fact that the most common mode of HIV infection is by unprotected sexual intercourse is enough to elicit stigmatizing reactions to persons who have HIV/AIDS. The saliency of this dimension can be generally attributed to the historical fact that the topic of sex and debates about morality and social ethics in Western society are virtually inextricable (Foucault, 1980). Judgments of Responsibility/Controllability Judgments of responsibility/connollability were the second most frequently reported dimension of PHV/AIDS stigma among the articles reviewed. Twelve (26%) studies reported stigmatization as a result of perceived controllability of an individual’s HIV infection (Bean et al., 1989; Crandall, 1991; Dooley, 1995; Herek & Capitanio, 1993; LePoire, 1994; Lewis & Range, 1992; Peters et al., 1994; Range & Starling, 1991; St. Lawrence, Husfeldt, etal., 1990:]; St. Lawrence, Kelly, et al., 1990:2, Strasser & Damrosch, 1992; Trezza, 1994). Weiner’s (1980) Attributional Model of Helping Behavior appears to have provided the theoretical framework from which measures of 20 responsibility/connollability were developed and used to predict specific affective reactions (e.g., pity and anger) and helping judgments (Crandall, 1991; Dooley, 1995; Strasser & Damrosch, 1992). As with judgments of moral wrong-doing, sex and IV drug use were again implicated as the source of judgments of personal responsibility/confiollability, but with a somewhat different rationale. Given that HIV may be contracted through unprotected sex or unclean needle-sharing with someone who is infected, this dimension of stigma views HIV/AIDS as a disease of the promiscuous and of the addicted (e.g., Bolten, 1992; Dooley, 1995; Herek & Glunt, 1988; Weiner, Perry, & Magnussan, 1988). Hence, persons with HIV/AIDS are stigmatized because they failed to refrain fi'om particular behaviors that put them at risk. Although they may stop short of blaming AIDS victims on moral grounds, the stigrnatizers chide persons with HIV/AIDS on the grounds that they are poor self-regulators. Fear of Contagion The belief that HIV is contagious was the third most frequently reported dimension of HIV/AIDS stigma among the articles reviewed. Eight studies reported some evidence of fear of contagion (Bean et al., 1989; Bishop et al., 1991; Herek & Capitanio, 1993; Herek & Capitanio, 1994; Meisenhelder & La Charite, 1989; Trezza, 1994; Young et al., 1991; Young et al., 1993). AIDS is contagious only via particular body fluids, namely blood, semen, vaginal fluids, and breast milk (Singer, Rogers, & Corcoran, 1987). Nonetheless, this research reveals that people are still inclined to avoid persons with HIV/AIDS for fear of being infected by casual contact. 2 1 Lack of Compassion Lack of compassion, was the fourth most frequently reported dimension among the articles reviewed. Five studies found evidence that persons with HIV/AIDS are Often the objects of compassion, pity, or empathy (Bean et al., 1994; Dooley, 1995; Herek & Capitanio, 1994; Peters etal., 1994; Strasser & Damrosch, 1992). Compassion, although not inherently a negative reaction, is similar to its counterparts of HIV/AIDS stigma in that it is indicative of an individual’s or group’s deficiency. Sympathetic actions of others are, therefore, potentially stigmatizing behaviors. Research on pro-social behavior towards others has also noted that where issues of personal morality are raised, sympathy and understanding are decreased, often creating an attitude of ambivalence on the part of the potential sympathizer (Bean et al., 1989; Herek & Glunt, 1988; Katz & Glass, 1979). Although Herek & Glunt (1991) and Bean et a1. (1989) found that ambivalence is a common reaction to persons who have HIV/AIDS, they do not elaborate on the meaning of these results. Assessment of Dependency/Disability This dimension of HIV/AIDS stigma was measured in 3 of the 20 studies that were reviewed (Lang, 1991; Walkey, Taylor, & Green, 1990; Westbrook, Legge, & Pennay, 1993). It arises from the notion that a person with HIV /AIDS is often expected to be someone who is, or who will be at some point in the near future, overwhelmingly needy. It is generally understood that the disease process of AIDS is often unpredictable, and that persons with HIV/AIDS are known to cycle through numerous periods of sickness and relative health. Knowledge of this process could compel others, many of whom may have limited time or personal resources to begin with, to keep away from a person with 22 HIV /AIDS. In addition, persons with AIDS lose their physical attractiveness toward the end of the disease process, and in approximately one third of all cases some degree of dementia will set in (“HIV-related conditions,”1994). For these reasons, dependency/ disability is a plausible dimension of HIV/AIDS stigma. Fear of Death Somewhat surprisingly, this was the least common dimension of HIV /AIDS stigma reported among the studies that were reviewed. Although it was expressly discussed as a potential source of stigmatization in a number of articles (e.g., Herek & Glunt, 1988; Meisenhelder et al., 1989), it is measured in only one quantitative study (Bean et al., 1989). In this study, fear of death reactions fall under the rubric of thanatophobia, which was measured using a single item, “I fear anything associated with death” (p. 197). Considering the fact that ultimately AIDS takes away life, fear of death appears to be an under-explored dimension of stigma among quantitative studies. Recent research indicates that although some persons with HIV/AIDS are living longer, nearly all cases (99%) will go on to develop full-blown AIDS within 10 to 15 years of being infected with HIV (Pinner et al., 1996). Herek and Glunt (1988) comment that AIDS forces a feeling of vulnerability for many people: “When people interact with a [person with AIDS], hear AIDS discussed, or simply read about it in a newspaper, they are reminded of their own mortality; their day-to-day sense of reality is challenged in a profoundly disturbing way” (p. 887). For these reasons, fear of death and dying are likely to be associated with HIV/AIDS stigma and warrant more careful consideration in future research. 23 Other Research on HIV/AIDS Stigma Having identified the dimensions of HIV/AIDS stigma that have been addressed in the literature, the following article summaries are used as examples of how previous research has conceptualized and explained the problem of AIDS stigma. In general, researchers of topics related to HIV/AIDS stigma have tended to limit their studies to one or two dimensions of stigma that were of particular relevance to their study. A variety of research questions about HIV/AIDS stigma are considered, most of them about HIV/AIDS-related knowledge and attitudes. One study investigated whether the presence of more than one source of stigma generated an additive or a multiplicative stigma-effect on an individual (Crandall, 1991). The author assessed this impact by presenting 16 different descriptions of a man who varied on two situational variables to 393 undergraduates enrolled in an introductory psychology course. Descriptions varied in how the target male was exposed to HIV— either through sexual contact with another man, through sharing needles during IV drug use, through an accidental exposure during surgery that the doctor-subj ect was performing, or through a contaminated blood product received as treatment for hemophilia——and whether or not he had AIDS, infectious hepatitis, paraplegia, or the flu. Results showed that the most social distance (i.e., stigma) was recorded when the person described was an IV drug user, followed by when he was a homosexual, a surgeon, and a hemophiliac, respectively. Independent of mode of transmission, the most social distance was recorded when the person described had AIDS, followed by when he had hepatitis, the flu, or was wheelchair-bound. There was no interaction between mode of transmission and any of the four afflictions, suggesting that multiple stigrnas are additive as Opposed to 24 multiplicative. In general, the author concludes that AIDS is stigmatizing to any infected person, and that stigmatization of persons with AIDS occurs regardless of whether it is cognitively linked to homosexuality and/or IV drug use. Range and Starling (1991) tested the hypothesis that more knowledge about AIDS- risk behaviors would correlate negatively with AIDS stigma. Their study varied gender of the victim, sexual orientation of the victim, and gender of the respondent. Respondents were 247 undergraduates, each of whom was asked to complete an AIDS-risk knowledge test, read a one sentence description about the victim, and then fill out a scale that measured prejudicial evaluation. Overall, these students showed a moderately high level of knowledge about HIV contagion and transmission and a moderately low level of stigma. AN OVA indicated that male respondents with lower AIDS-risk knowledge gave the highest levels of stigma to the victim, particularly when the victim was male. With respect to sexual orientation, the study found the highest stigmatization among those respondents who had low AIDS-risk knowledge and who were told the victim was a gay male. Along this same theme, the study found the lowest levels of stigmatization among those respondents who had high AIDS-risk knowledge and who were told the victim was a lesbian. A study by St. Lawrence et a1. (1990) asde 300 undergraduates to read a vignette about an ill person who was described as either afflicted with AIDS or leukemia and as either homosexual or heterosexual, and then to complete a set of measures sensitive to interpersonal evaluation, prejudicial attitudes, and willingness to interact casually with an ill person. In contrast to the previous study, results showed that these students held highly stigmatizing attitudes toward both AIDS patients and gay men, and that gay men with 25 AIDS were the most stigmatized persons. Primarily focusing on issues of personal controllability, Peters et al. (1994) applied Weiner’s (1988) attributional theory to study stigmatization and discrimination toward persons with AIDS. In a field experiment, 172 respondents in The Netherlands responded to vignettes describing patients with AIDS, syphilis, lung cancer, or tuberculosis. The onset of disease was described as either personally controllable or uncontrollable. Results indicated that AIDS and syphilis were both perceived to be controllable whether or not information reinforcing this was given. Accordingly, stigmatization and discrimination toward persons with AIDS or syphilis were found to be higher. This finding underscores the stigma attached to sexual behavior, especially between men. The authors also indicate that although disease controllability accounted for a significant amount of variance in helping behavior and stigmatization toward persons with AIDS, information about incurability of the disease, risk of infection, and homosexual identity appeared to be more useful in explaining reactions to persons with AIDS. Similarly, Strasser and Damrosch (1992) focused on how patient diagnosis and patient sexual orientation affect graduate nursing students’ reactions to persons with AIDS. They first asked 180 registered nurses enrolled in a master’s nursing program to each read one of six versions of a vignette about a male patient who was described as being either diagnosed with AIDS of unspecified origin, AIDS of a contaminated blood product given for the treatment of hemophilia, or leukemia, and who was also described as either homosexual or heterosexual. Respondents were then asked to evaluate the patient on two scales, one involving judgments of patients and the other concerning willingness to interact socially with them. 26 As was hypothesized, the hemophiliac with AIDS and the leukemia patient were judged significantly less responsible for as well as less deserving of their illness than was the patient with AIDS of unspecified origin, indicating that particular assumptions about the reason for the more ambiguously-described patient’s disease led to a more blameful attitude. However, all three diagnostic categories were considered equally deserving of the best possible care, which may be taken as an indicator of showing compassion towards persons who are afflicted with disease. Both categories of AIDS patients were stigmatized in terms of certain social interactions. For instance, the AIDS diagnosed hemophiliac was especially stigmatized when respondents were asked if they would renew a lease for him. This result may reflect how specific knowledge can affect AIDS stigma. Presumably the respondents, who were studying nursing, thought that being both HIV-positive and a “bleeder” would make for an especially risky tenant. Lewis and Range (1992) note that much of the research they reviewed about AIDS stigma explains stigmatization as a function of both the disease and the individual’s sexual orientation. They hypothesized that stigma and degree of social interaction with a person with AIDS would be explained by information about mode of HIV transmission (i.e., sexual contact, IV drug use, or blood transfusion). Results based on the responses of 619 undergraduate students indicated that more knowledge of HIV/AIDS is associated with greater willingness to interact with a person with AIDS, and that mode of HIV transmission affects both the level of stigmatization and degree of social interaction. Both males and females indicated that they would interact less willingly with a person who contracted HIV from sexual activity or IV drug use than they would with a person who 27 contracted HIV from a blood transfusion. Although this study indicates who is more likely to be blamed for contracting AIDS, it fails to explain whether variance in stigmatization and social interaction is more a fimction of judgments of immorality or of judgments of irresponsibility. Moreover, the design of this study does not exclude the possibility that knowledge of mode of HIV transmission may serve as a cue to the infected individual’s sexual orientation. Bishop et a1. (1991) sought to test the notion that responses to persons with AIDS are a result of the disease’s association with male homosexual behavior more than its perceived contagion. In an experimental design that manipulated contagion, sexual orientation, sex of stimulus person, and sex of respondent, the authors asked 160 tmdergraduates to rate the seriousness of the disease, how responsible the person was for their illness, and how willing they would be to interact with them. Results showed that willingness to interact with a diseased person was strongly related to the contagiousness of the disease, but only weakly related to its association with homosexuality. Their findings argue that avoidance of persOns with AIDS and other diseases are primarily related to concerns over contracting the disease. In another study focusing on contagion, Laschinger and Goldenberg (1993) used Ajzen and Fishbein’s (1980) Theory of Reasoned Action to test the degree to which 141 nurses’ attitudes and subjective norms predicted their intention to provide care for persons with HIV/AIDS. Consistent with the theory, intention to provide care was predicted (It2 = 0.27) by the interaction of personal beliefs with normative beliefs. Nurses who were less inclined to provide care were more likely to believe that they would be shunned by family and friends, but not by co-workers. 28 Three studies in particular focused on dependency/disability as a dimension of HIV/AIDS stigma. In Walkey et a1. (1990), a study of 312 first-year New Zealand university students compared ratings of an AIDS patient to others on semantic differential bipolar scales. Cluster analysis revealed that persons with AIDS could be distinguished fi'om persons with heart disease on the basis of a higher degree of negative moral judgment. In comparison, persons afflicted with cancer or coronary heart disease were more likely to be distinguished from AIDS patients on the basis of relative dependence. Using a combination of ethnographic and quantitative methods, Lang (1991) explored the process of “adoption of new social roles and resocialization of the individual into new forms of stigma and dependency” (p. 66). Their study evaluated 64 gay men on their levels of depression, sexual satisfaction, quality of peer relations, quality of family relations, and levels of self-esteem. The author hypothesizes that these variables mediate gay men’s responses to AIDS. For purposes of comparison, each respondent was classified as either being HIV-negative (“worried well”), being HIV -positive, having AIDS Related Complex (ARC), or having AIDS. Analysis of the data showed that AIDS, as a cultural phenomenon, has affected the lives of many gay men in significant ways. AIDS has changed perceptions of self as well as of others. Very often, AIDS has brought gay men, “. . . into new forms of dependency—physically, emotionally, and cognitively” (p. 7 1). Although not exclusively concerned with AIDS stigma, a study by Westbrook et a1. (1993) showed that AIDS stigmatizes because it is disabling. The authors assessed 665 health practitioners living in Australia from the Chinese, Italian, German, Greek, Arabic, and Anglo-Australian communities on their community’s attitudes toward 20 disability 29 groups. Significant differences were found across communities for 19 of these disabilities. Of all the communities surveyed, the German community expressed greatest acceptance of people with disabilities, followed by the English, Italian, Chinese, Greek, and Arabic communities. In all communities people with asthma, diabetes, heart disease, and arthritis were the most accepted despite their disability. However, persons with AIDS were the least accepted of these groups. The Arabic community, followed by the Chinese, the Italian, and the Greek communities were the most stigmatizing of persons with AIDS. The German community was the least stigmatizing of person with AIDS. The last two articles reviewed here address the stigma of HIV/AIDS at the community level. The first of these, by Lindhorst and Mancoske (1993), considered the particular problem of associational stigma as it relates to groups of people and communities not originally associated with the epidemic. They posed the following question: How do AIDS service organizations, the majority of which grew out of the experiences and resources of the white gay male community, nurture involvement of members of other communities (particularly people of color and women)? (p.185) These authors observed that many of the older HIV/AIDS organizations that are now starting to serve a more diverse population have only a superficial understanding of the prejudice and discrimination that is elicited by race, class, and gender. They believe that this reality inhibits effective delivery of services because newly affected communities that do not wish to be associated with particular other communities (because the former sees the latter as immoral or unworthy) will be unlikely to join forces in a straightforward manner, even if their stated goals are the same. Lindhorst and Mancoske see a need for 30 the creation of new models of service delivery that affirm a more inclusive, diversity- sensitive approach to fighting HIV /AIDS. Lastly, in a conceptual paper on motivations of volunteers who work with persons who have HIV/AIDS, Omoto and Snyder (1990) noted that: . . . in the specific case of [HIV/]AIDS, volunteers may be punished for their good deeds. That is, they may be judged by the company they keep and stigmatized because of the stereotyped beliefs and prejudicial attitudes associated with AIDS and persons with [HIV/]AIDS (p. 153). Here the stigma that surrounds the HIV/AIDS epidemic is suggested to be a detractor from progressive social action. Not only is much needed volunteer assistance potentially curtailed, there may also be some degree of reluctance to seek out health services or even to have conversations about topics concerning HIV prevention. To summarize, the topic of HIV/AIDS stigma and its impact on persons who have HIV/AIDS as well as their partners, fiiends, and family members has not been neglected. A review of research that measured HIV/AIDS stigma indicates that it is comprised of six dimensions, namely: (1 ) judgment of moral wrong-doing, (2) judgment of responsibility/controllability, (3) fear of contagion, (4) lack of compassion, (5) assessment of dependency/disability, and (6) fear of death. The saliency of a particular dimension in a particular study appears to be a function of both context and subject population, which provides general reinforcement for the notion that stigmatization is situationally determined. Regardless of the particular dynamics of these alluded-to situations of associational stigma, the degree to which it does exist ought to be measurable among persons who work with persons who have HIV/AIDS. Using the findings and insights of the literature reviewed in this chapter, Chapter 2 31 will now present a conceptual basis for the development and testing of a measure of associational HIV/AIDS stigma. CHAPTER 2 DEVELOPING AND TESTING A MEASURE OF ASSOCIATIONAL HIV/AIDS STIGMA Accepting that the impact of HIV/AIDS stigma adversely affects persons with HIV/AIDS (e.g., Bor, Miller & Goldman, 1993; Douglas, Kalman & Kalman, 1985; Herek, 1988; Herek & Glunt, 1988; Peloquin, 1990), the concept of associational stigma suggests that associates of persons who have HIV/AIDS will also be adversely affected. The present study developed a quantitative measure of the degree to which HIV/AIDS workers, such as nurses, doctors, volunteer ‘buddies,’ case mangers, and HIV/AIDS educators, perceive an associational stigma as a result of their close social proximity to persons who actually have HIV/AIDS. Present Study’s Research Questions Four research questions were posed, as follows: . Which dimensions of HIV /AIDS stigma comprise perceived associational stigma and in which contexts are they most salient? 0 Given that perceived associational stigma exists, what characteristics of the HIV/AIDS worker, and what experiences with persons who have HIV/AIDS, are related to stronger perceptions of associational stigma? . Given that perceived associational stigma exists, how is it related to perceived social distance (i.e., physical avoidance by others as a result of being identified as an HIV/AIDS worker)? 0 Lastly, given that perceived associational stigma exists, does it affect the degree to which HIV/AIDS workers talk to others about HIV/AIDS-related topics? 32 33 Answers to these questions will help generate a model of the dimensions of associational stigma and of the context(s) in which it would exist(s). Hypotheses A total of 29 hypotheses were generated. 0 Research Question l—Which dimensions of HIV/AIDS stigma comprise perceived associational stigma and in which contexts are they most salient? Two hypotheses were constructed for the first question. Hypothesis 1 predicts that perceived associational stigma is a multi—dimensional construct, that is, that it is comprised of two or more dimensions. Hypothesis 2 predicts that the strength of perceptions of associational stigma, should it exist, will vary depending on the social context in which HIV /AIDS workers find themselves. Recall that contexts have been operationalized as ‘fiiends,’ ‘family,’ ‘non-HIV/AIDS co-workers,’ ‘neighbors,’ and the ‘general public.’ Hypothesis 1 Perceived associational stigma among persons who work with persons who have HIV /AIDS is a multi-dimensional construct. . Six plausible dimensions that have been identified in the literature about HIV/AIDS-related stigma: (1) judgment of moral wrong-doing, (2) fear of contagion, (3) lack of admiration, (4) fear of death, (5) misunderstanding (6) lack of compassion [see Powell-Cope and Brown (1992)]. . AIDS stigma has been reported to have more than one component [see Crandall (1991)]. Hypothesis 2 Perceived associational stigma increases as persons of a particular context (e.g., friends) become less familiar. . Persons who have lost their partners to AIDS were reported to perceive themselves stigmatized by friends, family, the medical community, and religious organizations [see Geis, Fuller & Rush (1986); McDonnell, Abell & Miller (1991)]. . Volunteers viewed non-HIV/AIDS co-workers as highest source of stigma, then close friends, then family members [see Omoto 34 & Crain (1995b)]. In contrast, nurses who were less inclined to provide care to someone with HIV/AIDS were more likely to believe that they would be shunned by family and friends, but not by co-workers [see Laschinger & Goldenberg (1993)]. Comparing different ‘sources of stigma’ is an approach that models a study that compared different ‘sources of social support’ gay men at risk of HIV infection received from different groups of persons in their social network [see Schwarzer, Dunkel—Schetter & Kemeny (1994)]. . Research Question 2—Given that perceived associational stigma exists, what types of work experiences and individual characteristics are related to stronger perceptions of associational stigma? Recalling Goffman’s (1963) concept of stigma as a situation-specific event that generates an awareness of an individual’s possession of an unappreciated or devalued state of difference, particular characteristics and/or experiences may predispose HIV/AIDS workers to either stronger or weaker perceptions of associational stigma. Eight hypotheses were constructed to address Research Question 2, each one addressing either a characteristic of the HIV/AIDS worker or the amount of a particular type of experience that they have had as a person who works with persons who have HIV/AIDS. Hypothesis 3 Hypothesis 4 Perceived associational stigma and satisfaction with HIV/AIDS work experience are negatively correlated. . Perceptions of stigmatization have been correlated with caregivers’ attitudes of dissatisfaction with health care systems [see Folkman et a1. (1994)]. Perceived associational stigma and basis of current work (volunteer = 1; paid staff = 2) are negatively correlated. . ‘Voluntary’ as opposed to ‘involuntary’ association with a stigmatized group (such as gay men) has been linked to stigmatizing attitudes [see Sigehnan et al. (1991)]. In general, people may view volunteers as ‘special’ people: volunteers may be viewed as ‘too altruistic,’ which may bring Hypothesis 5 Hypothesis 6 Hypothesis 7 Hypothesis 8 35 negative judgment upon them [see Omoto & Synder (1995b)]. . In contrast, professionals are ‘just doing there job,’ therefore they may be more likely to be ‘forgiven’ for their ties to groups that are perceived to be stigmatized. Perceived associational stigma and work with persons who are likely to be held more accountable for their HIV-infection (e.g., IV drug users vs. children) are positively correlated. . Personal controllability has been shown to play a large role in how persons with HIV/AIDS are viewed. Gay men who are HIV -positive are viewed as ‘getting their due’ for their immoral, promiscuous behavior [see Peters et al. (1994); Weiner (1988), Strasser & Damrosch (1992)]. Perceived associational stigma and frequency of contact with persons who have HIV/AIDS are positively correlated. . A fear of contagion, which is a potential dimension of associational stigma, may cause others to avoid HIV /AIDS workers because of their frequent face-to-face interactions with persons who have HIV/AIDS [see Lewis & Range (1992); Bishop et al. (1992)]. . The more face-to-face contact one has with members of a stigmatized group, the more difficult it is to ‘pass,’ and therefore the more likely that one will be stigmatized by association [see Blum (1991)]. Perceived associational stigma and duration of HIV/AIDS work experience are positively correlated. . Like Hypothesis 6, a fear of contagion, which is a potential dimension of associational stigma, may be stronger if others are aware of an HIV/AIDS worker’s longer duration of interactions with persons who have HIV/AIDS [see Lewis & Range (1992); Bishop et al. (1992)]. . The longer one works with a potentially stigmatized group, the more difficult it is to ‘pass,’ hence the more likely that others will avoid them [see Blum (1991)]. Perceived associational stigma and perceived social support from peer HIV/AIDS workers are positively related. . Due to the stigma of HIV/AIDS, traditional sources of support, 36 such as the family, are not always available for persons living with HIV/AIDS [see McDonnell, Abell & Miller (1991)]. . When asked to imagine how caregivers of a man with HIV/AIDS would be treated by ‘others,’ respondents wrote that he would not generally find support [see Omoto & Crain, (1995b)]. . Researchers noted that HIV/AIDS workers may be more selective about whom they seek out for social support [see Bennett et al. (1994); Powell-Cope & Brown (1992)]. . Social support is delivered in different amounts and in different ways depending on who (among someone’s social network) does the giving [see Schwarzer et al. (1994)]. Hypothesis 9 Perceived associational stigma and percieved risk of HIV infection are positively correlated. . Persons who perceive themselves at high risk of HIV infection may feel more empathy for those they are serving. . Risk of infection, along with information about the incurability of the disease and a homosexual identity, have all been found to predict stigmatizing attitudes towards persons with HIV/AIDS [see Peters et al. (1994); Range & Starling (1991)]. Hypothesis lo Perceived associational stigma and the proportion of others who know about the respondents’ HIV/AIDS work are positively correlated. . For some, there may be an initial perception that friends, family, and others will be supportive of working with persons with HIV/AIDS — as more people learn about the worker’s role, the likelihood of encountering negative attitudes becomes higher [see Blum (1991)]. 0 Research Question 3—Given that perceived associational stigma exists, how is it related to perceived social distance (i.e., physical avoidance by others as a result of being identified as an HIV/AIDS worker)? Nine hypotheses were constructed, the first of these (Hypothesis ll) considering the relationship between perceived social distance (i.e., the perception that others physically avoid them because the are known to be HIV/AIDS workers) and perceived associational stigma. The eight remaining hypotheses consider the relationship between perceived 37 social distance and those individual characteristics and/or experiences of HIV/AIDS workers that were tested for Research Question 2. Note that the rationale provided for these hypotheses parallels, in large part, the rationale provided for the corresponding hypotheses for Research Question 2. It may very well be that perceived social distance and perceived associational stigma are, in essence, the same measure. Hypothesis ll Hypothesis 12 Hypothesis l3 Hypothesis l4 Perceived social distance and perceived associational stigma are positively correlated. . Parents of gay and lesbian children were found to experience social rejection when members of their social network heard that their son or daughter was a homosexual (i.e., shouldered a stigma) [see Pfuhl & Henry (1986)]. . Higher levels of social exclusion and strained rapport was found among parents who cared for mentally retarded children (i.e., shouldered a stigma) [see Birenhaum (1992)]. Perceived social distance and satisfaction with HIV/AIDS work experience are negatively correlated. . Perceptions of stigmatization have been correlated with caregivers’ attitudes of dissatisfaction with health care systems [see Folkman et al. (1994)]. Perceived social distance and the basis of current work (volunteer = I; paid staff = 2) are negatively correlated. . ‘Voluntary’ as opposed to ‘involuntary’ association with a stigmatized group (such as gay men) has been linked to stigmatizing behaviors [see Sigelman et al. (1991)]. . In general, people may view volunteers as ‘special’ people: Volunteers may be viewed as ‘too altruistic,’ which may cause others to avoid them [see Omoto & Synder (1995b)]. . In contrast, professionals are ‘just doing there job,’ therefore they may be more likely to be ‘forgiven’ for their ties to groups that are perceived to be stigmatized. Perceived social distance and work with persons who are likely to be held more accountable for their HIV -infection (e.g. IV drug users vs. children) are positively correlated. Hypothesis 15 Hypothesis l6 Hypothesis 17 Hypothesis 18 38 . Highest social distance was recorded when a person with HIV/AIDS was described as an IV drug user, followed by when he was a homosexual, a surgeon, and a hemophiliac [sec Crandall, 1991]. Perceived social distance and frequency of face-to-face contact with persons who have HIV/AIDS are positively correlated. . A fear of contagion may be stronger when an HIV/AIDS worker has more face-to-face interaction with persons who have HIV/AIDS [see Lewis & Range (1992); Bishop et al. (1992)]. . The more face-to-face contact one has with members of a stigmatized group, the more difficult it is to ‘pass,’ and therefore the more likely that one will be avoided [see Blum (1991)]. Perceived social distance and duration of work experience are positively correlated. . Like Hypothesis 6, a fear of contagion may be stronger if others are aware of an HIV/AIDS worker’s longer duration of interactions with persons who have HIV/AIDS [see Lewis & Range (1992); Bishop et al. (1992)]. . The longer one works with a potentially stigmatized group, the more difficult it is to ‘pass,’ hence the more likely that others will avoid them [see Blum (1991)]. Perceived social distance and perceived social support from peer HIV/AIDS workers are positively correlated. . Due to the stigma of HIV/AIDS, traditional sources of support, such as the family, are not always available for persons living with HIV/AIDS [see McDonnell, Abell & Miller (1991)]. . When asked to imagine how caregivers of a man with HIV /AIDS would be treated by ‘others,’ respondents wrote that he would not generally find support [see Omoto & Crain, (1 995b)]. . Researchers noted that HIV/AIDS workers may be more selective about whom they seek out for social support [see Bennett et al. (1994)]. . Social support is delivered in different amounts and in different ways depending on who (among someone’s social network) does the giving [see Schwarzer et al. (1994)]. Perceived social distance and perceived risk of HIV infection are 39 positively correlated. . Persons who perceive themselves at high risk of HIV infection may feel more empathy for those they are serving. . Risk of infection, along with information about the incurability of the disease and a homosexual identity, have all been found to predict stigmatizing attitudes towards persons with HIV /AIDS [see Peters et al. (1994); Range & Starling (1991)]. Hypothesis 19 Perceived social distance and the proportion of others who know about respondents’ HIV /AIDS work are positively correlated. . For some, there may be an initial perception that friends, family, and others will be supportive of working with persons with HIV/AIDS — as more people learn about the worker’s role, the likelihood of encountering negative attitudes becomes higher [see Blum (1991)]. 0 Research Question 4—Given that perceived associational stigma exists, does it affect the degree to which HIV/AIDS workers talk to others about HIV/AIDS- rclated topics? Communication behavior about HIV/AIDS-related behavior is considered to be an important information dissemination mechanism for community-level prevention programs (CDC, 1995a). There is broad consensus that individuals acquire information, form attitudes, and develop beliefs from member of their social network(s). Nine hypotheses were constructed to address Research Question 4. The first hypothesis considers the relationship between communication behavior about HIV/AIDS-related topics and perceived associational stigma. The next seven consider the relationship between communication behavior and the same set of characteristics and experiences of an HIV/AIDS worker that were examined for Research Question 2 and 3. The last hypothesis considers the relationship between communication behavior and perceived social distance. Hypothesis 20 Communication behavior about HIV IAIDS-related topics and Hypothesis 21 Hypothesis 22 Hypothesis 23 Hypothesis 24 40 perceived associational stigma are negatively correlated. . Parents of mentally retarded children tended to dissociate (i.e., communicate less) from parents of ‘normals’ [see Birenbaum, (1992)]. . In order to preserve one’s dignity, caregivers learn to cover up embarrassing social circumstances that could increase stigmatizing attitudes or behaviors towards stigmatized individuals or their associates [see Blum, (1991)]. . In general, workers will be less inclined to talk about HIV/AIDS or their contact with persons with HIV/AIDS if they believe others will be uncomfortable with such topics [see Powell-Cope & Brown (1992)]. Communication behavior and satisfaction with HIV/AIDS work experience are positively correlated. . The more one likes something, the more one will tell others about it. Communication behavior and basis of current work (volunteer = I; paid staff = 2) are positively correlated. . Paid HIV/AIDS workers are more likely to have more experience and better training, hence more skills for broaching the subject of HIV/AIDS with others. Communication behavior work with persons who are likely to be held more accountable for their HIV -infection (e.g. IV drug users vs. children) are negatively correlated. . Personal controllability has been shown to play a large role in how persons with HIV/AIDS are viewed. Gay men who are HIV-positive are viewed as ‘getting their due’ for their immoral, promiscuous behavior [see Peters et al. (1994); Weiner (1988), Strasser & Damrosch (1992)]. . Talking about helping children is ‘safer’ than talking about helping IV drug users. Communication behavior and fiequency of face-to-face contact with persons who have HIV/AIDS are positively correlated. . The more time someone spends with persons with HIV/AIDS, the more likely it is that topics related to HIV/AIDS will be discussed with others. Hypothesis 25 Hypothesis 26 Hypothesis 27 Hypothesis 28 Hypothesis 29 41 Communication behavior and duration of work experience are positively correlated. . The more time someone spends with persons with HIV/AIDS, the more likely it is that topics related to HIV/AIDS will be discussed with others. Communication behavior and social support from peer HIV /AIDS workers are positively correlated. . Feeling supported by peers may motivate caregivers to communicate their experiences and impressions to others [see Schwarzer et al. (1994)]. Communication behavior and perceived risk of HIV infection are negatively correlated. . For this group, communicating about HIV/AIDS may bring unwanted attention to the possibility (or reality) that they may also be (or already are) living with HIV/AIDS [see Powell-Cope & Brown (1992)]. Communication behavior and the proportion of others who know about respondents’ HIV/AIDS work are positively correlated. . If it is assumed that others know about oneself because one tells them about oneself, then this pair of variables must produce a relatively strong, positive correlation. Communication behavior and perceived social distance are negatively correlated. . The more HIV /AIDS workers perceive avoidance behavior, the less inclined they will be to bring up HIV/AIDS-relted topics. Results are presented in Chapter 4. Chapter 3 reviews the method by which the present study was carried out. Chapter 3 METHOD The present study is based upon self-reports about perceptions that respondents (i.e., HIV/AIDS workers) have of their friends, family members, non-HIV/AIDS co-workers, neighbors, and the general public. In particular, self-reports attempted to capture information about how respondents believe others view them as persons who work with persons with HIV/AIDS. For the purposes of this study, ‘fiiends,’ ‘family,’ ‘non- HIV/AIDS co-workers,’ ‘neighbors,’ and ‘the general public’ are operationalized as different contexts. HIV /AIDS workers from various caregiving organizations located throughout all eight of Michigan’s Regional Prevention Planning Groups [RPPG] (see Appendix A) were invited to participate in the study. (Note: Michigan’s RPPG were established by the CDC and the State health authorities to facilitate more effective primary, secondary, and tertiary HIV/AIDS prevention). Potential respondents were defined as anyone who worked, either as a volunteer or as a paid staff member, for an HIV/AIDS caregiving organization in Michigan. Persons who were less than 18 years of age were not allowed to participate. Procedure After receiving approval by Michigan State University’s Committee on Research Involving Human Subjects (see Appendix B), 802 study packages were mailed or handed 42 43 out among volunteers and paid staff persons of participating organizations. How study packages were delivered to potential respondents was a decision of the executive director of each organization. Study packages included the following: (1) a copy of the HIV/AIDS Work Experience Survey (see Appendix C) (2) a cover letter explaining how they have come to be asked to participate (see Appendix D), (3) an informed consent sheet that underscores the anonymous nature of the study (see Appendix E), (4) a form to request a personal copy of the study’s findings (i. e., Study Results Request F orm; see Appendix F), and (5) a small “red remembrance ribbon” decal as a token of appreciation. In addition, two pro-paid, pre-addressed business reply envelopes were provided, one for return of the completed survey, and one for return of the Study Results Request Form. Use of separate envelopes ensured that a respondent’s survey and the whatever contact address was provided on the Study Results Request Form could not be associated, thereby maintaining the respondent’s anonymity. Measures The HIV/AIDS Work Experience Survey measured various aspects of the respondent’s role as a person who works with persons with HIV/AIDS. Each section measures information about a particular domain, namely the respondent’s: (1) HIV/AIDS work experience, (2) perceptions of others’ beliefs about HIV/AIDS workers, (3) perceptions of others’ behavior towards HIV /AIDS workers, (4) communication behavior about HIV/AIDS-related topics, (5) memory of an unexpected reaction from another person related to their HIV/AIDS work, and (6) personal background (e.g., age, sex). Appendices C, G, H, and I have been prepared to help answer technical questions regarding the study’s electronic data set (Note: data is stored in a single SPSS for 44 Windows computer file). Appendix C is a copy of the HIV/AIDS Work Experience Survey that has been annotated with each item’s name as it appears in the computer file. Appendix G lists each variable (i.e., raw, computed, or secondarily sourced) along with its (1) position in the computer file, (2) data type, (3) range of possible values, (4) ‘Not Applicable’ and ‘Missing’ codes, (5) sample size, (6) actual minimum and maximum values, mean, standard deviation, and (7) variable label. Appendix H lists value labels for categorical variables. Lastly, Appendix I lists SPSS for Windows compute statements for multi-item or conditionally generated variables. The following paragraphs provide an overview of what was measured in each section of the survey. Section A. HIV/AIDS Work Background This section asked respondents about their work experience with persons who have HIV/AIDS. It asked on what basis the respondent currently works (either volunteer or paid), which groups describe the persons who have HIV/AIDS with whom they work, which HIV/AIDS organization or agency they work for, what type of work they do, the duration and frequency of their work experience, their overall impression of their experience to date, and the degree to which they look to peer HIV/AIDS workers as opposed to non-peers for social support. Items for the social support scale were adapted from a 6-item scale developed for another study by Sarason, Levine, Basham and Sarason (1983). Section B. Perceptions of Others’ Beliefs It is in this section that self-reports about how respondents believe others view them as persons who work with persons with HIV/AIDS are obtained. The design of this section is modeled after an instrument used in a recent study by Schwarzer, Dunkel-Schetter, and 45 Kemeny (1994) which measured social support for gay men who are at risk for HIV infection. Their study compared four sources of support (fiiends, relatives, partner, and organizations) and three dimensions of support (amount, satisfaction, and reciprocity). The present study’s measure is comprised of five parts, each part tapping into the respondent’s perception of different social groups, or contexts, that make up an HIV/AIDS worker’s social network (fiiends, family members, non-HIV/AIDS co- workers, neighbors, and the general public in their community). The first item of each item for each part asked respondents about how many people from a particular group know that they work with persons who have HIV/AIDS. The next six items ask the respondent to rate the strength of their beliefs about the same group on selected dimensions of associational stigma, namely: (1) judgment of moral wrong-doing, (2) fear of contagion, (3) lack of admiration, (4) fear of death, (5) misunderstanding, (6) lack of compassion. Three of these six items were presented using positive, or pro-social, language (e.g., “I believe that my friends admire me because I work with persons who have HIV/AIDS”); These items were recoded so that all items provide a measure of associational stigma on an ll-point Likert scale from 0 = “Do not believe at all [that I am stigmatized in this context ” to 10 = “Believe without any doubt [that I am stigmatized in this context].” Where necessary, items were recoded so that lower responses indicated lower levels of perceived associational HIV /AIDS stigma. Section C. Perceptions of Others’ Negative Behaviors Items in this section were used to develop a measure of perceived social distance. This section is adapted from Bishop’s et al. (1991) measure of a person’s willingness to 46 interact with a person with AIDS. It asked respondents about the degree to which their work with persons who have HIV /AIDS appears to cause others (i.e., non-HIV/AIDS workers) to avoid the respondent. For example, “Once people know that you work with persons who have HIV/AIDS, do you sense that they are less willing to strike up conversation with you?” All items were measured on an ll-point Likert scale from O=“Never sense this” to 10=“Always sense this.” No items required recoding. Section D. Communication with Others This section asked respondents about how they communicate with others (i.e., non- HIV/AIDS workers) about their work with persons who have HIV/AIDS (e.g., “Telling people that I work with persons who have HIV/AIDS gives me a sense of pride and satisfaction”). All 12 of the items were designed by the author and placed on an ll-point Likert scale from O=“Not at all like me” to 10=“Completely like me.” Where necessary, items were recoded so that a lower responses indicated lower levels of communication behavior. Section E. Unexpected Reactions of Others This section asked respondents to recall a situation in which someone’s awareness of their HIV/AIDS work elicited a particular unexpected behavior. It is wholly qualitative in design. Four open-ended questions probe the situation (i.e., “What was the person’s behavior?”, “How was their behavior unexpected?”, “How did this person’s behavior make you feel?”, and “How did you respond to this person?” Based on the responses provided, information about the situation was coded into five principal variables that described the reported incident. These five variables classified (1) how the situation was thought to be unexpected, (2) whether or not the situation was 47 constructive (positive), neutral, or destructive (negative), (3) to what the other’s behavior in this situation might be attributed, (4) how the respondent felt about the situation, and (5) how the respondent reacted to the situation. In addition, other variables were created to code the apparent strength or severity the situation that was reported. Section F. Personal Background The final section of the survey asked about the respondents’ personal background, including sensitive information about their sexual orientation, current HIV status, and perceived risk for HIV infection. General information about the respondents’ race and ethnicity, age, education, and income was also included. Because of the sensitive nature of some of the items (i.e., “Are you HIV-positive?”), text at the beginning of the section informed respondents that their answers to these items were completely optional. Some items, such as the respondent’s race/ethnicity, sexual orientation, current marital/partnership status, HIV serological status, and perceived risk for HIV were recoded for the purposes of correlational data analyses. Chapter 4 RESULTS This chapter reports the findings of the present study. Findings have been organized in four parts, as follows: 0 Description of Study Sample Dirnensionality of Perceived Associational Stigma Bivariate Correlational Findings Supplemental Analyses. Description of Study Sample will review information regarding (1) who responded to the survey, (2) what types of HIV/AIDS-related organizations they are affiliated with, and (3) what types of services they provided to persons living with HIV/AIDS. For all of these data, a comparison of two binomial proportions (male HIV/AIDS workers to female HIV/AIDS workers) is presented. Dimensionality of Perceived Assocational Stigma presents the study’s cornerstone: a measure of ‘perceived associational stigma.’ Findings for Research Question 1 will be presented here. In particular, this part will consider whether or not perceived associational stigma is uni-dimensional or multi-dimensional. Details of the process by which the measure was developed will be provided in three sections, as follows: 0 An exploratory factor analysis of six plausible dimensions of HIV/AIDS perceived associational stigma (i.e., moral-wrongdoing, fear of contagion, lack of admiration, fear of death, misunderstanding, lack of compassion) for five contexts (i.e., as 48 49 mentioned previously, friends, family, non-HIV/AIDS co-workers, neighbors, and the general public); 0 A first order confirmatory factor analysis (CFA) - based upon the results of the exploratory analysis — of a measurement model that identifies the dimensionality of perceived associational stigma for each of the five contexts under consideration; and 0 A second order CF A - based upon the results of the first order CFA — of a measurement model that identifies the ‘macro,’ or ‘context-transcendent,’ dimensionality of PAS. Final reliability measures for all perceived associational stigma scales derived fiom the first and second order CFA will also be presented, followed by a comparison of perceived associational stigma across the five measured contexts. Bivariate Correlational Findings reports results for Research Questions 2 through 4, which part be divided into four sections, as follows: 0 Scale Composition and Psychometrics o Correlates of Perceived Associational Stigma o Correlates of Perceived Social Distance, and o Correlates of HIV/AIDS-Related Communication Behavior. This part begins with an overview of the set often variables that are hypothesized to be correlates of percieved associational stigma. Half of these are single item variables; half are multi-item variables. The scale composition and psychometrics for the five, multi- item variables are presented in a first order comfirrnatory factor analysis. Reliabilities for the multi-item variables will also be reported. Following introduction to the ten hypothesized correlates, results for the three sets of bivariate correlations will be presented. Note that all sample correlations reported in the present study have been corrected for attenuation. Confidence intervals, inference probabilities, and odds ratios 50 are used to analyze the strength (magnitude) and direction (positive or negative) of the theoretical population value (see Use of Confidence Intervals, Inference Probabilities, and Odds Ratios below for further explanation of analyses and interpretation of correlational output). The final part of this chapter, Supplemental Analyses, will present the results of two explorations of the data: 0 a respondent clustering procedure that grouped respondents based upon levels of perceived associational stigma, and 0 a path analysis that proposes specific causal relationships among key variables measured in this study. These analyses were used to help integrate and summarize the results of the bivariate correlational findings. Use of Confidence Intervals, Inference Probabilities, and Odds Ratios Confidence intervals, inference probabilities, and odds ratios have been calculated — when useful and appropriate - for this study’s sample statistics. In addition, all bivariate correlation coefficients reported here have been corrected for attentuation. The following paragraphs define these innovations and Show how they were used to interpret findings. Significance Testing and Confidence Intervals In place of the traditional significance test, confidence intervals will be built about each bivariate sample correlation, binomial proportion, arithmetic mean, or other statistical parameter that is presented in this study. Confidence intervals have been chosen over the significance test because (1) they are correctly centered about the observed value rather than about the hypothetical value of the null hypothesis (i.e. p = 0) and (2) they give a complete picture of the extent of uncertainty due to less than optimal small sample 51 sizes (Hunter & Schmidt, 1990). As all hypotheses in the present study made a directional statement, a one-way statistical analysis is allowed. For the present study, a 90% two-sided confidence interval (i.e., a 95% one-sided confidence interval) has been selected. In terms of the traditional significance test, this means that where zero is found to lie between the limits of the confidence interval, r is said to be ‘not statistically significant’ (i.e., p2.10). Likewise, where zero is found to lie above the upper limit of the interval or below the lower limit of the interval, r is said be ‘statistically significant’ (i.e., p < .10). For the purposes of the present study, ‘ns’ denotes ‘not statistically significent’ and ‘sig’ denotes ‘statistically significant.’ Note that this interpretation will always return the same result as the traditional significance test. The confidence interval is a probability statement. For example, it may be written as: 0 Pr(.07 S n; - n; S .22) = .95, for the dtflerence between two binomial proportions (at; - m), which may be read “the probability that the difference between two independent sample proportions will lie between 6.9% and 22.1% is exactly 95%.” 0 Pr(.07 S p S .22) = .95, for the Pearson population correlation value (p), which may be read “the probability that population correlation value is lies between .069 and .221 is exactly 95%,” 0 Pr(.07 S 11 S .22) = .95, for the nonlinear population correlation coeflicient (n), which may be read “the probability that eta lies between .069 and .221 is exactly 95%.” Correcting for Attenuation Hunter and Schmidt (1990) note that correctable artifacts other than sampling error are systemic rather than unsystemic in their impact on bivariate sample correlations. Measurement error in either variable causes the correlation to be lower than it would have been with no measurement error. If the amount of measurement error is known, sample 52 correlations may be ‘corrected for attenuation’ using an algebraic formula. In the present study, all sample correlations have been corrected for attenuation using the following formula: r corrected = $7,103 where Jr; and Jr; are the square root of the reliability (or) for variable x and variable y, respectively. Correcting for attenuation will not affect interpretation of whether a given population value is statistically significant or not as long as the lower and upper limits are corrected using the same reliabilies for variable x and variable y. The following formula was used: Limit Limitcomcted = m where ‘Limit’ is either the uncorrected upper bound or the uncorrected lower bound of a given confidence interval. Inference Probabilities and Odds Ratios for Correlations When a given sample correlation (r) is small in magnitude and/or is not determined to be statistically significant, additional information about the sign of the population correlation can be obtained from inference probabilities and odds ratios. The inference probability (PI) is an estimation of the likelihood that the population value (p) is positive. Where a positive association is predicted, the odds ratio is defined as the probability that p is positive divided by the probability that p is negative (odds = PIN/P1,“). Where a negative association is predicted, the odds ratio is defined as the probability that p is negative divided by the probability that p is positive (odds = PIneg /Plpo,). 53 Table 1 is provided as a guide to interpretation of inference probabilities and odds ratios for correlations. Note that an inference probability of greater than .67 affirms that the sign of p is positive, and that an inference probability of less than .33 affirms that the sign of p is negative. Likewise, an odds ratio greater than 2 to 1 affirms that the sign of p is positive (or negative, as the case may be). Table 1 - Interpretation of Inference Probablitles and Wm Sign of Inference Population Probabi_tx [Pl] 1 - Pl Odds Value .98 .02 49 101 positive .96 .04 24 to1 positive .93 .07 13 to1 positive .90 .10 9 to1 positive .75 .25 3 to1 positive _ nee--. . , ..35. -___.__-2._..t_9..1..-...__._1_>951ti.¥9 .67 ' .33 1.99 tat mam .50 .60 1 to1 inconclusive g .nfi--- . ........§Z......... Sandwiches .34 .68 2 to1 negative .25 .75 3 to1 negative .10 .90 9 to1 negative .07 .93 13 to1 negative .04 .96 24 tot negative .02 .98 49 to 1 negative 54 Description of Study Sample Response Rates Of the 802 study packages mailed or handed out to persons who work with persons with HIV /AIDS, 40% (N=319) were completed and returned. Survey distribution successfully reached all but one of Michigan’s eight regional HIV Prevention Planning Groups (RPPGS) (see Table 2). The region that was not reached was Kalamazoo (Region 3). Kalamazoo declined full participation in the study because of a recent bad experience with another community researcher. Nonetheless, it completed and returned the two sample packages that they had been mailed. Excluding Kalamazoo, Ypsilanti generated the lowest rate of return (15%). Note that 27 surveys were returned without a proper US. Mail postmark, and therefore could not be classified by region. Lansing/East Lansing produced the highest rate of return (47%), followed by Table 2 - Respondents' City and County of Residence by Regional HIV Prevention Planning Group (RPPG) Surveys % of 96 of Distri- Surveys RPPG Total RPPG City County buted Returned Returned Returned 1 Detroit/Royal Oak Wayne/Oakland 300 127 42 40 2 Ypsilanti Washtenaw 75 11 15 3 3 Kalamazoo Kalamazoo 2 2 100 1 4 Lansing/E. Lansing lngham 99 47 47 15 5 Grand Rapids Kent 100 37 37 12 6 Flint/Bay City GeneseelBay 95 33 35 10 7 Traverse City Grand Traverse 71 24 34 8 8 Negaunee Marquette 60 11 18 3 — Unknown Unknown - 27 — - Total 802 319 40% 100% Note: The Kaiunazoo-besed organ'aation declined full partic‘pation in the study. 55 Detroit/Royal Oak (42%). Note, however, that respondents from Detroit/Royal Oak accounted for the greatest percentage of surveys used in the present study (40% overall; n=127). A higher allocation of surveys to be distributed in Region 1 was justified by the substanially higher impact of HIV/AIDS in the Detriot area. Table 3 shows that the cumulative incidence of HIV/AIDS among its population is more than twice that of any other region in the State. Table 3 - Cumulative Incidence of AIDS In Michigan by Regional HIV Prevention Planning Group (RPPG) Population density Total cases of Cum Incidence of RPPG Population' per square mile' A103” A108 per 100,000“ 1 4,191,886 1,323.4 5,662 135.1 2 639,814 233.9 339 53.0 3 936,599 156.3 469 50.1 4 431,336 137.2 241 55.3 5 1,057,755 153.3 561 53.0 6 1,104,694 191.9 400 36.2 7 537.793 42.0 97 13.0 3 313,915 17.3 45 14.3 '1990 US. Census. ”January 1931 to October 1993 (Michigan Department of Community Health. Fall 1993). Respondent Demographics Study respondents tended to be white (i.e., caucasian) (83.8%), English-speaking (98.4%), college-educated (69.4%), and come fi'om households with yearly incomes in greater than $30,000 (67.5%). In addition, respondents tended to be single (53.9%) and politically liberal (63.2%). Their average age was 39.5 (SD=11.6). Three statistically significant differences in demographics were found when female HIV/AIDS workers were compared to male HIV/AIDS workers. First, male HIV/AIDS 56 workers were more likely to self-identify as homosexual rather than as heterosexual or bisexual [68% of the male workers (1:2); 14% of the female workers (in); Pr(.44 S n2 - in S .64) = .95]. Second, female HIV/AIDS workers were more likely to be partnered by marriage rather than be single or partnered by domestic partnership [21% of the male workers (112); 33% of the female workers (111); Pr(-.22 S n2 - m S -.02) = .95]. Last, male HIV/AIDS workers were more likely to have tested HIV-positive [18% of the male workers (n2); 3% of the female workers (111); Pr(.07 S n2 - m S .22) = .95]. See Appendix J for details regarding respondents’ race and ethnicity, primary language, highest level of education, yearly household income, current political leanings, and whether or not they current a place of worship. Types of HIV/AIDS Organizations Figure 1 shows the types of organizations or agencies to which respondents were affiliated. The majority of respondents were affiliated with community-based support organizations (72%); followed by prevention planning organizations (16%) or health/medical service organizations (11%). On average, respondents were affiliated with only one organization in the community (M=l .37, SD=.78, N=295), although some respondents reported involvement with up to five different places. How Respondents Worked with Persons with HIV [AIDS The present study described how respondents worked with persons with HIV/AIDS using three broad categories, as follows: (1) their basis of work (either volunteer or paid staff member), (2) the type of service they provided (either ‘direct’ services — caregiving/ personal support, advocacy/case management, and counseling for persons with HIV/AIDS and/or ‘indirect’ services — general community support and/or administrative 57 Health/medical service Other 11% 1% Prevention planning 16% Community-based support service 72% Figure 1 - Types of HNIAIDS Organizations or management services for the HIV/AIDS organization in which they worked), and (3) the their frequency of face-to-face contact with persons with HIV/AIDS (everyday, more than once a week, about once a week, about once a month). The proportion of respondents within each of these types of services is presented in Figure 2. Caregiving and/or personal support accounted for 36% of all respondents, followed by advocacy/case management services (19%). Community support, counseling, and administrative or secretarial work taken together comprised (40%) of respondents. The remaining 5% of respondents provided management or leadership services for an HIV/AIDS-related organization. Table 4 presents an analysis by sex for basis of work, type of service, and frequency of contact. More than half of all respondents (64%) worked on a mostly voluntary basis. Men, however, were more likely than women to be volunteers [68% of the male workers 58 Management/leader shi Admin/actuarial 5% Care giving/personal support Counseling _ 36% 14% ‘ Community support 1 7% Advocacy/case management 1 9% Figure 2 - Types of HMAIDS Services (1:2); 53% of the female workers (in); Pr(.05 S 11:2 - m S .27) = .95]. Put another way, women were more likely than men to be paid for their HIV/AIDS work [32% of the male workers (in); 47% of the female workers (in); Pr(-.27 S 1:; - m S -.05) = .95]. When asked how often respondents had face-to-face contact with persons who have HIV/AIDS, 66.9% of this study’s sample reported having some interaction at least once a week (see Table 4). This percentage is approximately the same as the 64.0% of respondents who reported providing direct services only. It appears to be that HIV/AIDS workers who participated in the survey have a relatively high level of face-to-face contact with persons with HIV/AIDS. However, note that 11.3% of respondents reported that they had face-to-face contact with a person with HIV/AIDS less than once a month. 59 Groups Served by HIV/AIDS Workers Respondents worked with a wide range of groups of persons who have HIV/AIDS. Nearly all respondents provided some sort of assistance or support to gay or bisexual men (91.9%). In contrast, commercial sex workers were the least common group served among this study’s respondents (19.7%) (see Table 5). In general, male HIV/AIDS workers reported working as much as female HIV/AIDS workers with any of the groups served except for women with HIV/AIDS. Here a statistically significant difference was found when the percentage of women who reported working with HIV-positive women was compared to the percentage of men who reported working with HIV-positive women [59% of the male workers (m); 75% of the female workers (1:1); Pr(-.27 S n2 - 1n S -.05) = .95]. 60 Table 4 - How Respondents Worked with Persons who have HIVIAIDS Sex of HlVIAiDS 95% Two-eided Worker Confidence Interval Sig Work Experience Women Men Difference SE0! Lower Upper (p<.06) Beale of Work Al or mostly volunteer work Sample proportion 53% 68% 16% 6% 5% 27% sig Number of affirrned cases 94 82 Sample size 179 120 Al or mostly paid work Sample proportion 47% 32% -16% 6% -27% -5% sig Number of affirmed cases 85 38 Sample size 179 120 Type of Service Direct service only Sample proportion 61% 68% 7% 6% -4% 18% ns Number of affirmed cases 110 82 Sample size 180 120 Indirect service only Sample proportion 21% 17% -4% 5% -13% 5% ns Number of affirmed cases 38 20 Sample size 180 120 Some direct. some indirect Sample proportion 18% 15% -3% 4% -11% 6% ns Number of affirmed cases 32 18 Sample size 180 120 Frequency of Contact Everyday Sample proportion 20% 25% 5% 5% -5% 14% ns Number of affirmed cases 38 31 Sample size 187 124 More than once a week Sample proportion 28% 30% 1% 5% -9% 12% ns Number of affirmed cases 53 37 Sample size 187 124 About once a week Sample proportion 16% 15% -1% 4% -9% 8% ns Number of affirmed cases 30 19 Sample size 187 124 About once a month Sample proportion 4% 9% 5% 3% -1% 10% ns Number of affirmed cases 8 11 Sample size 187 124 Table 5 - Groups Served by HIVIAIDS Workers 61 Sex of l-llVlAIDS 96% Two-sided Worker Confidence Interval Sis Group Served Women Men Difference SE Lower Upper m Gay men Sample proportion 90% 95% 5% 3% 0% 11% ns Number of affirmed cases 168 117 Sample size 187 123 Women Sample proportion 75% 59% -16% 5% -27% -5% sig Number of affirmed cases 141 73 Sample she 187 123 IV drug users Sample proportion 64% 60% -4% 6% -15% 7% ns Number of affirmed cases 120 74 Sample size 187 123 Hemophiliacs Sample proportion 31% 36% 5% 5% -6% 16% ns Number of affirmed cases 58 44 Sample size 187 123 Children Sample proportion 28% 30% 2% 5% -9% 12% ns Number of affirmed cases 53 37 Sample size 187 123 Adolescents Sample proportion 25% 26% 1% 5% -9% 11% ns Number of affirmed cases 47 32 Sample size 187 123 Commercial sex workers Sample proportion 19% 21% 2% 5% -7% 12% ns Number of affirmed cases 35 26 Sample she 187 123 Others Sample proportion 15% 11% -4% 4% -11% 4% ns Number of affirmed cases 28 14 Sample she 187 123 62 Dimensionality of Perceived Associational Stigma (Hypotheses I - 2) This part of the chapter begins the review of results for each of the 29 hypotheses listed in Chapter 2. Results of hypothesis tests have been classified in the following way: 0 Confirmed 0 Disconfirmed (No Relationship) 0 Disconfirmed (Reversed Support). ‘Confirmed’ indicates that support was found for the hypothesis as stated. ‘Disconfirmed (N 0 relationship)’ indicates that no support was found for any substantial relationship between the constructs under consideration. ‘Disconfirmed (Reversed Support)’ indicates that if the predicted direction of the relationship under consideration were to have been switched, the hypothesis would have been supported. Recall that the list of hypotheses has been organized around a set of four research questions. The first such research question was: 0 Research Question l—Which dimensions of HIV [AIDS stigma comprise perceived associational stigma and in which contexts are they most salient? Table 6 restates the two hypotheses and lists their corresponding table references. Table 6 - Hypotheses for Research Question 1 . II ' . .~ 'M‘l _ $63915. " ms-cu...1.5:5:.-.x.\:a.-.sf-..-...:r. ..s ~§w .5‘rwe~'"r. r was“ ... .. ., Puddles .. . . -. .. _._ “55...“... Perceived associational stigma (PAS) mono HIV/AIDS 7 _ 11 workers is a multidimensional constnict. L 2 PAS increases as persons in a setting become less familiar. I 12 I 63 Hypothesis l—Perceived associational stigma among persons who work with persons who have HIV/AIDS is a multi-dimensional construct. It was determined that perceived associational stigma exists among HIV/AIDS workers, and that it is a multi-dimensional construct. A three-step process was used to develop the measure. Exploratory Factor Analysis As an initial examination of the data, a series of five, six-item exploratory factor analyses (EFA) were carried out, one for each context measured (i.e., as mentioned previously, friends, family, non-HIV/AIDS co-workers, neighbors, and the general public). For each context, data for six items were collected. For example, consider the context of ‘friends’: 0 Item 1 - I believe that my friends judge my work to be morally wrong because I work with persons who have HIV/AIDS. 0 Item 2 - I believe that my friends are afraid that I might pass HIV on to them because I work with persons who have HIV /AIDS. 0 Item 3 - I believe that my friends admire me because I work with persons who have HIV/AIDS. 0 Item 4 - I believe that my friends associate thoughts of death and dying with me because I work with persons who have HIV/AIDS. 0 Item 5 - I believe that my friends understand and value me because I work with persons who have HIV/AIDS. - Item 6 - I believe that my friends show compassion for me because I work with persons who have HIV/AIDS. Note that items 3, 5, and 6 (lack of admiration, misunderstanding, and lack of compassion, respectively) were recoded so that they reflected negative perceptions of others, as the scores for items 1, 2, and 4 already did. 64 Using the principal axis method, each EFA extracted two orthogonal factors per context. The first cluster included items 1, 2, and 4 (moral-wrongdoing, fear of contagion, and fear of death, respectively) for all contexts except ‘the general public.’ For this EFA (the filth EPA) the procedure attempted to extract two clusters, but terminated because the communality of item 4 (fear of death) exceeded 1.0. The fifth EFA was then rerun without item 4, and this time two clusters were extracted, the only difference being that the first cluster did not include item 4. The second cluster, however, always included items 3, 5, and 6 (lack of admiration, misunderstanding, and lack of compassion, respectively) (see Table 7). Review of the factor loadings indicate that ‘fear of death’ appears to be the only item with poor quality. Table 8 shows the amount of variance explained (sum of squared loadings) for each of the unconfirmed clusters. The context of ‘neighbors’ accounts for the most variance (75.9%); the context of ‘friends’ accounts for the least variance (55.8%). In general, the outcome of these EFAs are strikingly consistent across contexts. These results suggest that a two-factor solution exists within each context. 65 Table 7 - Factor Loadings and Uniqueness for Exploratory Factor Analyses of Dimensions of Perceived Associational Stigma Loadan Unconfirmed cluster and item Factor 1 Factor 2 Uniqueness 1st EFA (Friends) Unconfirmed cluster 1 Moral Wrongdoing iiiml’i'"- '3 .11 .82 Fear of contagion .98 .06 .03 Fear of death ,2," .. .33__ g; -.10 .88 Unconfirmed cluster 2 ., Lack of admiration .03 5177”" “ 181'? .35 Misunderstanding .05 f; .94 f. .12 Lack of compassion -.03 g, .74 ;._,._. .; .45 2nd EFA (Family) Unconfirmed cluster 1 Moral Wrongdoing i“ 85 ”5 .27 .51 Fear of contagion S~ .98 , .21 .03 Fear of death ,_ 39 -.05 .85 Unconfirmed cluster 2 Lack of admiration .13 -;" .8? ' 7’": .23 Misunderstanding .12 i. .97 .04 Lack of compassion .08 figgggwg .33 3rd EPA (Non-HNIAIDS co-workers) Unconfirmed cluster 1 Moral Wrongdoing 8““ “1‘1“” .19 .36 Fear of contagion j_ .90 .12 .17 Fear of death 48 _ 3; -.18 .75 Unconfirmed cluster 2 . 7 Lack of admiration .10 "in .32 Misunderstanding .03 '_ .98 .09 Lack of compassion -.05 F.85 1,: r .27 4th EFA (Neighbors) Unconfirmed cluster 1 Moral Wrongdoing if?” ° " err“,4 .16 .33 Fear of contagion .94 £4: .15 .10 Fear of death ;__.88. -.11 .51 Unconfirmed cluster 2 Lack of admiration .12 ‘1’ 7%“ “‘7? .27 Misunderstanding .04 9f .98 .04 Lack of compassion 02 1...... fig“, 7, .19 5th EFA (General public) Unconfirmed cluster 1 Moral Wrongdoing "“81““ .12 .27 Fear of contagion 33.. . _ 84 .09 .29 Unconfirmed cluster 2 Lack of admiration .07 Misunderstanding .16 Lack of compassion .09 Note:$hededareelndlceiesbestfactorsssignrnent 66 Table 8 - Percentage of Variance Explained for Exploratory Factor Analyses of Dimensions of Perceived Associational Stigma umu e Percentage Percentage Factor lD Eigenvalue of Variance of Variance Friends 1 2.121 35.4 35.4 2 1.228 20.5 55.8 Family 1 2.820 47.0 47.0 2 1.198 20.0 67.0 Non-HIVIAIDS Co-workers 1 2.465 41.1 41.1 2 1.566 26.1 67.2 Neighbors 1 2.724 45.4 45.4 2 1.832 30.5 75.9 General Public 1 2.418 48.4 48.4 2 1.246 24.9 73.3 First Order Confirmatory Factor Analysis A first order confirmatory factor analysis (CFA) — based upon the results of the preceding EFA - was carried out next. The confirmatory factor model that was proposed was comprised of ten factors, two for each of the contexts measured in the study. The first factor would be comprised of items 1 and 2 (moral wrong-doing and fear of contagion). The second factor would be comprised of items 3, 5, and 6 (lack of admiration, misunderstanding, and lack of compassion). Table 9 shows the results of the proposed CFA. Just as the preceding EFA suggested, a ten factor solution (two factors within each of the five contexts) was confirmed. These clusters of items suggest the following factor definitions: 67 Imam new 0:) saleH-uon Aromas mucus 11:0un new 0:) SON/NH'UON a o h o n v n N 2.5.8 zoos-.83 328.... so too: .22“. asacnccoo 3. 85.23.. sou-was. a... 5...: 5.52.8 :20 5.“. . a 2...... 68 0 Judgment of depravity. HIV/AIDS workers are morally bad, corrupt, infectious and perverted (because they attend to the needs of persons who have HIV /AIDS) [Factors 1 through 5]. 0 Sense of disempathy. HIV/AIDS workers are misunderstood, unadmired, and not worthy of compassion (because then attend to the needs of persons who have HIV/AIDS) [Factors 6 through 10]. The quality of the items within any given factor appear to be uniform, and every item loads highest on its intended factor. Note, however, that correlations among items for the depravity factors (F1 to F5) are relatively high (rmmg, = .42), as are correlations among items for the disempathy factors (F6 to F10) (rmmge = .55). This observation suggests that the factor scores themselves may cluster into two ‘macro’ or ‘context-transcendent’ clusters. Second Order Confirmatory Factory Analysis The third and final step towards development of a measure of perceived associational stigma was to conduct a second order CF A. This time the proposed model tested a two factor model. The first factor would be comprised of all five depravity factors scores; the second factor would be comprised of all five disempathy factors scores. Table 10 shows the results of this procedure. As with the first order CFA, the quality of the factors within any given macro-factor appear to be uniform, and every item loads highest on its intended macro-factor. Moreover, the second order inter-macro-factor correlation indicates a relatively independent factor structure (r=.18). To summarize these findings, percieved associational stigma appears to be comprised of ten factors and two macro-factors. For the purposes of the present study, ‘factors’ may be conceptualized as ‘dimensions’ and ‘macro-factors’ may be conceptualized as ‘macro- 69 .3. flea Ego-u .520 EN 0.2 is :85! 533.8 832.13: R =o_eceE_u.9__ulslI“ Nan—35 _. 5.555.803. '1‘ 2.5.3 .2258! 328.... 3 3.8: .88.. 55.5.30 .2 8:58.. 58......3. a... 5.5... 5.52.8 5.5 2.88 . 3 so: 70 dimensions.’ Hence, the measurement model of perceived associational stigma includes ten dimensions and two macro—dimensions. This is diagrarnmed in Figure 3, which shows the combined first and second order confirmatory factor models. Psychometrics for Perceived Associational Stigma Scales Table 11 reports two measures of internal consistency for each of the ten dimensions (D1 to D10) and the two macro-dimensions (MDl to MD2) of perceived associational stigma: (1) The standard score coefficient alpha (or) and (2) the average correlation Table 11 - Standard Score Coefficient Alpha and Average Correlation for Perceived Associational Stigma Scales Dimen- Number Stand. Score Avg. Corr. sion lD Variable of items Coei'i. Alpha among lterns D1 Depravity from Friends 2 .59 .42 DZ Depravity from Family 2 .81 .88 D3 Depravity from Non-HiV/AIDS Co—workels 2 .85 .73 Depravity from Neighbors 2 .88 .78 OS Depravity from General Public 2 .84 .72 N01 Depravity (Macro-dimension 1) 10 .87 .40 08 Disempatiiy from Friends 3 .87 .88 D7 Disempathy from Family 3 .92 .79 DO Disempathy from Non-HlVlAlDS Co-workers 3 .91 .78 D9 Disempathy from Neighbors 3 .93 .83 D10 Disempathy from General Public 3 .89 .74 '02 Disempathy (Macro-dimension 2) 15 95 .54 among items (rump). Overall the measurement model is convincing, except that the five depravity dimensions are only two-item scales, which are theoretically less reliable than scales with three or more items (N unnally & Bernstein, 1994). Depravity from fi’iends generated the lowest alpha (or = .59) and the lowest average inter-item correlation (rung... = .42) among all ten dimensions. In contrast, disempathy from neighbors 71 2......» 3858.2 828.... .o. .28.. .88.. cos-€58 .n 2.6... m 03:... 83:03.00 32E 5.53.00 2. e e ..... e e .2... e. .... mcoficoEE ' Q meg W 8 me 8 WWW“ 8 ”W8: men 3 mm 8 norm-dumnm 3. ammonium 8, mun-lam 3 p )0 Wiener) 3 wwwm mEQ. 2.95 .mco_.m_oomm< 3235... .0 303565935. 3. 72 generated the highest alpha (or = .93) and the highest average inter-item correlation (rmmg, = .83) among all ten dimensions. Note that the reliability of each of the macroodimensions is based upon the raw items that comprise the first order dimensions. Because the macro-dimensions were actually derived from factor correlations, not raw items, they may be viewed as constructs, which are theoretically measurement error-free. However, they are still fallible to the degree that the first order factors from which they are empirically derived did not achieve perfect reliability. Although coefficient is relatively high for both macro-dimensions (am), = .87, am), = .95), their average inter-item correlation is relatively low (rummmg, = .40, rum...” = .54). In summary, the results of the exploratory analysis, the first order confirmatory factor model, and the second order confirmatory factor model suggest that perceived associational stigma is comprised of two macro-dimensions: perceived associational depravity and perceived associational disempathy. Each macro-dimension is comprised of five context dimensions. Context dimensions are representative of different components of the HIV/AIDS worker’s social network (i.e., the worker’s friends, family, non- HIV/AIDS co-workers, neighbors, and members of the general public). Given these findings, the degree to which the strength of perceived associational stigma varies by context will now be considered. Hypothesis 2—Perceived associational stigma increases as persons of a particular context become less familiar. Table 12 shows the outcome of two univariate repeated measures analyses. The first analysis is for dimensions (i.e., contexts) of perceived associational depravity. The second analysis is for dimensions of perceived 73 Table 12 - Univariate Repeated Measures Analysis for Dimensions oi Perceived Associational Stigma Confidence Analysis of interval for Eta Variance Dhneneion oi Perceived Associational Stigma Mean SD... N Eta SE... Lower Upper F p-vaiue Depravity Friends .68 1.23 311 .61 .02 .58 .64 122.21 .00 Family 1.40 2.09 311 Non-HIVIAIDS Co-workers 1.42 1.88 243 Neighbors 2.27 2.56 264 General Public 3.80 2.38 308 Disempathy Friends 3.47 2.42 310 .49 .02 .45 .53 112.72 .00 Family 4.17 2.91 310 Non-HIVIAiDS Co-workers 4.62 2.74 242 Neighbors 5.85 2.80 263 General Public 5.58 2.13 307 associational disempathy. Eta, the nonlinear correlation coefficient, indicates that perceived associational stigma varies in ‘less familiar’ social contexts than in ‘more familiar’ social contexts. Note that, for the purposes of this study, friends are taken to be the ‘most familiar’ members of the HIV/AIDS worker’s social network, followed by family members, non-HIV/AIDS co-workers, neighbors, and the general public in the worker’s community. Although this ordering of contexts may or may not be valid for all HIV/AIDS workers, it is thought to reflect a particular reality for many people living with HIV/AIDS and their associates. Rejection by family members is not an uncommon occurrence (Geis, Fuller & Rush,1986; McDonnell, Abell & Miller, 1991). For instance, the mean for depravity increases as the respondent reports on friends (M=.68), then family members (M=1.40), then non-HIV/AIDS co-workers (M=l .42), and so on [Pr-(.58 s n s .64) = .95]. For depravity, there appears to be a monotonic increasing relationship that ebbs among family members and neighbors, but then picks up again when the general public is considered. A similar relationship is shown for disempathy 74 [Pr(.45 S 11 S .58) = .95]. Disempathy appears to increase fiom context to context in an almost linear fashion, decreasing slightly when public is considered. These results support the hypothesis that perceived associational stigma tends to be higher in less familiar contexts. To review this section’s results, perceived associational stigma is a multi- dimensional construct that may be conceptualized as having two macro dimensions, depravity and disempathy. Furthermore, perceptions of associational stigma appear to become stronger for ‘less familiar’ components of the HIV/AIDS workers social network. These results are summarized in Table 13. Table 13 - Summary of Results for Research Question 1 r. 5.. ..‘E‘fi._ "il’.fi', ,v—v w T ‘1' I: 7 Perceived associational stigma (PAS) among HIV/AIDS workers is a multidimensional construct. l 2 IPASincreasesaspersonsinaaettingbecomeiessfamiliar. Confin'ned I Confirmed] 12 I Bivariate Correlational Findings This part of the results chapter will report findings from a series of bivariate correlational analyses that respond to Research Questions 2, 3, and 4, respectively. The analyses are divided into three sections, as follows: a Correlates of Perceived Associational Stigma (Research Question 2) o Correlates of Perceived Social Distance (Research Question 3), and o Correlates of HIV/AIDS-Related Communication Behavior (Research Question 4). 75 Before presenting findings, information about the scale composition and Psychometrics of perceived social distance, HIV/AIDS communication behavior, and eight other variables will be reviewed. Scale Composition and Psychometrics A total of ten different characteristics and experiences hypothesized to be germane to HIV/AIDS workers were used in the correlational analyses. Half of these are single-item responses to survey questions. They include: (1) whether or not they are volunteers or paid staff members, (2) the number of ‘otherwise stigmatized’ groups (e.g., IV drug users) with whom they are associated, (3) their frequency of face-to-face contact with persons who have HIV /AIDS, (4) the duration of their HIV /AIDS work experience, (5) their perceived risk of HIV infection. (See Appendices C, G, H, and I for full information about all data collected for this study). ‘Volunteer vs. paid status,’ ‘number of otherwise stigmatized groups,’ ‘frequency of face-to-face contact,’ and ‘duration of work’ are variables that describe the HIV /AIDS work experience. ‘Perceived risk of HIV infection’ describe an individual characteristic of the HIV/AIDS worker. The other half are multi-item scales. They include: (1) satisfaction with their HIV/AIDS work experience, (2) the amount of social support they report receiving from peer HIV/AIDS workers (relative to non-HIV/AIDS workers), (3) the proportion of others (i.e., friends, family members, neighbors, etc.) who know about their HIV/AIDS worker, (4) perceived social distance that they attribute to their HIV/AIDS work, and (5) the amount of HIV/AIDS-related communication behavior that engage in with others. ‘Satisfaction with HIV/AIDS work experience,’ ‘perceived social support fi'om HIV/AIDS workers,’ and ‘the proportion of others who know about one’s HIV/AIDS 76 work’ describe the HIV/AIDS work experience. ‘Perceived social distance’ and ‘HIV/AIDS-related communication behavior’ describe an individual characteristic of the HIV/AIDS worker. In order to show the measurement properties of these five multi-item scales, a confirmatory factor analysis was completed. Table 14 shows the first order correlation matrix and item-factor loadings for the five multi-item scales used in the present study. Note that all items load highest on the factor for which they were intended, and that the quality of these items appear to be relatively uniform. Measures of reliability for these scales are presented in Table 15. Perceived social distance appears to be the most reliable (or = .94; rmmge = .73). The other four have satisfactory coefficient alphas, but relatively low average correlations among the items from which they are comprised. 77 9...... 228 88.3. so one... 81.8 =2 28.. e3. ice-Sm os. ow.- ss. so. 9. 3 5 no. on on 9.. 9.. 9.- 9 - 9.- 2... nm vn. on 5 5.. oo. oo 9 9 5 us..- 28298 on 2 use: No. 5.- mv. no. 9. av on on. 5 sv 9.- sfi- C.- 9.. nu; 5.- on an on. on n? no. no. «o oo s9 9 on 85.9... 3588 n =0. .8 v.33 on nu: 0v 9. oo. sm on 5. on «v nu; on.- 9.- 9: NH; 9.- «N ov. on «n no s9. so. no 5 - 5. no 9 __e._ E93 Sons stolen as no - so. 5 NF 5 on so. uv «n ow.- vwr our 9.- 5.. Nu.- ov 5 on. on no no. no 5 so or 3 9 Eifisezeéoafi on.- 5. 9 - no. 5 an; 9.- 2..- nu: our on so 5 cs no ss 9 - sf. 9.- oo.- 5 5. so. no so no 5.- s9 .0582 38:3 on o. 29.... .3.. sn- so. 5.. oo.- no. oo.- 9.- sf. om.- vmu 5 ms ss. so vs vs I - 9.. st- oo.- 8; «or no.- no; 5 no 5 9 959...... 3:58 2 Enos... 88.. on.- sn. N F .. no. oo. may 9.- C.- 9.- om.- 5 ss as. on vs cs oo.- n F .- oo.- 5.. no «or no No; no. 5 nor 9 850 .- 5; 2.3.5 20! sN.- os. oo.. 5.. so.. ow.- 9; 9 . 9.- 9.- os so on no on on 9.- 9.- so.- no. 5.. no.- no no: «or oo.. 5.. v— 3.2.8... ass is... aspen :9... to! on: on. 9.. No. no. 5.- 9.. nu; Nu; 5.- no vs vs on vs vs 9.- 9.. 9.- oo.- 5.- no - no. No no No. no 9 .63 o o. 8.. .3- 2 29... 3.. 3.. no. S.- 3- 5.. on: s... 5.. 9.. «N- C. vs vs on. vs so 5.. so.. 8.. vo; no.- mo; 8. no 5 «o.- ..o.. «— Eggeztcflga 3. 9.. no. no. no. on nm on. «N ov 9 - 3.. oo.. 9.. n_... 5.- oN 9. on. sn no oo. so no 8 no oo 2. 3395556038582... on. 9.- 5. 9. mo. 9 on «n ov : s_..- 9.- 9.. o—.- 9.- so.- no 8 av No 5 oo. 9 9 «o no so 9 .65. 95......qu 5:88... at. 3.. so. NF. so. 9 on om. nn on 9: sf- oo.- 5.. 9.- oo.- mn ov 3. ow no so. 9 oo 5 oo. oo o .65. 95 8.8.... B 8.58... ov. no; ms. 9. no. 3 we tn. 5 on oo.. oo.- 5.- no. oo.- 5.- sn no on. on vo. up so 5 mo oo. so n 8.1380252. SE30 9. no: mo. ms. 9. oo. 5.- 9. oo. no. 5. oo.- no. 5.- 5.- oo.. no 5 no. 5 on. on 5 5 NF 1.. vo s 59.8 e 3 o... 223.co- 23... 2.. 5.. 9. vs. so. no. oo. no. s9. no. 5.. «or No; no.. 8.. oo.- oo oo. so 9 on. on on. no. so so 5 0 Es... 9.3.- =S>E on 2.3. 50 no. 5. sw. oo. oo. 5. no. no. so. no. so. no.- no. no. oo. oo. so 9. 9 so 5 on we on 5.- 5. oo ..- !=2:e5_o.Eo£coano 5. oo. «P. on. or. oo. 5. «o. no. 5. no. no.- no; «o.- No. no. no 9. 0o 3 5 no on on no so. no v clause-ES :2. seasons... to: so. no. no. ow. an. 5. oo. oo. 5.. so so 5. No «or no. 5. oo «o. 5 no «r so 5.. co. s« of nv n 9.5253... 55 9.553 202 s9. oo. so. o—. 5. 9. 9. s9. 5. or. no. no. 5. no.- No. «or no no oo. oo 3 so. 5 so ov on as N 3.5.5.. 56 955;! to! s... «or :. vo. 5. up. n p. 9. No. C. 5.. 5. no.- so.. no. 5.- no so no. so 5 5 oo. oo nv os os w c0203 on v... nu an E NN 5 ca 9 9 s9 9 9 3 9 NF 3 or o n s o n v n N P u a. 7 . .1, . 220m". .020 «at .6328 :88_c:EEoo 8:830 icon 328.0... ..82. 832: 89:25 mesa: 8:0..on BQE-nQSZI 53¢ 305. on: So: 38.6 38m ..82. 9.23.: 825 .0 conga 5.3 Sign“ oo.-um 5312:! 02m .0 .05! .30.“. boa-5530 3* 3:53-— nOuo-k-Eoz u..- go! Eva-.230 .020 “2.... - 3 03.... 78 Table 15 - Standard Score Coefflclent Alpha and Average Correlation for Multl- Item Scales Survey Nunher Stand. Score Avg. Corr. Secuon Varlable of Items Coetl'. Alpha among llama A Satisfaction with HIV/AIDS Work Experience 3 .80 .57 Social Support from HIV/AIDS Workers 4 .78 .48 8 Proportion of Others who know about HIV/AIDS Work 4 .77 .46 C PerceNed Social Distance 6 .94 .73 D HlVIAlDS—related Communication Behavior 5 .79 .44 Correlates of Perceived Associational Stigma (Hypodreso 3 - 10) This part of the chapter reviews results for hypotheses 3 through 10. These hypotheses address Research Question 2, which was: . Research Question 2—Given that perceived associational stigma exists, what types of work experiences and individual characteristics are related to stronger perceptions of associational stigma? Note that all the tables produced for Research Question 2 show two sets of sample correlations. The first set of sample correlations describes the relationship between each dimension of perceived associational depravity and the hypothesized correlate; the second set of sample correlations describes the relationship between each dimension of perceived associational disempathy and the hypothesized correlate. Table 16 restates the eight hypotheses and lists their table references. Hypothesis 3—Perceived associational stigma and satisfaction with work experience are negatively correlated. Table 17 shows that only one of the six odds ratios for depravity but all six of the odds ratios for disempathy supported the hypothesis that the population value (p) is less than 0. However, four of the odds ratios for depravity (more than half) supported the hypothesis that (p) is greater than 0. Table 17 79 Table 16 - Hypotheses for Research Question 2 Perceived associational stigma (PAS) and satisfaction with work experience are negatively correlated. 17 PAS and basis of current work (volunteersi; paid=2) are negatively correlated. ‘8 PAS and work with otherwise stigmatized groups are positively correlated. PAS and frequency of lace-to-face contact with PWAs are positively correlated. PAS anddurationotworkexperlencearepositively correlated. 19 at —; 21 PAS and perceived social support from peer HIV/AIDS workers are positively correlated. PAS and perceived risk of HIV infection are positively correlated. PAS andproportionototherswhoknowaboutrespondent‘s [HIV/AIDS work are positively conelated. 10 24 also shows that two of the six sample correlations for depravity were statistically significant but not in the hypothesized, negative direction, namely: depravity fi'om friends [Pr(.03 S p _<_ .32) =.90] and depravity from family [Pr(.03 S p s .28) =.90]. One of the six sample correlations for disempathy was statistically significant in the hypothesized direction: disempathy from non-HIV/AIDS co-workers [Pr(-.28 S p S -.02) =.90]. Based on these results, the hypothesis was disconfirmed with reversed support for depravity but confirmed for disempathy. Hypothesis 4—Perceived associational stigma and basis of current work (volunteer=l; paid stafl=2) are negatively correlated. Table 18 shows that two of the six odds ratios for depravity and none of the odds ratios for disempathy supported the hypothesis that the population value (p) is less than 0. However, the other four odds ratios 80 Tabb17-ComhflomlAmlyshtorPerchvedAuochflonflSflgrnaandSedstacflonvflm Work Experience 90% Two-sided pm. Conflgence lnterval' blilty Dimension or Perceived Value ls Odd! sig m r‘ Low U . " N (Bi-1.0L Depravity Friends .17 .03 .32 .03 .03 304 859 Family .15 .03 .28 .02 .02 304 859 Non-HNIAIDS Co-workers .02 -.12 .15 .43 .75 240 ns Neighbors -.04 -.17 .09 .69 2.23 259 ns General Public .05 -.07 .17 .25 .33 301 ns Macro .08 -.05 .19 .18 .19 305 ns Dlsernoethv Friends -.08 -.20 .04 .84 5.25 303 ns Familv -.11 -.23 .00 .93 13.29 303 ns Non-HlV/AIDS Co-workers -.15 -.28 -.02 .98 49.00 239 859 Neighbors -.07 -.19 .08 .80 4.00 258 ns General Public -.05 -.17 .07 .75 3.00 300 ns Lacro -.12 -.23 .00 .93 L339 304 n_s_ 'Corredied ror W. 'Oddethetpopihtionvdueislesethano. Table 18 - Correlational Analysis for Perceived Associational Stigma and Basis of l-lMAlDS Work (Volunteer V8. Paid) 9016 Two-sided Confidence Interval'_ bill” Probe- Dimension or Perceived Value ie Odd- sig mm " W. N lei-29L Depravity Friends .01 -. 11 .14 .43 .75 298 ns Family -.06 -.16 .05 .80 4.00 298 ns Non-HNIAIDS Co-workers -.13 -.25 -.02 .96 24.00 231 sip Neighbors .03 -.08 .14 .31 .45 253 ns General Public .00 -.10 .11 .50 1.00 295 ns Macro ~.02 -. 12 .08 .63 1.70 299 ns Disernpethv Friends .09 -.01 .19 .09 .10 297 ns Familv .03 -.07 .13 .31 .45 297 ns Non-HMAIDS Co-workers .01 -.11 .12 .44 .79 230 ns Neighbors .09 -.02 .19 .09 .10 252 ns General Public .01 -.09 .11 .43 .75 294 ns Mo .06 -.03 .18 .18 .19 298 ns 'COriected for m. 'Oddemmeeumvauieieeemmo. 81 for disempathy (more than half) supported the hypothesis that p is greater than 0. Table 18 also shows that one of the six sample correlations for depravity was statistically significant in the predicted direction, namely: depravity from non-HIV/AIDS co-workers [Pr(-.25 S p S -.02) =.90]. None of the six sample correlations for disempathy were statistically significant. Based on these results, the hypothesis was disconfirmed with no relationship found for depravity and disconfirmed with reversed support for disempathy. Hypothesis S—Perceived associational stigma and work with persons who are likely to be held more accountable for their HIV-infection (e.g., IV drug users vs. children) are positively correlated. Table 19 shows that none of the six odds ratios for depravity and none of the six odds ratios for disempathy supported the hypothesis that the population value (p) is less than 0. However, four of the odds ratios for depravity (more than half) and three for disempathy (just half) supported the hypothesis that p is greater than 0. Table 19 also shows that none of the twelve sample correlations for depravity or disempathy were statistically significant. Based on these results, the hypothesis was disconfirmed with reversed support for depravity and disconfirmed with no relationship for disempathy. Hypothesis 6—Perceived associational stigma and frequency of contact with persons who have HIV/AIDS are positively correlated. Table 20 shows that four of the six odds ratios for depravity (more than half) but none of the odds ratios for disempathy supported the hypothesis that the population value (p) is less than 0. However, four of the odds ratios for disempathy (more than half) supported the hypothesis that p is greater than 0. Table 20 also shows that none of the six sample correlations for depravity were 82 Tabb19-ComhdonflAmiyebthemeNedAuochflomlSdgmaandmeNunbuotOdnrwiu WGroupsorPWAswlthwhomRespondentsWork “Oddsttidpopuaionvalueisyeetermano. “Sbidconeistionisoppoelteotvmetwespredieted. 90% Two-sided pm- Mumf— bllItv Dimension or Perceived Value is Odd. Sig Mon-4m r‘ Low 0 Po- Mo" N m Depravity Friends -.12 -.24 .00 .07 .08 311 ns Familv .02 -.08 .13 .63 1.70 311 ns Non-HN/AIDS Co-workers -.11 -.23 .00 .05 .05 243 ns Neighbors -.01 -. 12 .09 .43 .75 284 ns General Public -.04 -.14 .06 .25 .33 308 ns Macro -.04 -. 14 .06 .25 .33 312 ns Disernoethv Friends .02 -.08 .12 .57 1.33 310 ns Familv .01 -.09 .11 .57 1.33 310 ns Non-HNIAIDS Co-workers -.03 -.14 .08 .31 .45 242 ns Neighbors -.08 -.19 .02 .09 .10 263 ns General Public -.05 -.15 .05 .20 .25 307 ns Macro -.01 -. 11 .08 .43 .75 311 ns 'Corrected tor Mutton. ”Odds that population value is waster than 0. Tabie20-ConelatlonelAnalyeistorPerceivedAssociatlonalStlgmaand FrequencyorFace-to- Face Contact with PWAs 90% Two-sided Probe- Confidence lnterval‘ billty Dhnsnsion of Perceived Value is Odd. Sig Associational slime r' Lower Upper Positive Ratio' N (510; Depravity Friends -.05 -.17 .07 .25 .33 311 ns Family 04 -.08 .15 .75 3.00 310 ns Nori-HNIAIDS Co-workers .00 -.12 .12 .50 1.00 243 ns Neighbors -.02 -.13 .09 .37 .59 264 ns General Public 08 -.03 .18 .88 7.33 308 ns Macro 06 -.05 .15 .80 4.00 312 ns Disernpethy Friends -.04 -.14 .06 .25 .33 310 ns Family -.04 -.14 .06 .25 .33 309 ns Non-HlVIAlDS Co-workers -.07 -.18 .04 .12 .14 242 ns Neighbors -.11 -.22 -.01 .03 .03 263 sig° General Public -.08 -.18 .01 .09 .10 307 ns Macro -.07 -.17 .02 .12 .14 311 ns ‘Corrected for mom. 83 statistically significant and that only one of the sample correlations for disempathy was statistically significant, but not in the predicted direction: disempathy from neighbors [Pr(-.22 s p .<_ -.01) =.90]. Based on these results, the hypothesis was confirmed for depravity but disconfirmed with reversed support for disempathy. Hypothesis 7—Perceived associational stigma and duration of work experience are positively correlated. Table 21 shows that none of the six odds ratios for either depravity or disempathy disempathy supported the hypothesis that the population value (p) is greater than 0. However, four of the odds ratios for depravity (more than half) and three for disempathy (just half) supported the reverse hypothesis, that is, p is less than 0. None of the sample correlations for either depravity or disempathy were statistically significant. Based on these results, the hypothesis was disconfirmed with reversed support for depravity and disconfirmed with no relationship for disempathy. Hypothesis 8—Perceived associational stigma and perceived social support from peer HIV/AIDS workers are positively related. Table 22 shows that four of the six odds ratios for depravity (more than halt) supported the hypothesis that the population value (p) is greater than 0. However, five of the six odds ratios for disempathy supported the reversed hypothesis that p is less than 0. Table 22 also shows that four of the six sample correlations for disempathy were statistically significant but not in the hypothesized, positive direction, namely: disempathy from friends [Pr(-.25 S p S -.02) =.90], disempathy from family [Pr(-.26 s p S -.03) =.90], disempathy from the general public [Pr(-.24 S p S -.01) =.90], and disempathy at the macro-dimensional level [Pr(- .24 s p s -.02) =.90]. Based on these results, the hypothesis was confirmed for depravity Table 21 - Correlational Analysis for Perceived Associational Stigma and Duraflon otWork 84 Experience 90% Two-sided pm- oonridence lnterval' blllty Dimension or Perceived Value is Odds Sig M r‘ I-ow U luv " N Ml. Depravity Friends -.03 -.15 .09 .37 .59 307 ns Familv -.03 -. 14 .07 .31 .45 308 ns Non-HNIAIDS Co-workers -.07 -.18 .05 .16 .19 241 ns Neighbors -.06 -.17 .05 .16 .19 281 ns General Public .02 -.08 .12 .63 1.70 304 ns Macro -.04 -.14 .06 .25 .33 308 ns Disempathv Friends -.01 -.11 .09 .43 .75 306 ns Familv -.09 -.19 .01 .07 .08 305 ns Non-HMAIDS Co-workers -.07 -. 18 .04 .12 .14 240 ns Neighbors .01 -.09 .12 .57 1.33 260 ns General Public .01 -.09 .11 .57 1.33 303 ns _i_Aa_ero -.03 -.13 .07 .31 .45 307 ns 'Corrected rcr alternation. I’Odde that population value is greater than 0. Tabhn-ComhdonaimtyshforPerceNedAuochdoMISflgmaandPerceNedSochl Support from Peer HlVIAlDS Workers 90% Two-sided Proba- Confidence Interval‘ blllty Dimension or Perceived Value is Odd. Sig Associational Stigma r' Lower Upper Poeldve Ratio” N (fiJO) Depravity Friends .02 -.12 .17 .63 1.70 291 ns Family .01 -.11 .13 .57 1.33 290 ns Non-HNIAIDS Co-workers .07 -.06 .21 .80 4.00 228 ns Neighbors .07 -.06 .19 .84 5.25 250 ns General Public .05 -.07 .17 .75 3.00 288 ns Macro .06 -.06 .17 .80 4.00 292 ns Disempediy Friends -.14 -.25 -.02 .03 .03 290 sig° Family -.15 -.26 -.03 .02 .02 289 sig° Non-HIV/AIDS Co-wcrkers -.09 -.22 .03 .13 .15 227 ns Neighbors -.04 -.16 .08 .31 .45 249 ns General Public -.13 -.24 -.01 .03 .03 287 sig" Macro -.13 -.24 -.02 .03 .03 291 g' “ ‘Corrected for atteriudion. ”Oddethetpopuletionvslueisgredertheno. ‘Siwolcorrelationisoppoeiteotm'letmpredicted. 85 but disconfirmed with reversed support for disempathy. Hypothesis 9—Perceived associational stigma and perceived risk of HIV infection are positively correlated. Table 23 shows that five of the six odds ratios for depravity but none six of the odds ratios for disempathy supported the hypothesis that the population value (p) is greater than 0. Moreover, five of the odds ratios for disempathy supported the hypothesis that p is less than 0. Table 23 also shows that three of the six sample correlations for depravity were statistically significant in the hypothesized, positive direction, namely: depravity from neighbors [Pr(.lO S p s .31) =.90], depravity from the general public [Pr(.05 s p S .25) =.90] and depravity at the macro-dimensional level [Pr(.07 S p s .27) =.90]. None of the six sample correlations for disempathy were statistically significant. Based on these results, the hypothesis was confirmed for depravity and disconfirmed with reversed support for disempathy. Hypothesis lO—Perceived associational stigma and the proportion of others who know about the respondent’s HIV/AIDS work are positively correlated. Table 24 shows that all six odds ratios for depravity as well as all six of the odds ratios for disempathy supported the reversed hypothesis that the population value (p) is less than, not greater than, 0. Table 24 also shows that four of the six sample correlations for depravity and all of the sample correlations for disempathy were statistically significant but not in the hypothesized, positive direction. Sample correlations for disempathy were stronger than those for depravity, the strongest of all being disempathy from non- HIV/AIDS co-workers [Pr(-.43 s p s -.20) =.90]. Based on these results, the hypothesis was disconfirmed with reversed support for depravity as well as for disempathy. 86 Tafle23-CareladondAmiysbforPemdvedAssochflonalSflgnaandPemeNedekof i-llVlnfection 90% Two-sided prong. Confidence Interval' blllty Dimension of Perceived Value is Odds Sig Associational stigma r“ Lower Upper Positive Ratlo' N (5.10) Depravity Friends -.07 -.20 .05 .20 .25 298 ns Family .10 -.01 .20 .93 13.29 297 ns Nori-HNIAIDS Co-workers .07 -.05 .19 .84 5.25 232 ns Neighbors .20 .10 .31 1.00 999.99 253 sig General Public .15 .05 .25 .99 99.00 295 sig Macro .18 .07 .27 1.00 999.99 298 sig Disempathy Friends -.04 -. 14 .07 .31 .45 297 ns Family .00 -.10 .10 .50 1.00 296 ns Non-HMAlDS Co-workers -.10 -.21 .02 .10 .11 231 ns Neighbors -.06 -. 16 .05 .20 .25 252 ns General Public -.05 -. 15 .06 .25 .33 294 ns Macro -.04 -. 13 .06 .31 .45 297 ns ‘Correcled for W. ”Oddethetpopulstionvalueisgeeterlhano. Table24-ComhdondAmlyflefwPemdvedAuochdoml86gmaandanmpomonodeun who Know about Respondents' HIVIAIDS Work 90% Two-sided pm. Confidence Interval‘ blllty Dirnenslon of Perceived Value is Odd. Sig Aeooclatlonalggme r' Lower Upper Positive Ratio” N (E30) Depravity Friends -.10 -.24 .04 .12 .14 311 ns Family -.17 -.29 -.05 .01 .01 311 slg" Non-HN/AIDS Co-workers -.17 -.30 -.05 .01 .01 243 sig° Neighbors -.17 -.29 -.05 .01 .01 264 fig" General Public -.05 -.17 .07 .25 .33 308 ns Macro -.16 -.27 -.05 .02 .02 312 eig‘ Disernpethy Friends -.22 -.33 -.11 oo .00 310 eig‘ Family -.31 -.41 -.21 00 .00 310 sig° Norl-HNIAIDS Co-workers -.32 -.43 -.20 00 .00 242 sig° Neighbors -.25 -.37 -.14 oo .00 263 sig° General Public -.12 -.24 -.O1 05 .05 307 sig° Macro -.28 -.38 -.17 00 .00 311 sig“ 'Corrected for W. ‘Oddelneipopuleiionveluelegreerermeno. cSignofcrnnelationisoppositeofwtletlillespredicted. 87 Reviewing the results for hypotheses 3 through 10 shows that perceived associational stigma appears to be related to all the variables in this section except two. Support for whether an HIV/AIDS worker served ‘otherwise stigmatized’ groups, such as gay men and IV drug users, or not was not found when perceived associational disempathy was considered. Similarly, support for whether an HIV/AIDS worker had been serving persons with HIV/AIDS for a long or short duration was not supported. Table 25 summarizes these results. Table 25 - Summary of Results for Research Question 2 Perceived associational stigma (PAS) and satisfaction with work experience are negatively correlated. lPAS and basis of current work (volunteer=1; paid=2) are 18 negatively correlated. 5 PAS and work with otherwise stigmatized groups are 19 positively correlated. 6 PASandfrequencyofface—to-facecontactwithPWAsare 2° positively conelated. 7 PAS and duration of work experience are positively correlated. (Reversed WIH' I?” 21 Support) 8 PAS and perceived social support from peer HIV/AIDS c n I WI 22 workers are positively correlated. Sum 9 PAS and perceived risk of HN infewon are positively c n | (R I 23 consisted. Support) 10 PAS and proportion of others who know about respondent’s WI WI 24 HIV/AIDS work are positively correlated. SW0 SW1) 88 Correlates of Perceived Social Distance (Hypotheses II - I9) Perceived social distance is defined as the HIV/AIDS workers’ perception that someone is physically avoiding them because they have contact with persons who have HIV/AIDS. This is conceptually different from perceived associational stigma in that perceived associational stigma does not call attention to avoidance maneuvers, but to beliefs, that they, as HIV/AIDS workers, are somehow discounted, or devalued, by others as a result of their interaction with persons who have HIV/AIDS. The measure of perceived social distance is taken from the survey’s Section C, which measured perceptions of specific types of stigmatizing behavior that may be directed at an HIV/AIDS worker. For example, respondents were asked, “Once people know that you work with persons who have HIV /AIDS, do you sense that they are less willing to strike up conversation with you?” 0 Research Question 3—Given that perceived associational stigma exists, how is it related to perceived social distance (i.e., physical avoidance by others as a result of being identified as an HIV/AIDS worker)? Considering the same set of characteristics and experiences of HIV/AIDS workers that were used in the previous section, it was generally hypothesized that a pattern of relationship similar to those found for perceived associational stigma would also be found for perceived social distance. Table 26 restates the nine hypotheses and lists their table references. 89 Table 26 - Hypotheses for Research Question 3 11 Perceived social distance (PSD) and PAS are positively correlated. 27 12 lPSDandsatisfactionwithworkexperiencearenegativelycorreieted. 28 13 IPSD and basis of current work (volunteer=1; paid=2) are negatively correlated. 28 14 lPSD and work with otherwise stigmatized groups are positively conelated. 15 P80 and frequencyofface-to-facecontactwith PWAs arepositively conelated. 16 IPSD and duration of work experience are positively conelated. 28 17 P80 and perceived social support from peer HIV/AIDS workers are positively conelated. 28 18 IPSD and perceived risk of HIV infection are positively conelated. 28 19 PSD and proportion of others who know about respondents' HIV/AIDS work are positively correlated. 'Confirrned for both Depravity and Disempathy. Hypothesis ll—Perceived social distance and perceived associational stigma are positively correlated. Table 27 shows that all odds ratios for depravity as well as for disempathy supported the hypothesis that the population value (p) is greater than 0. Moreover, all of the sample correlations for depravity and all but one for disempathy were statistically significant. Note that the relationship between depravity and social distance appears to be stronger than the relationship between disempathy and perceived social distance. This result may be summarized by examining the confidence interval for the two macro-dimensions (depravity [Pr(.54 S p s .69) =.90]; disempathy [Pr(.03 S p s .23) =.90]. Based on these results, the hypothesis was confirmed for both depravity and disempathy. 90 Tabie27-CorreiationalAnslysisforPercelvedAssoclationelStigmaand PerceivedSoclalDlstance 90% Two-sided prong. Confidence Interval‘ blllty Dimension of Perceived Value is Odd! Sig Associational stigma r‘ Lower Upper Positive Ratio" N (5.10) Depravity Friends 39 .27 .51 1.00 999.99 309 sig Family .43 .34 .53 1.00 999.99 309 sig Non-HNIAIDS Co-workers .51 .41 .60 1.00 999.99 241 sig Neighbors .55 .46 .63 1.00 999.99 263 sig General Public 46 .37 .55 1.00 999.99 308 sig Macro 61 .54 .69 1.00 999.99 310 sig Disempathy Friends .06 -.04 .17 .84 5.25 308 ns Family .12 .01 .22 .97 32.33 309 sig Non-HIVIAIDS Co-workers .12 .00 .23 .97 32.33 240 sig Neighbors .13 .02 .24 .99 49.00 262 sig General Public .12 .02 .22 .97 32.33 307 sig Macro .13 .03 .23 .98 49.00 309 mg’ 'Conected for alternation. I’Oddsli'ldpopulationvalueisueetel'lheno. Hypothesis lZ—Perceived social distance and satisfaction with HIV IAIDS work experience are negatively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is less than 0 is inconclusive. Also, the sample correlation is positively signed and not significant. Based on these results, the hypothesis was disconfirmed with no relationship found between HIV/AIDS-related work experience satisfaction and perceived social distance. Hypothesis l3—Perceived social distance and the basis of current work (volunteer = I; paid staff = 2) are negatively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is less than 0 is inconclusive. However, the sample correlation is negatively signed, but not statistically significant. Based on these results, the hypothesis was disconfirmed with no relationship found I ll Ill . . o . F V B the We 91 Table 28 - Correlational Analysis for Perceived Social Distance and Selected Variables 90% Two-sided pm. Confidence interval' blllty Value is Odds Sig Variable r' Lower Upper Positive Ratio N (E40) Satisfaction with HIV/AIDS Work .03 -.O9 .15 .63 .59 b 305 ns Experience Volunteer vs. Paid Work -.01 -. 11 .09 .43 1.33 b 299 ns Number of Odlerwise .02 -.08 .12 .63 1.70 ° 312 ns Stigmatized Groups Frequency of Face-to-face .09 .00 .19 .93 13.29 ° 311 ns Contact in Past 3 Months Number of Years Working with .02 -.08 .12 .63 1.70 c 307 ns Persons with HIV/AIDS Social Support from HNIAIDS- .01 -.10 .13 .57 1.33 ° 291 ns workers W Risk Of HIV Infection .29 .20 .38 1.00 999.99 c 299 sig Proportion of others who know -.17 -.27 -.06 .01 99.00 c 312 .59“ about HIV/AIDS work ‘Ccrrecied for attenuation. ’Oddelheipopueiionvelueieleeemeno. “Oddsthetpopiaetionvdueisgreeterthsno. ‘Slgnorconeleiionieoppoeiucrwheiweepredlcud. between volunteer versus paid work status and perceived social distance. Hypothesis l4—Perceived social distance and work with persons who are likely to be held more accountable for their HIV -infection (e.g. IV drug users vs. children) are positively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is, like the previous two hypotheses, inconclusive. The sample correlation is positively signed, but not statistically significant. Based on these results, the hypothesis was also disconfirmed with no relationship found between work with otherwise stigmatized groups and perceived social distance. Hypothesis lS—Perceived social distance and frequency of face-to-face contact with persons who have HIV/AIDS are positively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is, supported. 92 The sample correlation is not statistically significant, although the lower limit of the confidence interval is O, which adds support for the hypothesis [Pr(.OO S p s .19) =.90]. Based on these results, the hypothesis was confirmed; more frequent contact is related to stronger perceptions of perceived social distance. Hypothesis l6—Perceived social distance and duration of work experience are positively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is inconclusive. The sample correlation is positively signed, but not statistically significant. Based on these results, the hypothesis was disconfirmed with no relationship found between duration of work and perceived social distance. Hypothesis l7—Perceived social distance and perceived social support from peer HIV [AIDS workers are positively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is inconclusive. The sample correlation is positively signed, but not statistically significant. Based on these results, the hypothesis was disconfirmed with no relationship found between social support fi'om peer workers and perceived social distance. Hypothesis l8—Perceived social distance and perceived risk of HIV infection are positively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. Moreover, the sample correlation is statistically significant [Pr-(.20 S p s .38) =.90]. Based on these results, the hypothesis was confirmed; perceived risk for HIV infection is positively related to perceptions of perceived social distance. Hypothesis l9—Perceived social distance and the proportion of others who 93 know about respondents’ HIV/AIDS work are positively correlated. Table 28 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is, supported in the reversed direction. The sample correlation is also statistically significant in the reversed direction [Pr(-.27 S p S -.06 =.90]. Based on these results, the hypothesis was disconfirmed with reversed support. A review of Hypotheses 11 through 19 indicates that perceived social distance is positively related to perceived associational stigma, positively related to face-to-face contact with persons with HIV/AIDS, and positively related to perceived fear of HIV infection. It also appears to be related negatively to the proportion of persons who know about the respondent’s HIV/AIDS work. Table 29 summarizes these results. Table 29 - Summary of Results for Research Question 3 W... - I _ 11 Perceivedsocial distance (PSD) and PAS arepositiveiycorrelated. W 27 12 PSDandsafisfactionwithworkexperiencearenegativelyconelated. WM“? 23 13 PSDandbssisofcurientwork(volunteer-1;paid-2)arenegativelycorrelated. Wain”? 2s 14 PSDandworkwlthotherwisestigmatizedgmupsareposltivelycorrelated. my 29 15 PSDandfrequencyofface—to—facecontactwithPWAsarepositively W 28 16 PSDand duration ofworkexperience arepositivelycorreleted. We? 29 1., PSDandperceivedsocialsupportfrompeerHNIAlDSworkersarepositively Discorlrlnhedruo correlated. W) 28 18 [PSDandperceivedriskoleVinfectionarepositivelycorrelated. Confirmed 28 P80 and proportion ofotherswhoknowaboutrespondents‘ HIV/AIDSwork W 19 . (Reversed 28 are positively correlated. m ‘ConflrmedforbothDepravityand Disempathy. 94 Correlates of HIV [AIDS-related Communication Behavior (Hypodrm 20 -29) The fourth and final research question considered in this study focuses on how communication behavior about HIV/AIDS-related topics is related to perceived associational stigma. It was hypothesized that HIV /AIDS workers who reported stronger perceptions of either type of perceived associational stigma were less likely to exhibit HIV/AIDS-related communication behavior. Primarily as an exploratory effort, the same set of individual characteristics and experiences of HIV/AIDS workers that were used for Research Question 2 and 3 were reconsidered for Research Question 4. a Research Question 4—Given that perceived associational stigma exists, does it affect the degree to which HIV/AIDS workers talk to others about HIV/AIDS- related topics? Table 30 restates the ten hypotheses and lists their table references. Table 30 - Hypotheses for Research Question 4 Irv ..- Cornmunication behavior about HNIAIDS-related topics (CB) and PAS are negatively correlated. CBandsatisfactionwithwcrkexperiencearepositivelycorrelated. CB and basis of current work (volunteer=1; paid=2) are positively correlated. CBandworkwithotheMisestigmatizedgroupsarenegathrelyconelated. it: 24 CBandhequencyoffaMo-facecontactufithPWAsareposibvelyconelated. 25 CBanddurationofworkexperiencearepositivelycorrelated. CBand perceived socialsupportfrcmpeeriilVlAlDSworkersarepositively conelated. 27 C8 and perceived risk oleV infection are negatively correlated. CB and proportion ofotherswhoknowaboutrespondents’ HIV/AIDSworkare [positively conelated. 29 CB and P80 are negatively conelated. 1683383 95 Hypothesis 20—Communication behavior about HIV [AIDS-related topics and perceived associational stigma are negatively correlated. Table 31 shows that all odds ratios for depravity as well as for disempathy supported the hypothesis that the population value (p) is less than 0. Moreover, all of the sample correlations for both depravity and disempathy were statistically significant. This finding may be summarized by examining the confidence intervals for the relationship between communication behavior and the macro-dimensions of perceived associational stigma (depravity Pr(-.31 S p S -.09) =.90]; disempathy [Pr(-.34 S p s -.13) =.90]). It appears depravity has a stronger impact than disempathy on communication behavior. Based on these results, the hypothesis was confirmed for both depravity and disempathy. Hypothesis Zl—Communication behavior and satisfaction with HIV/AIDS work experience are positively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. Moreover, the sample correlation is statistically significant [Pr(.06 S p s .30) =.90]. Based on these results, the hypothesis was confirmed Hypothesis 22—Communication behavior and basis of current work (volunteer = I; paid staff = 2) are positively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. The sample correlation is also statistically significant [Pr(.09 S p s .30) =.90]. Based on these results, the hypothesis was confirmed. Hypothesis 23—Communication behavior work with persons who are likely to be held more accountable for their HIV-infection (e.g. IV drug users vs. children) are negatively correlated. Table 32 shows that the odds ratio for the hypothesis that the 96 Table 31 - Correlational Analysis for HNIAIDS-related Communication Behavior and Perceived Associational Stigma [33%-3'33 3333-83 E3 90% Two-sided prong. Confidence Interval‘ blllty Dimension of Perceived Value ls Odd. Aaeoclationaggma r‘ Lower Upper Negative Ratio" N 009mm! Friends -. 17 -.21 .07 .98 49.00 305 Family -.24 -.37 -.14 .99 999.99 305 Non-HNIAIDS Co-workers -.35 -.40 -.15 1.00 999.99 239 Neighbors -.27 -34 -.10 1.00 999.99 290 General Public -.28 -. 11 .12 1.00 999.99 303 Macro -.35 -.31 -.09 1 .00 999.99 306 Disempathy Friends -. 12 -.38 -. 17 .95 999.99 304 Family -. 16 -.36 -. 14 .98 999.99 304 Non-HNIAIDS Co-workers -. 15 -.41 -.17 .98 999.99 238 Neighbors -. 12 -.25 -.01 .95 19.00 259 General Public -. 14 -. 17 .05 .98 49.00 302 Macro -. 16 -.34 -. 13 .99 999.99 305 ‘Corrected for starvation. I’Odda that population value is less tlnn 0. Table 32 - Correlational Analysis for HNIAIDS-related Communication Behavior and Selected Variables 90% Two-sided Proba- Confidence lnterval' bility Value is Odds Sig Variable r' Lower Upper Positive Ratio N (E10) Satisfaction with HIV/AIDS Work .18 .06 .30 .99 99.99 ° 301 sig Experience Volunteer vs. Paid Work .19 .09 .30 1.00 999.99 ° 295 sig Number of Otherwise .12 .01 .22 .95 .05 b 308 3.9“ Stigmatized Groups Frequency of Face-to-face .08 -.03 .18 .88 7.33 c 307 ns Contact in Past 3 Months Number of Years Working with .05 -.06 .16 .75 3.00 c 303 ns Persons with HIV/AIDS Social Support from HIV/AIDS- .13 .01 .26 .95 999.99 ° 287 sig workers Perceived Risk of HN Infection -.22 -.33 -.12 .00 999.99 b 295 sig Proportion of others who know .64 .55 .73 1.00 999.99 ° 308 sig about HIV/AIDS work Perceived Social Distance -.37 -.47 -.27 .00 999.99 b 307 sig ‘Ccrrecied for attenuation. 'Oddsthatpopilationnlueislessthsno. cOddethatpopulalioniraluaiegreatarthano. ‘Slgnofcorrdationisopposibofwhatwaspredicted. 97 population value (p) is greater than 0 is not supported. In addition, the sample correlation is also statistically significant [Pr(.Ol S p .<_ .22) =.90], but not in the predicted direction. Based on these results, the hypothesis was disconfirmed with reversed support. Hypothesis 24—Communication behavior and frequency of face-to-face contact with persons who have HIV/AIDS are positively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. The sample correlation, however, is not statistically significant [Pr(-.03 S p S -.18) =.90]. Based on these results, the hypothesis was confirmed. Hypothesis 25—Communication behavior and duration of work experience are positively correlated. Similar to the results of Hypothesis 24, Table 32 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. Note, however, that the sample correlation is not statistically significant [Pr(-.06 S p S . 16) =.90]. Despite lack of statistical significance, the hypothesis was confirmed. Hypothesis 26—Communication behavior and social support from peer HIV/AIDS workers are positively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. The sample correlation is also statistically significant [Pr-(.01 s p S .26) =.90]. Based on these results, the hypothesis was confirmed. Hypothesis 27—Communication behavior and perceived risk of HIV infection are negatively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is less than 0 is supported. The sample correlation is also statistically significant [Pr(-.33 s p S -.12) =.90]. Based on these results, the hypothesis was 98 confirmed. Hypothesis 28—Communication behavior and the proportion of others who know about respondents’ HIV/AIDS work are positively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is greater than 0 is supported. The sample correlation is also statistically significant [Pr(.55 s p S .73) =.90]. Note that this sample correlation (which was corrected for attenuation, as were all the others) was the strongest of all correlations produced for this study. Based on these results, the hypothesis was confirmed. Hypothesis 29—Communication behavior and perceived social distance are negatively correlated. Table 32 shows that the odds ratio for the hypothesis that the population value (p) is less than 0 is supported. The sample correlation is also statistically significant [Pr(-.47 S p S -.27) =.90]. Based on these results, the hypothesis was confirmed. To review, support was found for all ten hypotheses regarding communication behavior about HIV/AIDS-related topics. Note, however, that a positive relationship, as opposed to the predicted negative relationship, was found for the number of ‘otherwise stigmatized’ groups served by an HIV/AIDS worker and communication behavior. Table 33 summarizes these results. 99 Table 33 - Summary of Results for Research Question 4 "a? ' ”3} _r,,e -s s abet Communication behavior about HNIAIDS-related topics (CB) and PAS are 2° negatively conelated. 3” Id 31 21 CB and satisfawon with work experience are positively conelated. Confirmed 32 22 CB and basis of current work (volunteersi; paid=2) are positively correlated. Continued 32 Dieconflnned 23 CB and work with otherwise stigmatized groups are negatively conelated. (Reversed 32 film 24 CB and frequency of face-to-face contact with PWAs are positively correlated. Continued 32 25 CB and duration of work experience are positively correlated. Confirmed 32 26 CBandpercehredsocialsupportfrompeerHN/AlDSworkersareposltiver c n l 32 conelated. 27 CBandperceredriskoleVinfectionarenegativelycorreIated. Confirmed 32 CB and proportion of others who know about respondents' HNIAIDS work are 28 . Confirmed 32 lpositlvely conelated. 29 CB and P80 are negatively conelated. Confirmed 32 Supplemental Analyses Results of the bivariate correlational analyses that respond to Research Questions 2, 3, and 4 reveal a relatively complicated array of inter-variable correlations. In order to put these results into a more understandable arrangement, two additional, exploratory analyses were completed: 0 a respondent clustering procedure that grouped respondents based upon their level of perceived associational depravity and perceived associational disempathy, and o a path analytic model that tested specific causal relationships among perceived associational depravity, perceived associational disempathy, and their respective correlates. Exploratory Cluster Analysis of Study Respondents A sequential, agglomerative, hierarchical clustering method commonly referred to as 100 ‘K-means clustering’ was used (Ward, 1963; Milligan & Cooper, 1987) to group respondents by the two macro-dimensions of depravity and disempathy. The K-means method uses a cluster-assignment algorithm that begins with each case (i.e., respondent) treated as an independent cluster, and then merges two of them together with each successive iteration. Clustering may continue until all cases belong to a single cluster. The researcher specifies the number of non-overlapping clusters, or partitions, desired, which may be from 1 to n, where n is the total number of cases under consideration. Once the algorithm has generated the specified number of clusters, the procedure stops and the final location of cluster centers, or centroids, is computed. Using the present study’s sample of 319 HIV/AIDS workers, a four group solution was generated (see Figure 4). Note that group labels describe the relative level of perceived associational depravity and perceived associational disempathy found within each group’s assigned cases. Group 2, ‘Medium depravity/medium disempathy,’ was assigned the most cases (34.1%; n=106); group 4, ‘High depravity/high disempathy,’ was assigned the fewest cases (15.4%; n=48). To validate the grouping structure, a discriminant function comprised of six variables that showed a comparatively strong relationship to either perceived associational depravity or perceived associational disempathy was tested. Variables included in this discriminate analysis (DA) were: perceived risk of HIV infection, social support from HIV/AIDS-workers, satisfaction with HIV/AIDS work experience, HIV/AIDS-related communication behavior, perceived social distance, and the proportion of persons who know about the respondent’s HIV/AIDS work. lOl 2r— fi 0 I Group3 1 F 0 3701412 Grolp4 l . l . 0 . 1 . 1 -2 1 1 2 . 1 g Group1 -2— 9 Low High ¢ W ’ Grown Lmvmprevityllowdisermathym-OO) Grown MediulrldepravitylMedilxndisermethy(n-106) Gretna Lowdepravitylhighdisempathy (n-58) Grom4 Highdepravitylhighdlsempathy(n-48) Figure 4. Standardized Respondent Group Csntroids Table 34 shows how well the DA function predicted group membership. Given four possible groups to which a respondent may be assigned, a useful discriminant function would be one that explains membership for more than 25% of the cases (i.e., better than chance). The results show that for the low depravity/low disempathy cluster and the high depravity/high disempathy cluster, the DA function explains a majority of group membership (59.0% and 53.5%, respectively). The DA function does less well for the low depravity/high disempathy group, but still better than what would be expected by chance alone (42.2%). Prediction of cluster membership for the medium depravity/medium disempathy cluster, however, is poor (15.1%; less than 25%). In general, the DA function correctly predicted respondent group membership for 39.4% of all cases. 102 Table 34 - Validation of Group Membership by Selected External Criteria‘ __Emdlctag_QmUD_Mamltarshln_ Group N Lowllow Med/med Lowlhi h H hlh h Low depravity/low disempathy 78 ‘ 46 . 8 20 4 % of respondents 100% ,. ,. . " 10.3% 25.6% 5.1% Med depravity/med disempathy 93 32 26 21 % of respondents 100% 34.4% 28.0% 22.6% Low depravity/high disempathy 45 18 5 3 %ofrespondents 100% 40.0% 11.1% 6.7% High depravity/high disempathy 43 5 5 10 % of respondents 100% 11.6% 11.6% 23.3% Unclustered cases 2 1 0 1 0 % of respondents 100% 50.0% 0.0% 50.0% 0.0% 'Extemel Criteria included Perceived Risk of HIV Infection. Social Support from Peer HNIAIDS Workers. Satisfaction with HIV/AIDS Work Experience. HNIAIDS-related Communication Behavior. Perceived Social Distance. Proportion of Others who know about Respondent's HIV/AIDS Work. Note: Percent of correctly grouped respondents is 39.4%. Figure 5 presents a ‘group profile’ for each of the six variables included in the DA. For ease of comparison, standardized group means were plotted. Figure 5 shows how these respondent groups differed across each of the six variables included in the DA. Table 35 provides further evidence that, indeed, there are differences between respondent groups. Note, however, that social support from HNIAIDS-workers [Pr(.O S 11 S .21) =.95] and satisfaction with HIV/AIDS work experience [Pr(.O s n S .22) =.95] do not appear to provide explanatory power at a statistically significant level. Despite these non- significant results, the analysis of variance of the discriminant function score by respondent group was statistically significant [Pr(.49 S 11 S .55) =.95]. 852.. 966 28:88: .e 2:5 103 on. F- as; 8.52: 55288”. 58.. cos. of :26 s 8282... 8.5.5 .eoom oozeeede 18...- 5358... 5.5958 :9: e 920 .92-cam 835580 322.832: o 2.353... 5.5.6.38 3.. m 89o 88.9w so; 832: 5.; 85993... o . 2.358... 523233230 Face: w 9.80 89.2.6032... EB. .385 .38 a . . on o. §e§§§ pause 889e_>_:simeeze2ene ”loan. 9.80 Usen-e. cum I. 8.6. I. ovdr + cud. e 8.0 a e .. cud .. cod v 9.80 m 990 u 390 .. omd .. cad . . oo.? o owe coo—2 Eaton—Lg“ 104 Table 35 - Nonlinear Correlational Analysis for Selected External Criteria and Respondent Group 95% Two-sided Confidence Interval for Analysis of Bt- ism. Variable Description Mean SD N Eta SE3. Lower Upper F p Perceived Risk of Hiv' Infection _ Low depravity/low disempathy 2.16 1.14 94 .18 .05 .08 .28 3.28 .02 Med depravity/med disempathy 2.53 1.39 101 Low depravity/high disempathy 2.07 1.23 55 High depravity/high disempath' y 2.72 1.68 47 Social Support from HNIAIDS-workers Low depravity' now disempathy 4.55 0.48 92 .10 .07 .00‘ .23 .97 .41 Med depravity/med disempathy 4.58 0.57 102 Low depravity/high disempathy 4.39 1.07 51 High depravity/high disempathy 4.50 0.76 46 Satisfaction with HNIAIDS Work Experience Low depravity/low disempathy 1.66 1.30 95 .11 .07 .00b .25 1.24 .29 Med depravity/med disempathy 1.47 1.46 105 Low depravity/high disempathy 1.32 1.37 57 High depravity/high disempathy 1.76 1.16 47 HNIAIDS-related Communication Behavior Low depravity/low disempathy 8.11 2.05 89 .29 05 19 .39 9 06 00 Med depravity/med disempathy 7.23 2.27 104 Low depravity/high disempathy 7.54 2.23 55 High depravity/high disempathy 6.03 2.42 46 Perceived Social Distance Low depravity/low disempathy 0.41 0.82 98 .51 .04 .43 .59 35.51 .00 Med depravity/med disempathy 1.26 1.61 105 Low depravity/high disempathy 0.49 1.06 58 High depravity/high disempathy 2.99 2.50 48 Proportion of Others who know about HIV/AIDS Work Low depravity/low disempathy 3.20 0.60 99 .27 .07 .13 .40 7.73 .00 Med depravity/med disempathy 2.95 0.60 106 Low depravity/high disempathy 2.75 0.78 58 High depravity/high disempathy 2.70 0.65 48 'nle probability the eta is zero is .097. ”The probability the ole is zero is .057. ExPlor'ator-y Path Analysis of Major Constructs A post hoc path analysis of perceived associational depravity and perceived associational disempathy and their important correlates was carried out as an additional way to integrate this study’s findings. In particular, the path analytic model attempted to CStBbliSh a causal order of impact among the following five constructs: perceived 105 associational depravity, perceived associational disempathy, perceived risk of HIV infection, perceived social distance, and communication behavior about HIV/AIDS- related topics. Hunter and Hamilton’s (1992) Path software was used for this analysis. Figure 6 shows the best-fit model (chi square=8.15, dfil l, p=.70) with 90% confidence intervals about its path coefficients. The model is comprised of seven variables that are either directly or indirectly linked to a respondent’s perception of associational depravity and associational disempathy. It shows that HIV/AIDS-related communication behavior is directly affected by depravity [Pr(-.4O S p S -.18) =.90], disempathy [Pr(-.19 s p S .03) =.90], and by satisfaction with HIV/AIDS work experience [Pr(.04 S p s .26) =.90]. It also shows that disempathy mediates a second pathway between communication behavior and depravity. Considering the antecedents of the two measures of perceived associational stigma, it was found that depravity was strongly linked to workers who believed that others physically avoided them as a result of their work in the community [Pr(.47 s p S .63) =.90]. In turn, perceived risk of HIV infection was found to be antecedent to perceived social distance [Pr(.l8 S p s .3 8) =.90]. Disempathy was linked to workers who perceived more depravity [Pr(.09 S p s .29) =.90] and who reported receiving less social support fiom other HIV/AIDS workers [Pr(-.23 .<_ p S -.01) =.90]. Table 36 refers the reader to relevant parts of the bivariate correlational analyses that preceded this supplemental analysis. See Appendix K for a complete set of Path output, including a sampling error analysis. 106 Les-com 5.925558 352.325.: .3 sees» .2953 8288.. .o seem 2.. .o sees: a... .e 2.5: 332.8 :35; 983.52: euceocooeom 88.5.5 so; 822: 5.: Seceseeh 9. £353 aeeeeso8< a... 8.- 838.2. e 2. 0 on..- 9» a... 9a a.» a.» 9m Egg-$025.1 55o E3 tong—5 .Soow 9e ofiva 0N. no. m _. .- 5.- am. no. we. 9.. mo.- mu.- NV.- 2. mm. on. nub-"Q 5: etc u 230w 20 ”.032 3 goo-r =Eo>O 3. 2..- oo.- mu.- mo. he. 3. Lone: L .96.. no. a no. a so. 0 no. u 8. o no. a co. m mm 5mm ”mite“:— oococccoo CODE-03... 30m braces 8:93 38.3332 .88 328.8 one. 828.8 .8. c3035 21 3 it 3283a 107 Table 36 - List of Results Tables for Path Analytic Modei'e Direct Links a Risk of HIV Infection —) Social Distance .28 28 b Social Distance —) moravity .55 27 c Depravity --) Disempathy .19 10 Social Support from . d HNIAIDS Workers ‘7 “WWW "12 22 . HIV/AID Communication e Depravrty —) Beh i -.29 31 . HNIAIDS Communication f Disempathy —) Behavior -.08 31 0 ”dealt: HNIAIDS -) Communication Behavior .15 32 Chapter 5 DISCUSSION Building upon previous research that shows that persons living with HIV /AIDS bear a particular social stigma (e.g., Bor, Miller & Goldman, 1993; Douglas, Kalman & Kalman, 1985; Herek, 1988; Herek & Glunt, 1988; Peloquin, 1990), the present study sought to explore the possibility of a similar outcome for persons who work with persons with HIV/AIDS. Although this study is not the first to research the topic of an associational stigma attributable to HIV/AIDS (see Omoto & Crain, 1995b), it is the first to build a psychometrically validated measurement model of the dimensions of the construct from the perspective of nurses, doctors, volunteer ‘buddies,’ case mangers, HIV/AIDS educators and others who work with persons who have HIV/AIDS. Differentiating Depravity from Disempathy Results showed that two macro—dimensions of perceived associational stigma exist among HIV/AIDS workers: (1) judgment of depravity and (2) sense of disempathy. Recall that depravity was defined as perceiving oneself to be viewed as morally bad, corrupt, infectious and perverted (because one attends to the needs of persons who have HIV/AIDS), and that disempathy was defined as perceiving oneself to be viewed as misunderstood, unadmired, and not worthy of compassion (because one attends to the needs of persons who have HIV/AIDS). 108 109 Depravity and disempathy represent strikingly different perceptions of the self as an HIV /AIDS worker. It appears that depravity is the more severe of the two macro- dimensions of perceived associational stigma. Its combination of ‘moral wrong-doing’ and ‘fear of contagion’ present a discouraging view of what it means to be an HIV/AIDS worker. Depravity connotes feelings of condemnation, mistrust, and fear. It seems to assert that people with AIDS—as well as others who can be associated with them—are affected by this disease because they deserve to suffer. The meaning of perceived associational depravity, therefore, suggests that being HIV-positive and being an HIV/AIDS worker are equally immoral and equally punishable. As was pointed out in Chapter 1, the saliency of moral wrong-doing to depravity can be generally attributed to the fact the topic of sex—and therefore HIV/AIDS—and debates about morality and social ethics in Western society are virtually inextricable (Foucault, 1980). The attribution of immorality appears to be strong enough to wipe away rational thinking about how HIV is actually transmitted. Despite the fact that HIV is contagious only via particular body fluids, namely blood, semen, vaginal fluids, and breast milk (Singer, Rogers, & Corcoran, 1987), HIV/AIDS workers are inclined to believe that they are viewed as contagious reservoirs of HIV. In contrast to depravity, disempathy seems somewhat more benign. Its combination of ‘misunderstanding,’ ‘lack of admiration,’ and ‘lack of compassion’ connote a reaction of general discomfort between HIV/AIDS workers and members of their social networks. Although disempathy does not bring with it the same sense of impending punishment that depravity does, it appears to cause uncertainty and cautious concern about how others view anyone who is affected by HIV /AIDS. This is consistent with Powell-Cope and l 10 Brown’s (1992) finding that ‘uncertainty’ was the basic psycho-social problem of AIDS family caregiving, particularly when caregivers made decisions about how and when to ‘go public’ about a family member’s AIDS diagnosis. For some HIV /AIDS workers, the uneasiness generated by a perception of disempathy may be explained in terms of need for a more robust sense of community. That is, some HIV/AIDS workers may find themselves feeling lonely. Rock’s (1984) definition of loneliness seems to capture the essence of perceived associational disempathy. He writes that loneliness is “. . . an enduring condition of emotional distress that arises when a person feels estranged from, misunderstood, or rejected by others and/or lacks appropriate social partners for desired activities, particularly activities that provide a sense of social integration and opportunities for emotional intimacy” (p. 139). Disempathized HIV /AIDS workers may feel that their work sets them apart—even keeps them apart—from others. Along a similar line of thinking, HIV/AIDS workers’ perception of associational disempathy may result from a lack of positive feedback about the value of their contribution to the community at large. Social Exchange Theory (or Equity Theory) would explain that HIV/AIDS workers perceive themselves as disempathized when they do not experience positive appraisal for their work with persons who have HIV/AIDS (Shumaker & Brownell, 1984). Although both loneliness theories and social exchange theories suggest plausible explanations about why disempathy exists, which of these theories drive such perceptions is not clearly answered by this study. It is important to underscore that the present study has deve10ped a measure of perceived, not actual, associational stigma. As such it provides a window into the lll HIV/AIDS worker’s personal attitudes and beliefs about HIV/AIDS. Considered from this standpoint, perceived associational stigma may be explained by Attribution Theory, which posits that individuals understand, predict, and control their environment according to relative weights that they assign to internal (person) or to external (environment) factors (Weiner, 1988; Heider, 195 8). Hence, perceptions of depravity may be best understood as an expression of the degree to which internal (person) factors affect how HIV/AIDS workers see themsleves, as opposed to perceptions of disempathy, which may be best understood as an expression of the degree to which external (environment) factors affect how HIV/AIDS workers see themselves. Conceptualizing depravity as an internally motivated perception may help explain why the present study’s path model of major constructs showed that perceived social distance mediated the relationship between perceived risk of HIV infection and perceived associational depravity, but that neither risk of HIV infection nor perceived social distance were linked to perceptions of disempathy. Recall the perceived social distance was a measure of avoidance behavior on the part of a third party who somehow became aware of the target’s role in the community as an HIV/AIDS worker. These results suggest that HIV/AIDS workers who strongly fear the possibility of becoming HIV- positive may actually present themselves in such a way that others tend to avoid them. Furthermore, their perception of being viewed as depraved may be a function of an internally motivated perception that they are somehow deserving of such a negative judgment. If this is the case, then some HIV/AIDS workers may be projecting onto themselves their own negative attribution about why some people are HIV-positive and others are not. 112 Similarly, considering disempathy as an externally motivated perception appears to explain why the path model showed that stronger perceptions of social support fiom other HIV /AIDS workers was linked to weaker perceptions of associational disempathy, but not to perceptions of associational depravity. As was mentioned earlier in this chapter, the possibility that a perception of disempathy arises out of a need for a more robust sense of community suggests that external cues, as opposed to internal cues, are driving perceptions of disempathy among HIV/AIDS workers. Although the negative relationship between social support fiom other HIV/AIDS workers and disempathy was not predicted, it suggests not only an evaluation of external factors, as opposed to internal factors, but also the possibility of a ‘buf’fering effect’ on perceived associational disempathy. Social support has been shown to function directly as a coping strategy by providing the recipient with the resources required to meet the specific needs evoked by the stessor, which in this case is perceived associational disempathy (Gottlieb, 1985). This outcome is also consistent with previous research by Bennett, Kelaher, and Ross (1994), which found that HIV /AIDS workers may be more selective about whom they seek out for social support than other health care workers who do not work with persons who have HIV/AIDS. Other findings are less straightforward to interpret. For instance, satisfaction with HIV/AIDS work experience and fiequency of face-to-face contact with persons who have HIV /AIDS were positively correlated with depravity and negatively correlated with disempathy. It is possible that the overall HIV/AIDS work experience creates a ‘safe space’ for workers who perceive associational depravity. This by itself may be enough to generate satisfaction with their HIV/AIDS work experience. In contrast, the negative 113 relationship between satisfaction with HIV /AIDS work experience and a perception of disempathy implies that HIV/AIDS work mitigates this macro-dimension of associational stigma. By working directly (i.e., face-to-face) with persons with HIV/AIDS or with HIV/AIDS service organizations, workers are able to develop a stronger understanding of their own location within the epidemic and of the forces that affect their perceptions of the disease. Hence, a renewed faith in the community is discovered through their HIV/AIDS work. Also somewhat difficult to interpret are the results of the bivariate correlational analyses for number of ‘otherwise stigmatized’ groups served and the duration of HIV /AIDS work experience. Both of these variables were found to be negatively correlated with depravity—which was opposite of what was hypothesized—and unrelated to disempathy. One explanation is that HIV /AIDS workers who have (1) had more contact with, for example, HIV -positive gay men, I.V. drug users, and commercial sex workers and who have (2) worked with these groups over a longer period of time [more than five years] are somehow ‘above’ perceptions of associational stigma. Their more intense and/or longer experience in the field of HIV/AIDS work may have empowered them to deal more effectively with negative attitudes and beliefs about persons with HIV/AIDS when they encounter them. Nonetheless, these somewhat paradoxical findings about the relationship between percieved associational stigma and (1) HIV /AIDS work satisfaction, (2) frequency of face-to-face contact with persons with HIV/AIDS, (3) amount of work with otherwise stigmatized groups, and (4) duration of HIV /AIDS work experience appear to uphold Omoto and Synder’s (1990) view of HIV/AIDS work as socially adjustive. They explain 114 that HIV/AIDS work, particularly when volunteers are considered, serves either a value expressive function or an ego defensive function. Their ideas may be related to the present study’s macro-dimensions of associational stigma. According to Omoto and Synder (1990), HIV /AIDS workers for whom HIV /AIDS work provides a value expressive function would tend to be more altruistic and externally focused. Value expressive workers would be expected to communicate a dissatisfaction with ‘the system’ and they would tend to espouse a social change orientation. By comparison, those for whom HIV/AIDS work provides an ego defensive function would tend to harbor internal fears about how AIDS could, or does, affect them and they would tend to espouse a personal change orientation. Applying these analogies to the present study’s findings, ego defensive HNIAIDS workers would be those who report stronger perceptions of depravity, while value expressive HIV/AIDS workers would be those who report stronger perceptions of disempathy. Strength of Association The confirmatory factor analyses presented in this study showed that perceived associational stigma is distinguishable across each aspect of an individual’s social network and that the two macro-dimensions were relatively independent (r = .18). Non- HIV/AIDS co-workers generated the highest measure of association for perceived associational depravity (away-0, = .83) and for perceived associational disempathy (rat-,,,,,‘,,a,;,y = .92). Friends generated the lowest measure of association for perceived depravity (newt-y = .60), although the general public generated the lowest measure of association for perceived associational disempathy (mum-1,, = .67). These results imply that HIV/AIDS workers are least likely to believe that their fiiends view them as 115 depraved. Likewise, HIV/AIDS workers are least likely to believe that the general public in their community views them as disempathized. The finding that non-HIV/AIDS co-workers—relative to other members of HIV/AIDS workers’ social networks—are shown to be the most stigmatizing group is intriguing. This may reflect that persons who work with persons with HIV/AIDS are particularly wary of the possibility that they could somehow be discriminated against at their non-HNIAIDS job. For instance, if their HIV /AIDS-related work was brought to the attention of a their non-HIV/AIDS employer, the HIV /AIDS worker could potentially be passed over for a promotion or a pay increase, or even be dismissed from the non- HIV/AIDS organization. This kind of negative outcome represents a direct and tangible loss when compared to, for instance, the possibility that a previously fi'iendly neighbor simply doesn’t reciprocate an HIV/AIDS worker’s ‘hello’ anymore. This rationale may also explain how perceptions of disempathy (albeit not depravity) were found to be stronger among survey respondents who were paid for their HIV/AIDS work than they were among volunteers. Both of these results appear to indicate that HIV/AIDS workers are relatively more concerned about outcomes related to associational stigma from their non-HIV/AIDS workers than they are from their fi'iends, family members, neighbors, or the general public in their community. Strength of Belief Accepting that depravity is the more severe of the two macro-dimensions, it is somewhat comforting to know that HIV/AIDS workers are not likely to strongly believe that others view them this way. On a scale from 0 to 10, this study’s sample of HIV/AIDS 116 workers reported almost no perception of depravity from their friends (M=.68, SD=1.23, N=311), with gradual, but significant mean increases across other components of their social network. Depravity from the general community was reported to be highest (W180, SD=2.38, N=308). By comparison, HIV/AIDS workers are somewhat more likely to believe themselves disempathized. Using the same scale upon which depravity was measured, this study’s sample of HIV/AIDS workers reported relatively stronger perceptions of disempathy. Recall that, for friends, the average level of perceived associational disempathy was $3.47 (SD=2.42, N=310), and that it climbed as high as M=5.58 when HIV/AIDS workers were asked to consider the general public (SD=2.13, N=307). The fact that the strength of the belief in associational stigma tends to increase as HIV/AIDS workers report on presumably less familiar persons in their social network reinforces a fundamental principle of social psychology: people like familiar things (or familiar people) more than unfamiliar things (or unfamiliar people)(Swap, 1977). This outcome implies that programs that facilitate greater interaction between HIV/AIDS workers and non-HIV/AIDS workers would likely alleviate perceptions of associational stigma and, in turn, increase community involvement. Previous studies have shown that efforts can be made to effectively increase perceived familiarity and thereby attenuate negative perceptions of others. Allport’s (1954) review of contact and acquaintance programs—which were used to help members of different ethic or racial groups breakdown stereotypes of each other—are a testimony to how this can be accomplished. 1 17 HIV [AIDS Worker Profiles The respondent cluster analysis provided insight into the proportion of HIV/AIDS workers that reported experiencing different levels of perceived associational stigma. A four-group solution revealed that a ‘high’ level of perceived associational stigma was reported by a minority of the total sample (see Figure 4). Recall that only 43 HIV/AIDS workers (13%) could be classified as having reported a strong belief that they are perceived as depraved and disempathized. Ninety-three respondents reported a medium level of both perceived depravity and perceived disempathy (29%). In general, these results imply that a strongly perceived associational stigma does not appear to affect a large proportion of HIV /AIDS workers. The discriminant analysis (DA) helped describe characteristics of each of the four groups. Recall that group characteristics included (1) members’ perceived risk of HIV infection, (2) perceived social support from HIV /AIDS workers, (3) satisfaction with HIV/AIDS work experience, (4) HNIAIDS-related communication behavior, (5) perceived social distance, and (6) the proportion of others who knew about the respondent’s HIV/AIDS work. Results showed that levels of depravity relative to disempathy predicted group membership effectively for Group 1 (low depravity/low disempathy), Group 3 (low depravity/high disempathy), and Group 4 (high depravity/high disempathy), but not for Group 2 (medium depravity/medium disempathy). These group profiles complemented the results of the present study’s path model, providing another picture of how particular characteristics of HIV/AIDS workers where related to measures of perceived associational stigma. As expected, HIV /AIDS workers who perceived a high level of both depravity and disempathy showed the highest 118 perceived social distance and the lowest HIV/AIDS-related communication behavior. Also as expected, HIV /AIDS workers who perceived a low level of both depravity and disempathy showed the highest HIV/AIDS-communication behavior and the lowest perceived social distance. However, AIDS workers who perceived a low level of depravity and a high level of disempathy revealed a profile that was qualitatively different: all six characteristics measured below average. Their profile indicates a relatively ‘depressed’ and/or ‘frustrated’ circumstance. Additional analyses are needed for further interpretation of these results. Talking is Preventing In general, peer-to-peer communication about health-related topics is considered to be an important information dissemination mechanism for community-level prevention programs (CDC, 1995b). There is broad consensus that individuals acquire information, form attitudes, and develop beliefs from members of their social network(s). It is important to recognize that, in many situations, what is said can be just as important as what cannot be said. For instance, HIV/AIDS workers are all potential ‘key communicators’ of relevant information about health practices and health services. The impact of perceived associational stigma on communication behavior about HIV/AIDS-related topics underscores how this construct is germane to community-based HIV/AIDS prevention. Recall that the present study’s bivariate correlational analyses showed that workers who reported stronger perceptions of either type of perceived associational stigma were less likely to tell others about their HIV/AIDS work experience. Furthermore, results of the present study’s path analysis revealed that (l) a negative effect on communication behavior would be particularly salient when a strong 1 l9 perception of associational depravity exists and that (2) higher disempathy was also related to lower communication behavior, but not at a statistically significant level. In constrast, more satisfaction with HIV /AIDS work experience appeared to generate more communication about HNIAIDS-related topics, thereby mitigating some of the negative effect of perceived associational depravity and disempathy. Although not the focus of the present study, the positive effect of satisfaction with HIV/AIDS work experience on communication behavior is a potentially important insight for HIV/AIDS preventionists. These findings provide support for a ntunber of theories about health communication that conceptualize how informal, person-to-person interaction can profoundly change the way an entire community thinks and responds to a particular topic, such as HIV/AIDS, over time. Diffusion Theory is one of these. In general, it explains how information about new ideas, or some new set of behavioral norms, such as those that might be communicated about ‘safer sex’ by an HIV/AIDS worker, are received and then internalized by individuals in a community. By ‘community’ diffusion theorists refer to any interdependent group of people, such as HNIAIDS workers and their social network of friends, family, and co-workers. Researchers note that the most important mechanism at work in Diffusion Theory is interpersonal communication among peers (Dignan, Tillgren & Michielutte, 1994). To summarize, results of the present study suggest that, in an informal way, this activity is on-going between HIV/AIDS workers and members of their social network. However, perceptions of associational stigma tend to decrease the amount and/or frequency of communication about HIV/AIDS-related topics that might otherwise have taken place. 120 Conclusion HIV /AIDS workers, whether they provide primary, secondary, or tertiary prevention services to persons with HIV/AIDS, are carrying out much needed, much appreciated work in the community. However, the complex social circumstance that is attached to the HIV/AIDS epidemic may sometimes mean that persons who work with persons with HIV /AIDS will shoulder a social stigma Perceived associational stigma manifests as a subtle, but influential construct among HIV/AIDS workers. It underscores the notion that people do not readily expose personal beliefs of discrimination and fear to others. At the community level, inhibited communication about important health-related topics may be viewed as a potentially serious barrier for prevention. Detection of an associational stigma among health service providers, such as HIV/AIDS workers, may be particularly indicative that this type of barrier is at work. An increased awareness about the potential impact of associational stigma may empower HIV/AIDS workers—and therefore the communities in which they serve—to become more effective agents of prevention in the fight to end the AHDS epidemic. APPENDICES APPENDIX A APPENDIX A PARTICIPATING ORGANIZATIONS REGIONAL PREVENTION PLANNING GROUP 1 AIDS Consortium of SE Michigan Lydia Myers, MSW Ph: (313) 496-0140 Program Director AIDS Consortium of SE Michigan 1150 Griswold Suite 1400 Detroit, MI 48226 AIDS Partnership of Michigan Barbara Murray Ph: (313) 446-9800 Executive Director AIDS Partnership of Michigan 2751 East Jefferson, Suite 301 Detroit, Michigan 48207 REGIONAL PREVENTION PLANNING GROUP 2 HNIAIDS Resource Center Patrick Yankee Ph: (313) 572-9355 Executive Director (800) 578-2300 HIV/AIDS Resom'ce Center 3075 Clark Road Suite 203 Ypsilanti, MI 48197 REGIONAL PREVENTION PLANNING GROUP 3 CARES Cyril Colonius Ph: (616) 381-2437 Executive Director CARES 628 South Park Street Kalamazoo, MI 49007 REGIONAL PREVENTION PLANNING GROUP 4 Lansing Area AIDS Network Bill Bathie Ph: (517) 351-4534 Executive Director 4660 S. Hagadorn Suite 510 East Lansing, MI 48823 121 122 APPENDIX A REGIONAL PREVENTION PLANNING GROUP 4 Michigan Protection and Advocacy Service Teresa Muniz Ph: (517) 487-1755 Advocate (800) 288-5923 106 West Allegan, Suite 210 Lansing, MI 48933 REGIONAL PREVENTION PLANNING GROUP 5 AIDS Resource Center Jan Koopman, Executive Director Ph: (616) 459-9177 AIDS Resource Center PO. Box 6603 Grand Rapids, MI 49516-6603 REGIONAL PREVENTION PLANNING GROUP 6 Wellness HNIAIDS Services Rob Bader, Executive Director Ph: (810) 232-0888 Wellness HIV/AIDS Services 311 East Comt Street Flint, MI 48502 REGIONAL PREVENTION PLANNING GROUP 7 HIV/AIDS Wellness Networks GTA Jim Carruthers, Executive Director Ph: (616)947-1110 HNIAIDS Wellness Networks GTA PO. box 1632 Traverse City, MI 49685 REGIONAL PREVENTION PLANNING GROUP 8 Marquette County Health Department Penny Peterson Ph: (906) 475-7651 Marquette County Health Department 184 US Highway 41 Negaunee, Michigan 49866 APPENDIX B hflmqunmumwnm fiZMmmwmewmm E151 W00. Midllgar. fl£fl40$ 517/355-2180 FAX 517/432-1171 Newmmmamummwh maammmeawmm BowmamAmm uwsaHMmmmaMn maummmwmmmw APPENDIX B MICHIGAN STATE lJ hi I V’ E [I S l 1' Y May 7, 1996 To: David Lounsbury 129 Psychology Research RE: IRBfi: 96-259 TITLE: MEASURING ASSOCIATIONAL STIGMA AMONG HIV/AIDS WORKERS REVISION REQUESTED: N/A CATEGORY: FULL REVIEW APPROVAL DATE: 05/06/96 The University Committee on Research Involving Human Subjects'(UCRIHS) review of this project is complete.. I am pleased to adVise that the rights and welfare of the human subjects appear to be adequately protected and methods to obtain informed consent are appropriate. herefore, the UCRIHS approved this progect and any reVisions listed above. RIIIIIL: UCRIHS approval is valid for one calendar year, beginning with the approval date shown above. Investigators planning to continue a project beyond one year must use the green renewal form (enclosed with t e original agproval letter or when a. pr03ect is renewed) to seek u te certification. There is a maXimum of four such expedite renewals ssible. Investigators wishing to continue a prOJect beyond tha time need to submit it again or complete reView. IIVISIOII: UCRIHS must review any changes in rocedures involving human subjects, rior to initiation of t e change. If this is done at the time o renewal, please use the green renewal.form. To revise an approved protocol at any other time during the year, send your written request to the_ CRIBS Chair, requesting revised approval and referenCing the progect's IRB # and title.. Include in ur request a description of the change and any reVised ins ruments, consent forms or advertisements that are applicable. DIOBLIISI . , _ _ CRAIGIS: Should either of the followin arise during the course of the work, investigators must noti UCRIHS promptly: (1) roblems (unexpected side effects, comp aints, etc.) involving uman subjects or (2) changes in the research enVironment or new information indicating greater risk to the human sub'ects than existed when the protocol was previously reviewed an approved. If we can be of any future help, lease do not hesitate to contact us at (517)355-2180 or FAX (51714 2- 171. Sincerel avid E. Wright, Ph.D. UCRIHS Chair DEW:bed cc: Ralph Levine 123 APPENDIX C APPENDIX C HIV/AIDS WORK EXPERIENCE SURVEY This survey focuses on particular aspects of your experience as a person who works with persons who have )‘HV/AIDS, such as caregivers, case managers, counselors, community advocates, volunteer “buddies” and service administrators W W It takes approximately 30 minutes to respond to all items. SECTION A. HIV/AIDS Work Background ‘5’ This section asks about your HIV/AIDS work background. 1. On what basis do you CURRENTLY work with persons who have HIV/AIDS? Check one AOIWBASI D 1 All volunteer work (not for pay) 0 4 All paid work 0 2 Mostly volunteer work with some paid work 0 5 Neither working for pay nor volunteering my D 3 Mostly paid work with some volunteer work time at the moment Ifyou are affiliated with one or more HIV/AIDS agencies or organmtions in the community, which one(s)? Spec-'93».- 592nm AOZAFFIZ mums A02AI-‘Fl4 Aozxr-rr-‘rs Which of the following groups describe those persons who have HIV/AIDS with whom you work? Check all that apply. CI 1 Gay men A03lGAYM D 5 Children aoascrm. Cl 2 IV drug users A032NDG D 6 Adolescents A036ADOL CI 3 Hemophiliacs A033HEMO D 7 Commercial sex workers A037SEXW Cl 4 Women A034WOME D 8 Other Specify: W Briefly describe the nature of your work with persons who have HIV/AIDS. WAN How long have you been working with persons who have HIV/AIDS? Fill in blanks. __ years plus _ __ months AOSYEARS AOSMONTH Approximately how often have you had face-to-faee interaction with persons who have HIV/AIDS during the pest III!!! months? Consider all interactions that you may have with such people whether at work, home, school, etc. Check one. A06FACE1 D 1 Everyday C14 Twoorthreetimesamonth 02 Morethanonceaweek 05 Aboutonceamonth D3 Aboutonceaweek D6 Lessthanonceamonth Please continue on NEXT PAGE 124 l 25 APPENDIX C SECTION A (continued) How do you describe your overall work experience with persons who have HIV/AIDS? F or each word-pair respond by circling the response-manber that best indicates your experience on the two-sided scale fiom 0 to 3. MORE MORE um? WWI 3mm 1. Frustrating IE 3 2 1 0 l 2 3 E Encouraging A07lFRUS 2. Tiresome 3 2 l 0 l 2 3 Emerging A07211RE 3. Rewarding 3 2 1 0 1 2 3 Punishing A073REWA 4. Satisfying B 3 2 r 0 1 2 3 Dhsatistying 110743.411 5. Politial 3 2 1 0 l 2 3 Non-political AO‘ISPOLI 6. Manageable 3 2 l 0 I 2 3 E Unmanageable A076MANA Do you know persons other than yourself who have esperience working with persons who have HIV/AIDS? Check one. AOSPEERS D 1 Yes D 2 No -s Skip to next page If you answered “Yes” to question 8, use the following statements to indicate the level of support you receive FROM THEM as compared to FROM OTHERS whom you know ”9]: to have experience working with persons who have HIV/AIDS. F or each statement circle the response-number on the scale from I to 5 that corresponds most closely to your current situation. l. I count on THEM to listen to me when I need to 1 2 3 4 5 talk. A0918UPP 2. I count on THEM to help me out in a crisis even 1 2 3 4 5 if they have to go out of their way. A092$UPP 3. Around THEM I can really be myself. A093$UPP 1 2 3 4 5 4. THEY truely appreciate me as a person. A094$UPP 1 2 3 4 5 5. When I’m very upset I know I can count on 1 2 3 4 5 THEM to console me. A095$UPP Please continue on NEXT PAGE l 26 APPENDIX C SECTION B. Perceptions of Others’ Beliefs ‘3’ This section is comprised of five parts. Each part asks about your perception of a different group of persons in your life, namely your: 0 FRIENDS FAMILY MEMBERS CO-WORKERS NOT AFFILIATED WITH HIV/AIDS WORK NEIGHBORS THE GENERAL PUBLIC IN YOUR COMMUNITY. Please continue on NEXT PAGE 127 APPENDIX C SECTION B — Part 1. FRIENDS ‘3’ This part asks about how many of your FRIENDS know about your work with persons who have HIV/AIDS and about YOUR PERCEPTION of how THEY VIEW YOU in this role. I. How many of your FRIENDS know about your work with persons who have HIV/AIDS? Check one. BPlOlPRO Cl 1 None Cl 4 All or nearly all Cl 2 A few Cl 5 Not applicable (don’t have any friends) 4 PLEASE SKIP TO Cl 3 Most NEXT PAGE For the following statements base your response on those FRIENDS who know about your work with persons who have HIV/AIDS. If none of your FRIENDS know (i.e., you checked “None” for question 1 in this part), please respond to each item as if they did. Respond by circling the number that best indicates your overall level of belief on the scale fiom 0 to 10. (Suggestion: it may help to think of each number on the 11-point scale as a percentage. For example, ‘10’ corresponds to ‘100% of your belief,’ ‘9’ to ‘90% of your belief, ‘8’ to ‘80% of your belief and so on). I believe that MY FRIENDS . . . . . . judge my work to be morally wrong because I work with persons who have HIV/AIDS. BPIOZMOR . . . are afraid that I might pass HIV on to them because I work with persons who have HNIAIDS. BPlOBCON . . . admire me because I work with persons who have HIV/AIDS. BPIOMDM . . . associate thoughts of death and dying with me because I work with persons who have HNIAIDS. BPlOSDEA . . . understand and value me because I work with persons who have HIV/AIDS. 3P106UND . . . show compassion for me because I work with persons who have HIV/AIDS. BPIO‘ICOM DO NOT BELIEVE BELIEVE WITHOUT AT ALL ANY DOUBT 5310123456 78910 012345678910 012345678910 012345678910 012345678910 012345678910 012345678910 Please continue on NEXT PAGE 128 APPENDIX C 5 SECTION B — Part 2. FAMILY MEMBERS ‘3’ This part asks about how many of your FAMILY MEMBERS (i.e., spouse/intimate partner, children, siblings, parents/step-parents, aunts/uncles, nieces/nephews) know about your work with persons who have HIV /AIDS and about YOUR PERCEPTION of how THEY VIEW YOU in this role. 1. How many of your FAMILY MEMBERS know about your work with persons who have HIV/AIDS? Check one. BP20lPRO Cl 1 None Cl 4 All or nearly all 0 2 A few Cl 5 Not applicable (don’t have any family) 4 PLEASE SKIP Cl 3 Most TO NEXT PAGE For the following statements base your response on those FAMILY MEMBERS who know about your work with persons who have HIV /AIDS. If none of your FAMILY MEMBERS know (i.e., you checked “None” for question 1 in this part), please respond to each item as if they did. Respond by circling the number that best indicates your overall level of belief on the scale fiom 0 to 10. DO NOT BELIEVE BELIEVE WITHOUT AT ALL ANY DOUBT IbelievethatMYFAMILYMEMBERS... E01 2 3 4 5 6 7 8 9105] 2. ...judgemyworktobemorallywrong 0 1 2 3 4 5 6 7 8 9 10 because I work with persons who have HIV /AIDS. BP202MOR 3. ...areafraidthatlmightpassHIVontothem 0 l 2 3 4 5 6 7 8 9 10 because I work with persons who have HNIAIDS. BPZO3CON 4. ...admiremebecauselworkwithpersons 0 l 2 3 4 5 6 7 8 9 10 who have HIV/AIDS. BP204ADM 5. ...associatethoughtsofdeathanddyingwith 0 1 2 3 4 5 6 7 8 9 10 me because I work with persons who have HIV/AIDS. BP205DEA 6. ...understandandvaluemebecause1work 0 l 2 3 4 5 6 7 8 9 10 with persons who have HIV/AIDS. BP206UND 7. ...showcompassionformebeeauselwork 0 l 2 3 4 5 6 7 8 9 10 with persons who have HIV/AIDS. BP207COM Please continue on NEXT PAGE l 29 APPENDIX C 6 SECTION B — Part 3. CO-WORKERS NOT AFFILIATED WITH HIV/AIDS WORK a? This part asks about how many of your CO-WORKERS NOT AFFILIATED WITH HIV/AIDS WORK (i.e., people you work with on some other job or project unrelated to your work with persons who have HIV/AIDS) know about your work with persons who have HIV/AIDS, about what you do on this job or project, and about YOUR PERCEPTION of how THEY VIEW YOU as a person who works with persons who have HIV /AIDS. 1. How many of your CO-WORKERS NOT AFFILIATED WITH HIV/AIDS WORK know about your work with persons who have HIV/AIDS? Check one. BP301PRO Ell None. 04 Allorneerlyall Cl 2 A few Cl 5 Not applicable (don’t have other co-workersHPLEASE CI 3 Most SKIP T0 NEXT PAGE 2. What is your job title/description?_mgmn For the following statements base your response on those CO-WORKERS who know about your work with persons who have HIV/AIDS. If none of them know (i.e., you checked “None” for question 1 in this part), please respond to each item as if they did. Respond by circling the number that best indicates your overall level of belief on the scale fiom 0 to 10. DO NOT BELIEVE BELIEVE WITHOUT I believe that MY CO-WORKERS NOT AT ALL ANY oourrr AFFILIATEDWITHHIV/AIDSWORK... E01 2 3 4 5 6 7 8 910. 3. ...judgemyworktobemorallywrong 0 1 2 3 4 5 6‘ 7 8 9 10 because I work with persons who have HIV/AIDS. BP303MOR 4. ...areafraidthatlmightpassHIVontothem o 1 2 3 4 5 6 7 8 9 10 because I work with persons who have HIV/AIDS. BP304CON 5. ...admiremebecauselworkwithpersons 0 l 2 3 4 5 6 7 8 9 10 who have HIV/AIDS. BP305ADM 6. ...associatethoughtsofdeathanddyingwith 0 1 2 3 4 5 6 7 8 9 10 me because I work with persons who have HIV/AIDS. BPBOGDEA 7. ...understandandvaluemebecauselwork o 1 2 3 4 5 6 7 8 9 10 with persons who have HIV/AIDS. BP307UND 8. ...showcompassionformebeesuselwork o 1 2 3 4 5 6 7 8 9 10 with persons who have HIV/AIDS. smscou Please continue on NEXT PAGE l 30 APPENDIX C SECTION B — Part 4. NEIGHBORS ‘5’ This part asks about how many of your NEIGHBORS (i.e., those people who live on your block or in the same apartment building) know about your work with persons who have HIV/AIDS and about YOUR PERCEPTION of how THEY VIEW YOU in this role. How many of your NEIGHBORS know about your work with persons who have HIV/AIDS? Check one. BP401PRO Cl 1 None El 4 All or nearly all 1 El 2 A few 0 5 Not applicable (don’t have any neighborsH PLEASE Cl 3 Most SKIP TO NEXT PAGE For the following statements base your response on those NEIGHBORS who know about your work with persons who have HIV/AIDS. If none of your NEIGHBORS know (i.e., you checked “None” for question 1 in this part), please respond to each item as if they did. Respond by circling the number that best indicates your overall level of belief on the scale fiom 0 to 10. DO NOT BELIEVE BELIEVE WITHOUT AT ALL ANY DOUBT IbelievethatMYNEIGHBORS... [5101 2 3 4 5 6 7 8 910- 2. ...judgemyworktobemonllywrong 0 l 2 3 4 S 6 7 8 9 10 because I work with persons who have HIV/AIDS. BPtonOR 3. ...areafraidthatlmightpassHIVontothem 0 l 2 3 4 5 6 7 8 9 10 because I work with persons who have HIV/AIDS. BP403CON 4. ...ad-iremebecauselworkwithpersons 0 l 2 3 4 5 6 7 8 9 10 who have HIV/AIDS. BP404ADM 5. ...associatethoughtsofdeathanddyingwith 0 l 2 3 4 S 6 7 8 9 10 me because I work with persons who have HIV/AIDS. amososa 6. ...understandandvaluemebeeauselwork 0 l 2 3 4 5 6 7 8 9 10 with persons who have HIV/AIDS. BP4060ND 7. ...showcompassionformebecauselwork o 1 2 3 4 5 6 7 3 9 10 with persons who have HIV/AIDS. BP407OOM Please continue on NEXT PAGE 13 1 APPENDIX C SECTION B — Part 5. THE GENERAL PUBLIC IN YOUR COMNIUNITY 35’ This part asks about your PERCEPTION of how THE GENERAL PUBLIC IN YOUR COMMUNITY views people who work with persons who have HIV/AIDS. For the following statements base your response solely on what you believe most people in your community would think about people who work with persons who have HIV/AIDS. Respond by circling the number that best indicates your overall level of belief on the scale fiom 0 to 10. DONOT BELIEVE BELIEVE WITHOUT I believe that THE GENERAL PUBLIC IN AT ALL ANY DOUBT MYCOWUNITY... [‘30 l 2 3 4 5 6 7 8 9 10- 1. ...judgessuehpeopletobemorallywrong 0 1 2 3 4 5 6 7 8 9 10 because they work with persons who have HIV/AIDS. BPSOIMOR 2. ...isafraidthatsuchpeoplemightpassI-IIV 0 l 2 3 4 5 6 7 8 9 10 on to them because they work with persons who have HIV/AIDS. BPSOZCON 3. ...admiresuchpeoplebecausethey work 0 l 2 3 4 5 6 7 8 9 10 with persons who have HIV/AIDS. BP503ADM 4. ...associatethoughtsofdeathanddyingwith 0 l 2 3 4 5 6 7 8 9 10 such people because they work with persons who have HIV/AIDS. BPSMDEA 5. ...understandandvaluesuchpeoplebecause 0 1 2 3 4 5 6 7 8 9 10 they work with persons who have HIV/AIDS. BPSOSUND 6. ...showscompassionforsuchpeoplebeeause 0 1 2 3 4 5 6 7 8 9 10 they work with persons who have HIV/AIDS. BP506COM Please continue on NEXT PA GE 132 APPENDIX C 9 SECTION C. Perceptions of Others’ Behaviors ‘5'” This set of questions asks about the degree to which your work with persons who have HIV/AIDS has W the way others (i.e., persons who are not affiliated with HIV/AIDS work) interact with you. Respond by circling the number that best indicates your overall sense of this occurring on the scale fiorn 0 to 10. NEVER ALWAYS SENSE SENSE Once people know that you work with persons who ms "“5 haveHIV/AIDS,doyousensethatthey... E101 2 3 4 5 6 7 8 910. l. ...arelesswillingtostrikeup 0 l 2 3 4 5 6 7 8 910 conversation with you? conroaco 2. ...arelesslikelytoaskyoutoaparty? 0 1 2 3 4 5- 5 7 3 910 COZPOBPA 3. ...aremorelikelytodeclineanofl’er 0 l 2 3 4 5 6 7 8 910 to eat a meal that you prepared? cospoman 4. ...aremoredifficulttogetalongwith 0 l 2 3 4 5 6 7 8 910 in the omee or place of work? coaroawo 5. ...aremorereluctanttocontinuea 0 1 2 3 4 5 6 7 s 9 10 friendship with you? cosroam 6. ...are|esslikelytocontinnealegalor 0 1 2 3 4 5 6 7 3 910 business relationship with you? cosroaus 7. ...arelesslikelytovisitinyonrhome? 0 l 2 3 4 S 6 7 8 910 comanv Please continue on NEXT PAGE l 3 3 APPENDIX C 10 SECTION D. Communication with Others Telling people that I work with persons who have HIV/AIDS gives me a sense of pride and satisfaction. noncwora I am very selective about whom I tell and whom I don’t tell about my work with persons who have HIV/AIDS. oozcwoss The thought of being seen in public with a person with AIDS makes me uncomfortable. Doscworu I often wear a red "In remembrance" ribbon when I go out. omcwom I would not tell a potential employer about my work with persons who have HIV/AIDS unless the job directly called for such experience. Doscwom I am completely open with others about my work with persons who have HIV/AIDS. noecwoor I am not afraid to tell others that I work with persons who have HIV/AIDS. raovcwom= ‘3’ This set of questions asks about how you communicate with others (i.e., non-HIVIAIDS workers) about your work with persons who have HIV IAIDS. Respond by circling the number that best indicates the degree to which each statement is like you on the scale fiom 0 to 10. NOT AT LIKEME E1012 1 COMPLETELY LIKE ME 3456 78910 345678910 345678910 345678910 345678910 345678910 345678910 345678910 Please continue on NEXT PA GE l 34 APPENDIX C 11 SECTION D (continued) 10. 11. 12. I wouldn't bring up the topic of my work with persons who have HIV/AIDS unless someone expressly asked me. Doscwms I get the strong impression that people wonder whether I might be homosexual after I’ve told them I work with persons who have HIV/AIDS. noocwono I am concerned that people will think that I am HIV+ after I’ve told them I work with persons who have HIV/AIDS. mocwor As a rule I don't tell others about my work with persons who have HIV/AIDS. Dl ICWODT o I always try to figure out how my audience might respond to the information that I work with persons who have HNIAIDS before bringing up the topic. mzcwona NOT AT ALL LIKE ME E1012 012 COMPLETELY LIKE ME 3456 789108 345678910 345678910 345678910 345678910 345678910 Please continue on NEXT PAGE 135 APPENDIX C 12 SECTION E. Unexpected Reactions of Others 3’ This section asks you to recall a situation in which someone’s awareness of your HIV IAIDS work elicited an unexpected behavior. If you can think of such a situation, please answer the following four questions in the space provided 1. What was the person’s behavior? EOlURODE 2. How was their behavior unexpected? EMUROUN 3. How did this person’s behavior make you feel? sosuaorr. 4. How did you respond to th'n person? 5040mm: Please continue on NEXT PA GE l 36 APPENDIX C 13 SECTION F. Personal Background ‘5‘ The following questions ask about your personal background. Although information gathered m this section is central to the design of this study, Wis WW. Respond to items by checking appropriate boxes or by writing in the space provided. 1. Wlmt is your age? __ years FOIREAGE 2. What 8 your sex? FOZRESEX Cl 1 Female 0 2 Male 3. Howdoyoudesu'ibeyonrraeeorethnlcbackgrolmd?t=03£nn~n DI AfricanAmerican 05 White/Caucasian 02 AsianorPacificlslander D6 Chicano/Hispanicllatino 03 Haitian D7 OtherSpecifi: 04 NativeAmericanorAlaskanNative 4. Whatkyonrprhnaryorfirsthngmgehmwou 0 1 English C] 2 Spanish 0 3 Other Specity: 5. Whatisthehlghestlevelofedneafionyouhaveeanpletedtodate?F05HEDUC 0 1 Elementary CI 5 Some college 02 Middle/intermediateschool D6 Two-yeartmdergraduateprogram Cl 3 High school 0 7 Four-year undergraduate program 04 Tradeltechnicaleertificate 08 Oneormoreyearsofgraduate/professionaltraining 6. What 8 your yearly household income? FoemuNC O 1 $0 - $9,999 0 4 $30,000 - 839,999 El 2 $10,000 - 819,999 El 5 $40,000 - $49,999 0 3 $20,000 - $29,999 0 6 $50,000 or more 7. How do you describe your sexual orientation? FO7SEXOR D l Heterosexual Cl 2 Homosexual (gay or lesbian) Cl 3 Bisexual Please continue on NEXT PAGE 137 APPENDIX C 14 SECTION F (continued) 8. What b your current marital/intimate partnership status? F08MARST Cl 1 Single Cl 4 Separated DZPartneredbymarriage DSDivorced 10. ll. 12. D 3 Partnered by domestic agreement Cl 6 Widowed AreyouHIV+?l-‘09mvsr DlYes-DSkiptoquestionll 02No D3Notsure If you answered “No” or “Not sure” to question 9, to what degree do you believe you are at risk of becoming HIV+ in the future? FIOHIVRK DlNorisk D4Moderatelyhighrisk D2Exueme1ylowrisk DSExtremelyhighrisk D3Moderatelylowrisk Are you a member of a church, mosque, temple, synagogue or other place of worship? F1 1CI-iMEM 0 1 Yes Continuewithpartsa, b, andcbelow: 4 a. What is your religious aililiation? (e.g., “Luther-an”) Speciij-‘URFI m -s b. How often do you go there to pray or worship? F1 mom Ell Morethanonceaweek D4 Aboutonceamonth 02 Aboutonceaweek 05 Lessthanonceamonth El 3 Twoorthreetimesamonth -D c. How long have you been worshiping there? __ years F1 IWORDU D 2 No, I am not a member ofa place ofworship. How do you describe your current political leanings? FIZPOLIT Cl 1 Liberal D 2 Moderate D 3 Conservative END OF SURVEY -- Thanks for your participation! Please use the large pro-paid, pro-addressed envelope to return your survey to: David Lounsbury Michigan State University Department of Psychology 129 Psychology Research Building East Lansing, MI 48824-1117 APPENDIX D APPENDIX D I ICHIGAN STATE UNIVERSITY DEPMTHINTOP PSYC-iOIDGY EAST LANSING 0 MICHIGAN 0 40824-1117 PSYCHOLOGY RESEARCH BUILDING Dear HIV/AIDS Worker or Volunteer: Greetings! I write to you today to ask you to consider participating in an anonymous, state-wide survey of persons who work with persons who are living with HIV disease or AIDS. Although you are under no obligation to participate, your input is very much valued. Results from this survey will be used to strengthen future community-based HIV/AIDS caregiving interventions, which are unfortunately becoming increasingly in-demand throughout Michigan. Enclosed you will find a blank copy of the HNIAIDS Work Experience Survey. You are eligible to take the survey if you are 18 or older and if you have ever worked, either for pay or as a volunteer. wlth persons who have HIV/AIDS. It takes no more than 30 minutes to fill out. When you have finished. simply mail it back to me in its attached pro-paid, pro-addressed envelope. Completing and returning the survey will indicate your voluntary agreement to participate in the study. NOTE THAT THIS IS AN ANONYMOUS SURVEY-PLEASE DO NOT WRITE YOUR NAME ANYWHERE ON THE SURVEY OR ON ITS RETURN ENVELOPE. Your participation in this study is a potentially Important contribution towards an end to the epidemic. Although I cannot pay you for your time, I have enclosed a 'red remembrance ribbon' decal as a small gift of appreciation and as a symbol of our collective efforts in the fight against HIV/AIDS. In addition. lhavealsoencloudaSusdyReadtsRaquastFonn. lfyouwould Iikeapersonalcopyofthe findings from this study, please fill out this special form and mail it back to me in its pro-paid. pre- addressed envelope. Please feel free to contact me should you have any questions or concerns about the survey. I am easily reached by phone or e-mail. Sincerely, flew/'Z‘fi David W. Lounsbury Study Coordinator Contact information Michigan State University (617) 374-11 17 Department of Psychology Lounsbu10pilot.msu.edu 129 Psychology Research Building East Lansing. MI 48824-111 7 MSU is an W Action/Spat Wily Innitution 138 APPENDIX E APPENDIX E INFORMED CONSENT Purpose of the research. To learn more about particular aspects of community-based HIV/AIDS caregiving interventions through reports from persons who work with persons who have HIV/AIDS (i.e., HIV/AIDS workers). Efigihle respondents. Anyone who is (1) 18 years or older and (2) working for pay or as a volunteer as an HIV/AIDS worker. HIV/AIDS work may include, but is not limited to, efforts as a caregiver, case manager, counselor, community advocate, volunteer "buddy", or service administrator. Voluntary pardcipation. Anyone receiving this survey may choose not to participate at all or may refuse to fill out particular sections or items. Completing and returning it will indicate your voluntary agreement to participate in the study. Confidentialty and anonymity. All information gathered through this survey will be treated with strict confidence. All reports of research findings will be made in a completely anonymous manner. Study results requests. Upon request and within the bounds stated above, results will be made available to all respondents. 139 APPENDIX F APPENDIX F STUDY RESULTS REQUEST FORM If you would like a personal copy of the findings from this study, please fill out this special form and mail it back to me in the attached envelope—do not return this form in the same envelope as the completed survey. In order to maintain your anonymity, this request form will not be opened until the study is complete and final results are ready to be mailed. Please print. Contact name (optional) Street City State Zip Thanksagainforyourperticlpatlonl I40 APPENDIX C APPENDIX G en; «QQVN mod n and né 5. :tN vmwm Quito-ea e_ne_._e> I41 142 APPENDIX G $.28. tits-o .33.; 143 APPENDIX G 8. Son- :65. 0:3 Sana >65. Sena soon coon...» €3.33 0252.080 033.; 44 1 APPENDIX G .253 8,2589 .33.; 145 APPENDIX G a: 2 {as cc! 2828 x53 0:3 8050 823 80.5“ 888 952 35325:» 388 952 52.8. 83358.“. .33.; APPENDIX C :5 >3 5.. Queen #63 Son. nos—ma Soon .26.an €03 Sana =3 _ E053 Sons as...“ .8 Ea _ x55 5E8. 85.....88 .33.; 147 APPENDIX G .3800 gm 58:5 83 ac. 5.3: Esq-Ego 3 ESE-coo 59:92 05 ED: 2030 20! A: c0325 v 209.8% .02—mm £0325 8&8.— 0239 .2 SID u3oz $.23. 352.830 .33.; APPENDIX I-I APPENDIX H Value Labels for Categorical Variables Position Variable 3 LOCATION Value AOCDGNQUI-th-l d4 5 CNTYCODE Value AODONO’OI-wa—l Ad 10 RPCODE Value mummAwN-s Label Location Label Detroit Flint Grand Rapids Kalamazoo Lansing/E. Lansing Muskegon Royal Oak Saginaw/Bay City Traverse City Negaunee Ypsilanti County Label Wayne Genesee Kent Kalamazoo lngham Muskegon Oakland Saginaw/Bay Grand Traverse Marquette Washtenaw Regional planning code Label Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 I48 l 49 APPENDIX H Value Labels for Categorical Variables (cont'd) Position Variable 15 16 17 18 19 20 AO1WBASI Value (”halo-l AO1WBASR Value 1 2 A02AFF|1 Value th—l AOZAFFIZ Value wa-l A02AFFI3 Value 1 2 3 4 AOZAFFM Value th—t Label Basis of current work Label All volunteer work Mostly volunteer work Mostly paid work All paid work Neither working for pay nor volunteering time Basis of current work (recoded) Label Volunteers Paid workers First affiliation type Label Comm-based support service Health/medical service Prevention planning Undeterrninabie Second affiliation type Label Comm-based support service Health/medical service Prevention planning Undeterrninabie Third affiliation type Label Comm-based support service Health/medical service Prevention planning Undeterrninabie Fourth affiliation type Label Comm-based support service Health/medical service Prevention planning Undetenninable l 50 APPENDIX H Value Labels for Categorical Variables (cont'd) Position Variable Label 21 A02AFFI5 Fifth affiliation type Value Label 1 Comm-based support service 2 Health/medical service 3 Prevention planning 4 Undeterrninabie 22 A02ACNT1 First affiliation recorded Value Label 1 Yes 23 A02ACNT2 Second affiliation recorded Value Label 1 Yes 24 A02ACNT3 Third affiliafion recorded Value Label 1 Yes 25 A02ACNT4 Fourth affiliation recorded Value Label 1 Yes 26 A02ACNT5 Fifth affiliation recorded Value Label 1 Yes 28 A031GAYM Works with gay men Value Label 1 Yes 2 No 29 A032iVDG Works with IV drug users Value Label 1 Yes 2 No 30 A033HEMO Works with hemophiliacs Value Label 1 Yes 2 No l 5 1 APPENDIX II Value Labels for Categorical Variables (cont'd) Position 31 32 33 35 39 Variable A034WOME Value 1 2 AO3SCHIL Value 1 2 A036ADOL Value A0356CHI Value 1 2 A037SEXW Value 1 2 A0380THE Value 1 2 AO3CLASS Value 1 2 3 Label Works with women Label Yes No Works with children Label Yes No Works with adolescents Label Yes No Works with children and/or adolescents Label Yes No Works with commercial sex workers Label Yes No Works with others not specified above Label Yes No Description of clients/patients with whom HIV/AIDS worker Label Non-stigmatized groups only Both stigmatized and non-stigmatized groups Stigmatized groups only 1 52 APPENDIX H Value Labels for Categorical Variables (cont'd) Position 40 41 42 43 45 Variable A04WNA1 D Value 0301-5de A04WNA1 T Value 1 2 A04WNAZD Value O’Ol-bUN-h A04WNA2T Value AO4WNA30 Value @mth-fi A04WNA3T Value Label Type of HIV/AIDS work experience Label Admin/secretarial Advocacy/case management Care giving/personal support Community support Counseling Management/leadership Dir/Indirect HIV/AIDS work experience Label Direct care indirect care Type of HIV/Al DS work experience Label Admin/secretarial Advocacy/case management Care giving/personal support Community support Counseling Management/leadership Dir/indirect HIV/Al 08 work experience Label Direct care Indirect care Type of HIV/AIDS work experience Label Admin/secretarial Advocacy/case management Care giving/personal support Community support Counseling Management/leadership Dir/Indirect HIV/AIDS work experience Label Direct care Indirect care l 53 APPENDIX H Value Labels for Categorical Variables (cont'd) Position 45 48 49 6O 67 74 Variable AO4WNGEN Value 1 2 3 A06FACEI Value (bubonic-I» A06FACER AOBPEERS Value 1 2 BP101PRO Value boon-s BP201 PRO Value own- Label Overall type of HIV/AIDS work experience Label Direct only Both direct 8. indirect Indirect only Freq of face-to-face interaction in past 3 months Label Everyday More than once a week About once a week Two or three times a month About once a month Less than once a month Freq of face-to-face interaction in past 3 months (recoded) Label Less than once a month About once a month Two or thme times a month About once a week More than once a week Everyday Respondent knows other HIV/AIDS workers Label Yes No Proportion of friends who know about respondent‘s work Label None A few Most All or nearly all Proportion of family who know about respondent's work Label None A few Most All or nearly all l 54 APPENDIX H Value Labels for Categorical Variables (cont‘d) Position Variable 81 82 89 132 133 164 BP301 PRO Value #wN-h BP302JOB Value «bUN-b BP401 PRO Value econ-s BAVGPROR Value bUN-l BPROFILE Value 1 2 EO1ATTRI Label Proportion of co-workers who know about respondent's work Label None A few Most All or nearly all Current non-HIV-reiated job description Label Health care provider Pastoral/clergy Teacher Other . Proportion of neighbors who know about respondent‘s work Label None A few Most All or nearly all Proportion of persons who know about respondent's work (re Label None to one A few Most All or needy all Respondent's community profile Label Low High Behavior attribution recoded Label Admiration/appreciation Compassion/sympathylpity Curiosity/Inquisitivity Fear of AIDS Moraiizing about AIDS Not determinable 1 55 APPENDIX H Value Labels for Categorical Variables (cont'd) Position Variable 165 EOZUNEXP Value 166 E03AFFEC 167 EO4RESPO 168 EOOTONE Value -1 O 1 169 EQ1SEVER Value 1 2 3 Label Unexpected behavior of other recoded Label Support/encouragement Attention to self/topic of HIV/Al DS Awkwardness/confusion ignorance/lack of awareness intolerance Not detenninabie Affect of respondent towards other recoded Label Affirmed/proudlcontent Contemplative Pity/sympathy for other Depressed/disappointed Defensive/angry Not determinable Respondent's behavior towards other recoded Label Approving Provided HIV/AIDS related info Neutral Disapproving Avoidance No response - did nothing Not determinable General rating of others behavior Label Negative Neutral Positive Severity of others behavior Label Weak Mild Strong 156 APPENDIX H Value Labels for Categorical Variables (cont'd) Position Variable 170 171 172 173 174 175 EQ1TYPE Value Ulvwa-l EQ3SEVER Value EQ4$EVER Value EREVIEWE Value «bare-a» ECODERID Value #wN—B ECODELET Value 1 2 Label Type of behavior Label Physical Verbal Affective Non-reaction Other Severity of respondent's feeling Label Weak Mild Strong Severity of respondents reaction to other Label Weak Mild Strong Reviewer Label Andrea David Whitney Tim Coder Label Andrea David Whitney Tim Coder Assignment Label A B l 57 APPENDIX H Value Labels for Categorical Variables (cont'd) Position 178 179 180 181 182 Variable FOZRESEX Value 1 2 F03ETHNI Value NOMcfiGN-A F04LANGU Value 1 2 3 F05HEDUC Value ONGG1§0NJ F06HHINC Value OUI#ODN—l Label Respondent's sex Label Female Male Respondent's race/ethnicity Label African American Asian or Pacific Islander Haitian Native American or Alaskan Native White/caucasian Chicano/HispanicILatino Other Respondent's primary language Label English Spanish Other Respondent's level of education Label Elementary Middlefintermediate school High school Trade/technical certificate Some college Two-year undergraduate program Four-year undergraduate program One of more years of graduate training Respondent's yearly household income Label $0 to $9,999 $10,000 to $19,999 $20,000 to $29,999 $30,000 to $39,999 $40,000 to $49,999 $50,000 or more l 58 APPENDIX H Value Labels for Categorical Variables (cont'd) Position Variable 183 184 185 186 187 FO7SEXOR Value 1 2 3 F08MARST Value Omth-I F09HIVST Value 1 2 3 F1 OHIVRK Value Otth—a F11CHMEM Value 1 2 Label Respondent's sexual orientation Label Heterosexual Homosexual (gay or lesbian) Bisexual Respondent's current marital/Intimate partnership status Label Single Partnered by marriage Partnered by domestic agreement Separated Divorced Widowed Respondent's HIV status Label Yes No Not sure Respondent's perceived risk for HIV Label No risk Extremely low risk Moderately low risk Moderately high risk Extremely high risk Respondent is a member of a place of worship Label Yes No l 59 APPENDIX II Value Labels for Categorical Variables (cont'd) Position Variable 188 F11RELIG E C G (OGVOOI-wa-l 10 11 12 13 14 15 16 17 18 19 20 21 189 F11WORFR Value U’i&uN-I~ 191 F12POLIT Value 1 2 3 192 F03ETHNR Value 1 2 Label Respondent's religious affiliation Label Apostolic Baptist Buddist Catholic Non-specific Christian Episcopal Jewish Lutheran Maceyonian Orthodox Methodist Muslim Non-denominational Pentecostal Protestant Quaker Reformed Spiritualist Traditional Native American Unitarian Universalist Wesleyan Wiccan Frequency of worship Label More than once a week About once a week Two or three times a month About once a month Less than once a month Respondent's current political leanings Label Liberal Moderate Conservative Respondent's race/ethnicity (recoded) Label Non-whitelnon-ceucasion White/caucasian l 60 APPENDIX H Value Labels for Categorical Variables (cont'd) Position 193 194 195 196 200 Variable F07SXORR Value 1 2 3 F08MARSR Value 1 2 F09HIVSR Value 1 2 F1OHIVRR Value thwN-l ZBXCLUID Value bUN-lr Label Respondent's sexual orientation (recoded) Label Heterosexual Bisexual Homosexual Respondent's current maritalfrntim partnr stutus (recoded) Label Not married/partnered Married/partnered Respondent's HIV status (recoded) Label HIV positive HIV negative Respondent's percvd risk for HIV (recoded) Label No risk Extremely low risk Moderately low risk Moderately high risk Extremely high risk Already HIV positive Cluster ID Label Low/low Med/med Low/high HE hlh'gh APPENDIX I APPENDIX I Variable Compute Statements (SPSS for Windows Syntax) Position Satement SECTION A. HNIAIDS Work Background 22 IF (a02affil > 0 & aOZaffiI <= 4) a02acnti = l . EXECUTE . 23 IF (a02affi2 > 0 & aOZaffiZ <= 4) 30211ch = I . EXECUTE . 24 IF (aOZaffi3 > 0 & a023fli3 <= 4) a02acnt3 = l . EXECUTE . 25 IF (a02affi4 > 0 & a02afli4 <= 4) a02acnt4 = l . EXECUTE . 26 IF (aOZaffiS > 0 & a02affi5 <= 4) a023cnt5 = l . EXECUTE . 27 COMPUTE aOZafiot = SUM.l(a02acntI ,aOZacnt2,aOZacnt3,a02acnt4,a02acnt5) . EXECUTE . 34 IF (a035chil = l |a0363dol = 1) 30356chi = l . EXECUTE . IF (a035chil = 2 & 11036on = 2) a0356chi = 2 . EXECUTE . IF (a035chil = 99 & 3036adol = 99) a0356chi = 99 . EXECUTE . 37 COUNT a03nsgrp = a033hemo a034womc a0356chi (I) . VARIABLE LABELS a03nsgrp Non-stigmatized group count' . EXECUTE . 38 COUNT a03sgrps = a03 I gaym a032ivdg a037sexw (I) . VARIABLE LABELS a033grps Stigmatized group went . EXECUTE . 39 IF (a035grps > 0 & a03nsgrp = 0) a03class = 3 . EXECUTE . IF (a03sgrps > 0 & a03nsgrp > 0) a03class = 2 . EXECUTE . IF (a03sgrps = 0 & a03nsgrp > 0) a03class = I . EXECUTE . 16] 162 APPENDIX I Variable Compute Statements (SPSS for Windows Syntax) (cont’d) 41 IF (a04wna1d=2|a04wnald=3|a04wna1d=5) aO4wna1t= l. EXECUTE . IF (a04wnald = I |aO4wnald = 4 | a04wna1d = 6) a04wnalt = 2. EXECUTE . 43 IF (aO4wna2d = 2 | aO4wna2d = 3 l a04wna2d = 5) aO4wna2t = l . EXECUTE . IF (a04wna2d =1 |a04wna2d = 4 | a04wna2d = 6) a04wna2t = 2 . EXECUTE . 45 IF (a04wna3d = 2 | a04wna3d = 3 | a04wna3d = 5) a04wna3t = 1 . EXECUTE . IF (aO4wna3d =1 |a04wna3d = 4 | a04wna3d = 6) a04th = 2. EXECUTE . 46 IF (a04wnalt = I & aO4wna2t = 1& a04wna3t = l) a04wngen = 1 . EXECUTE . IF (a04wnalt = I & a04wna2t = I & a04wna3t = 99) a04wngcn = l . EXECUTE . IF (aO4wnalt = 1 & a04wna2t = 99 & a04wna31= 99) a04wngcn = l . EXECUTE . IF (a04wna1t = 2 & a04wna2t = 2 & a04wna3t = 2) a04wngen = 3. EXECUTE . 1F (a04wna1t = 2 & a04wna2t = 2 & a04wna3t = 99) a04wngcn = 3 . EXECUTE . IF (a04wna1t = 2 & a04wna2t = 99 & a04wna3t = 99) a04wngcn = 3. EXECUTE . IF (a04wnalt = l & a04wna2t = l & a04wna3t = 2) a04wngcn = 2. EXECUTE . IF (a04wnalt = 2 & a04wna2t = 2 & a04wna3t=1)a04wngen = 2. EXECUTE . IF (a04wnalt = 1 & a04wna2t = 2) a04wngen = 2. EXECUTE . IF (a04wnalt = 2 & a04wna2t=1)a04wngcn = 2. EXECUTE . 59 COMPUTE a07expcr = mean.3(a073rcwr,ao74satr,a076manr) . EXECUTE . 66 COMPUTE a0930csu = mcan.4(a091supp,a093supp,a0943upp,a0953upp) . EXECUTE . 163 APPENDIX I Variable Compute Statement (SPSS for Windows Syntax) (cont’d) Position 117 118 119 120 121 122 123 124 125 126 127 128 129 130 Satement SECTION B. Perceptions of Others’ Beliefs COMPUTE bpidisem = mean.3(bp1043dr,bp106unr,bp107cor) . EXECUTE . COMPUTE bpldepra = mean.2(bp102mor,bp103con) . EXECUTE . COMPUTE bp2disem = mean.3(bp204adr,bp206unr,bp207cor) . EXECUTE . COMPUTE bp2depra = mean.2(bp202mor,bp203con). EXECUTE . COMPUTE bp3disem = mean.3(bp305adr,bp307unr,bp308¢or) . EXECUTE . COMPUTE bp3depra = mean.2(bp303mor,bp304con) . EXECUTE . COMPUTE bp4disem = mean.3(bp404adr,bp406mtr,bp407cor) . EXECUTE . COMPUTE bp4depra = mean.2(bp402mor,bp403con) . EXECUTE . COMPUTE bdeisem = mean.3(bp503adr,bp505mtr,bp506cor) . EXECUTE . COMPUTE bdeepra = mean.2(bp501mor,bp502con) . EXECUTE . COMPUTE bxdepra4=mcan.4(bpldepra,bp2depra,bp3depra,bp4depra,bp5depra). EXECUTE . COMPUTE bxdisem4= mean.4 (bpidisem,bp2disem,bp3disem,bp4discm, bdeisem) . EXECUTE . COMPUTE bxdcpra2 =mean.2(bpldcpra,bp2depra,bp3depra,bp4dcpra, bdeepra). EXECUTE . COMPUTE bxdisem2 = mean.2(bpldisem,bp2disem,bp3discm,bp4disem, bdeisem) . EXECUTE . 164 APPENDIX I Variable Compute Statement (SPSS for Windows Syntax) (cont’d) Position Satement 131 COMPUTE bavgprop = mean.4(bp101pro,bp20Ipro,bp301pro,bp401pro) . EXECUTE . 133 IF (bavgprop < 3.00) bprofile = I . EXECUTE . IF (bavgprop >= 3.00) bprofile = 2 . EXECUTE . SECTION C. Percieved Social Distance 141 COMPUTE cavgperb = mean.6(c02pobpa, c03pobea, c04pobwo, c05pobfr, c06poble, dflmmhw. EXECUTE . SECTION D. Communication about HNIAIDS-related Topics 162 COMPUTE dcommbeh = mean.3(d02cwosr,d05cwoer,d08cwoar,d1lcwodr,d12¢worr) . EXECUTE . APPENDIX J APPENDIX J Respondent Demographics 96%Two-eided Sig Group Served Women Men Diff Sfil Lower Upper (p405) RacaIethnicity White/caucaslan Population proportion 85% 85% 0% 4% -8% 9% ns Number of affirmed cases 158 105 Sample size 186 123 African American Population proportion 10% 10% 0% 3% -7% 6% ns Number of affirmed cases 19 12 Sample size 187 123 Chicano/HispaniclLatino Population proportion 2% 3% 1% 2% -3% 5% ns Number of affirmed cases 4 4 Sample size 187 123 Native American Indian Population proportion 2% 1% -1% 1% -4% 1% ns Number of affirmed cases 4 1 Sample size 187 123 Asian or Pacific Islander Population proportion 1% 1% 0% 1% -2% 2% ns Number of affirmed cases 2 1 Sample size 187 123 Primary Language English Population proportion 99% 98% -1% 1% -4% 1% ns Number of affirmed cases 186 122 Sample size 187 124 Spanish Population proportion 0% 1% 1% 1% -1% 2% ns Number of affirmed cases 0 1 Sample size 187 124 Other Population proportion 2% 1% -1% 1% -3% 2% ns Number of affirmed cases 3 1 Sample size 187 124 Highest Level of Education One or more years of graduate training Population proportion 49% 45% -4% 6% -15% 8% ns Number of affirmed cases 91 56 Sample size 187 124 Four-year undergraduate program Population proportion 22% 23% 1% 5% -8% 1 1% ns Number of affirmed cases 41 29 Sample size 187 124 165 166 APPENDIX J Respondent Demographics (cont'd) 96% Two-aided Confidence Interval 819 ‘ Group Served Women Men Diff SE! Lower Upper (p<.05) Some wilege Population proportion 13% 18% 5% 4% -3% 13% ns Number of affirmed cases 24 22 Sample size 187 124 Trade/technical certificate Population proportion 2% 3% 2% 2% -2% 5% ns Number of affirmed cases 3 4 Sample size 187 124 High school Population proportion 7% 4% -3% 3% -8% 2% ns Number of affirmed cases 13 5 Sample size 187 124 Middle/intermediate school Population proportion 1% 0% -1% 1% -2% 1% ns Number of affirmed cases 1 0 Sarnpie size 187 124 Yearly Household lncorna $0 to $9.999 Population proportion 8% 4% -4% 3% -9% 2% ns Number of affirmed cases 14 5 Sample size 185 123 $10,000 to $19,999 Population proportion 11% 13% 2% 4% -6% 9% ns Number of affirmed cases 21 16 Swnple size 185 123 $20,000 to $29,999 Population proportion 12% 18% 6% 4% -2% 14% ns Number of affirmed cases 22 22 Sample size 185 123 $30,000 to $39,999 Population proportion 22% 16% -6% 5% -15% 3% ns Number of affirmed cases 41 20 Sernpla size 185 123 $40,000 to $49,999 Population proportion 14% 13% -1% 4% -8% 7% ns Number of affimied cases 25 16 Sample size 185 123 $50,000 or more Population proportion 34% 36% 2% 6% -9% 13% ns Number of affirmed cases 62 44 Sample size 185 1 23 167 APPENDIX J Respondent Demographics (cont'd) 96% Two-sided Confidence Interval 8'9 Group Served Women Nan Diff 680. Lower Upper (p<.06) 3.wa ' Heterosexual Population proportion 80% 25% -55% 5% «64% 45% sig Number of affirmed cases 148 31 Sample she 185 122 Bisexual Population proportion 6% 7% 1% 3% -5% 6% ns Number of affirmed cases 11 8 Sample size 185 122 Homosexual (gay or lesbian) Population proportion 14% 68% 54% 5% 44% 64% sig Number of affinned cases 26 83 Sample she 185 122 Current Naritalilntlmate Partnership Status Single Population proportion 37% 44% 7% 6% 4% 18% ns Number of affirmed cases 69 53 Sample size 186 120 Partnered by marriage Population proportion 33% 21% -12% 5% -22% -2% sig Number of affirmed cases 61 25 Sample size 186 120 Partnered by domestic agreement Population proportion 16% 22% 6% 5% -3% 15% ns Number of affirmed cases 29 26 Sample she 186 120 HIV Seroconvarslon Status HIV antibody positive Population proportion 3% 18% 14% 4% 7% 22% sig Number of affirmed cases 6 20 Sarnpie size 180 113 HIV antibody negative Population proportion 97% 82% -14% 4% -22% -7% sig Number of affirmed cases 174 93 Sample size 180 113 Current Political Leaninga Liberal Population proportion 66% 58% -8% 6% -19% 3% ns Number of affirmed cases 122 69 Sample she 184 118 Moderate Population proportion 30% 37% 7% 6% 4% 18% ns Number of affirmed cases 56 44 Sample she 184 118 168 APPENDIX J Respondent Demographics (cont'd) 96% Two-sided Confidence Interval Sle Group Served Women Men Diff SE“, Lower Upper (p<.06) - . - Population proportion 3% 4% 1% 2% -3% 5% ns Number of affirmed cases 6 5 Sample she 184 118 Member of a Place of Worship Currently participating Population proportion 56% 54% -2% 6% -14% 9% ns Number of affirmed cases 104 63 Sample she 186 117 Me Years of age Population proportion 38.54 40.87 2.33 1.34 - 29 4.95 ns Sampleshe 187 124 APPENDIX K APPENDIX K OUTPUT FROM HUNTER AND HAMILITON’S PATH ANALYSIS SOFTWARE Legend: ID Label Perceived Risk of HIV Infection Perceived Social Distance Perceived Associational Depravity Perceived Associational Disempathy Social Support from Other HIV/AIDS-workers Satisfaction with HIV/AIDS Work Experience Respondent's HIV/AIDS-related Communication Behavior (DQONU'l-wai-i Output: Variable 2 was deleted from working matrix. Input correlation matrix file name is c:\work\thesis\cfaruns\mod18.cor Indicator file name is mod22.ind Original correlations: 1 6 7 3 4 5 8 100 5 2 28 16 -3 -20 5 100 7 1 5 -11 10 2 7 100 2 6 -9 14 28 1 2 100 55 12 -32 16 5 6 55 100 18 -29 -3 -ll -9 12 18 100 -14 -20 10 14 -32 -29 -14 100 CDUIAUOle—i Path coefficients: U1 OOU‘IOOOOUJ l [.4 ONOOOOO¢ oombwqoxi—n N OOOQDOOOl-i UIOOOOOOxl \OKOOOOOO-b l GJOOOOOOUT OOOOOOOCD l-‘ l N l—’ EStandard errors for path coefficients: mmowqmp OOOOhOOOl—i OxiOOOOOO‘ \lOOOOOOQ OOU‘IOOOOW \lmOOOOOb \IOOOOOOU‘ OOOOOOOCD 169 '*** 68% confidence intervals for path coefficients. Upper mmbwdml-i U) OOODOOOH Lower mU'IIbUJxlONl—i N (DOOKJOOOl-I Multiple 1 6 O O Shrunken 1 6 0 0 Standard 1 6 0 0 1 mmtc-wxlml—I N on endpoints 6 7 3 4 5 O O O O O O O 0 O O 0 O O 0 O O 0 O 0 0 O 0 60 O O -5 0 O 25 O O 22 0 -22 -1 endpoints 6 7 3 4 5 O 0 0 O O O O 0 0 0 0 0 0 O 0 0 0 0 0 0 0 O 50 0 O -19 0 O 12 0 O 8 O -35 -14 correlations: O\l N \1 UT 01 N O U) N 6 7 3 4 5 5 2 28 15 2 100 7 1 1 -12 7 100 1 O -1 1 1 100 55 10 1 0 55 100 19 -12 -1 10 19 100 2 15 -16 -30 -13 170 APPENDIX K OOOOOOOCD OOOOOOOCD correlations: -4 15 -16 -30 -13 100 *** Errors: 1 1 0 6 0 7 0 3 0 4 l 5 -5 8 -16 171 APPENDIX K (Actual - reproduced) 6 7 3 4 5 8 0 0 O 1 -5 -16 0 0 0 4 l 8 0 O 1 6 -8 -1 0 1 0 O 2 -16 4 6 O 0 -l 1 1 -8 2 -l 0 -1 8 -1 -16 1 -1 O SPOdPLING ERROR ANALYSIS SPddPLE SIZE IS 300 'THE RELIABILITIES OF THE VARIABLES IN THE MODEL ARE 1 1.00 6 0.78 7 0.80 3 0.94 4 0.87 5 0.95 8 0.79 INDIVIDUAL LINK ANALYSIS Analysis for the missing link between The difference is -0.00 The normal 2 value is -0.04 The tail probability is .967 Analysis for the missing link between The difference is 0.01 The normal 2 value is 0.15 The tail probability is .879 Analysis for the missing link between The difference is 0.01 The normal 2 value is 0.07 The tail probability is .944 Analysis for the missing link between The difference is 0.04 The normal 2 value is 0.43 The tail probability is .670 Analysis for the missing link between The difference is 0.06 The normal 2 value is 0.58 The tail probability is .561 Analysis for the missing link between The difference is -0.05 The normal 2 value is -0.63 The tail probability is .530 Analysis for the missing link between The difference is -0.08 The normal 2 value is -O.88 The tail probability is .381 AND AND AND AND AND AND AND Analysis The The The Analysis The The The Analysis The The The Analysis The The The 172 APPENDIX K for the missing link between difference is 0.02 normal 2 value is 0.23 tail probability is .821 for the missing link between difference is -0.16 normal 2 value is -1.71 tail probability is .087 for the missing link between difference is 0.08 normal 2 value is 0.80 tail probability is .427 for the missing link between difference is -0.16 normal 2 value is -l.68 tail probability is .093 it************************************ 'THE ANALYSIS FOR THE MODEL AS A WHOLE IS 'THE OVERALL CHISQUARE IS 8.15 'THE DEGREES OF FREEDOM ARE 11 'THE TAIL PROBABILITY IS .700 5 AND 8 AND 8 AND 8 AND REFERENCES Adfit [‘3 igzen AHpo Bean. Bennl Bhtn Bfitn tho Bhnn Bohm Her I 9 Brand 3] BUCha} REFERENCES Adib, S. & Ostrow, D. (1991). Trends in HIV/AIDS behavioural research among homosexual and bisexual men in the United States: 1981-1991. AIDS Care, 3(3), 281- 287. Ajzen, I., & Fishbein, M. (1980). Understanding Attitudes and Predicting Social Behavior, Englewood Cliffs, NJ: Prentice-Hall. Allport, G. (1954). The Nature of Prejudice, Boston, MA: Beacon Press. Bean, 1., Keller, L., Newburg, C. & Brown, M. (1989). Methods for the reduction of AIDS social anxiety and social stigma. AIDS Education and Prevention, 1(3), 194-221. Bennett, L., Kelliher, M., & Ross, M. (1994). The impact of working on health care professionals: Development of the AIDS impact scale. Psychology and Health, 9, 221-232. Birenbaum, A. (1970). On managing a courtesy stigma. Journal of Health and Social Behavior, 11(3), 196-206. Birenbaum, A. (1992). Courtesy stigma revisited. Mental Retardation, 30(5), 265-268. Bishop, 6., Alva, A., Cantu, L. & Rittiman, T. (1991). Responses to persons with AIDS: Fear of contagion or stigma? Journal of Applied Social Psychology, 21 (23), 1877-1888. Blum, N. (1991). The management of stigma by Alzheimer family caregivers. Journal of Contemporary Ethnography, 20(3), 263-284. Bolton, R. (1992). AIDS and promiscuity: Muddles in the models of HIV prevention. Medical Anthropology, 14, 145-223. Ber, R., Miller, R., & Goldman, E. (1993). HIV/AIDS and the family: A review of research in the first decade. Journal of Family Therapy, 15, 187-204. Brandt, A. (1988). The syphilis epidemic and its relation to AIDS. Science, 239(4838), 375-381 . Buchanan, P. (1987, December 2) AIDS and moral bankruptcy. The New York Post, p. 23. Cadwell, S. (1991). Twice removed: The stigma suffered by gay men with AIDS. Smith College Studies in Social Work, 61(3), 236-246. 173 174 Cates, W. & Hinman, A. (1992). AIDS and absolutism: The demand for perfection in prevention. New England Journal of Medicine, 32 7, 492-494. Centers for Disease Control and Prevention (1995a). HIV/AIDS surveillance report: Mid- year edition. Rockville, MD: CDC National AIDS Clearinghouse. Centers for Disease Control and Prevention (1995b). Guidelines for Health Education and Risk Reduction Activities. Rockville, MD: CDC National AIDS Clearinghouse. Centers for Disease Control and Prevention (1993). Projections of the number of persons diagnosed with AIDS and the number of irnmunosuppressed HIV-infected persons: United States, 1992-1994. Morbidity and Mortality Weekly Report, 41(RR-18), 1-29. Centers for Disease Control and Prevention (1981). Pneumocystis pneumonia: Los Angeles. Morbidity and Mortality Weekly Report, 30, 250-252. Choi, K. & Coates, T. (1994). Prevention of HIV infection. AIDS, 8, 1371-1389. Cohen, R. (1987, May 1). Falwell’s hate mailing. Washington Post, p. A23. Crandall, C. (1991). Multiple stigma and AIDS: Illness stigma and attitudes toward homosexuals and IV drug users in AIDS-related stigmatization. Journal of Community & Applied Psychology, 1(2), 165-172. Dignan, M., Tillgren, P. & Michielutte, R. (1994). Developing process evaluation for community-based health education and research practice: A role for the diffusion model. Health Values, 18(5), 56-59. Dilley, J. (1994). The University of California at San Francisco AIDS health project: A community psychiatry approach to the AIDS epidemic. Psychiatric Clinics of North America, 1 7(1), 205-225. Douglas, C., Kalman, C. & Kalman, T. (1985). Homophobia among physicians and nurses: An empirical study. Hospital and Community Psychiatry, 36, 1309-131 1. Dooley, P. (1995). Perceptions of the onset controllability of AIDS and helping judgements: An attributional analysis. Journal of Applied Social Psychology, 25(10), 858-869. Foege, W. (1983). The national pattern of AIDS. In K. M. Cahill (Ed.), The AIDS Epidemic (pp. 7-17). New York: St. Martin’s Press. Folkman, S., Chesney, M. & Richards, A. (1994). Stress and coping in caregiving partners of men with AIDS. Psychiatric Clinics of North America, 1 7(1), 35-53. 175 Foucault, M. (1980). The History of Sexuality, New York: Vintage Books. Fullilove, M., Fullilove R., Haynes, K. & Gross, S. (1990). Black women and AIDS prevention: A view towards understanding the gender rules. The Journal of Sex Research, 27(1), 47-64. Geis, S., Fuller, R. & Rush, J. (1986). Lovers of AIDS victims: Psychological stresses and counseling needs. Death Studies, 10, 43-53. Gilmore, N. & Somerville, M. (1994). Stigmatization, scapegoating and discrimination in sexually transmitted diseases: Overcoming 'them' and 'us.’ Social Science & Medicine, 39(9), 1339-1358. Gochros, J. (1985). Wives’reactions to learning that their husbands are bisexual. Journal of Homosexuality, I I , 101-113. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall. Gottlieb, B. (1985). Social support and the study of personal relationships. Journal of Social and Personal Relationships, 2, 351-375. Hansen, R., Ranelli, P. & Ried, L. (1995). Stigma, conflict, and the approval of AIDS drugs. The Journal of Drug Issues, 25(1), 129-139. Haverkos, H. & Edelman R. (1988). The epidemiology of AIDS among heterosexuals. Journal of the American Medical Association, 260, 1922-1929. Heider, F. (1958). The Psychology of Interpersonal Relations. New York: Wiley. Herek, G. & Capitanio, J. (1994). Conspiracies, contagion, and compassion: Trust and public reactions to AIDS. AIDS Education and Prevention, 6(4), 365-37 5. Herek, G. & Capitanio, J. (1993). Public reactions to AIDS in the United States: A second decade of stigma. American Journal of Public Health, 83(4), 574-577. Herek, G. & Glunt, E. (1988). An epidemic of stigma: Public reactions to AIDS. American Psychologist, 43(11), 886-891. Herek, G. & Glunt, E. (1991). AIDS-related attitudes in the United States: A preliminary conceptualization. The Journal of Sex Research, 28(1), 99-123. “HIV-related conditions: Neurological Manifestation” (1994, Winter). Positively Aware Chicago: Positively Aware Network, p. 19. 176 Hunter, J. & Hamilton, M. (1992). Path: A program in BASICA [computer sofiware]. Hunter, J. & Schmidt, F. (1990). Methods of Meta-Analysis: Correcting Error and Bias in Research Findings. Newbury Park: Sage. Katz, 1. & Glass, D. (1979). An ambivalence-amplification theory of behavior toward thestigmatized. In W. Austin & S. Worchel (Eds) The Social Psychology of Intergroup Relations, Monterey, CA: Brooks/Cole Publishing Co. Kelly, J ., Murphy, D., Sikkema, K. & Kalichman, S. (1993). Psychological interventions to prevent HIV infection are urgently needed. American Psychologist, 48(10), 1023-1034. Kinsella, J. (1988). How to cover a Plague. In The Social Impact of AIDS in the United States, (pp. 115-122). Cambridge, MA: Abt Books, Inc. Lang, N. (1991). Stigma, self-esteem, and depression: Psycho-social responses to risk of AIDS. Human Organization, 50(1), 66- 72. Laschinger, H. & Goldenberg, D. (1993). Attitudes of practicing nurses as predictors of intended care behavior with persons who are HIV positive: Testing the Ajzen-Fishbein theory of reasoned action, Research in Nursing & Health, 16, 441-450. Lemp, G., Payne, 8., Neal, D., Temelso, T., & Rutherford, G. (1990). Survival trends for patients with AIDS. Journal of the American Medical Association, 263, 402-406. LePoire, B. (1994). Attraction toward and nonverbal stigmatization of gay males and persons with AIDS: Evidence of symbolic over instrumental attitudinal structures. Human Communication Research, 21(2), 241-279. Levinson, R. & Starling, D. (1981). Retardation and the burden of stigma. Deviant Behavior, 2(4), 371-390. Lewis, L. & Range, L. (1992). Do means of transmission, risk knowledge, and gender affect AIDS stigma and social interactions? Journal of Social Behavior and Personality, 7(1), 211-216. Lifson, A. R. (1994). Preventing HIV: Have we lost our way? Lancet, 343, 1306-1308. Lindhorst, T. & Mancoske, R. (1993). Structuring support of volunteer commitment: an AIDS services program study. Journal of Sociology and Social Welfare, 175-188. Mascola, J ., McNeil, J. & Burke, D. (1994). AIDS vaccines: Are we ready for human efficacy trials? Journal of the American Medical Association, 272, 488-489. 177 Maticka-Tyndale, E. (1996). AIDS prevention and services: Community-based research. Journal of Comparative Family Studies, 27(1), 164-166. McDonnell, J ., Abell, N. & Miller, J. (1991). Family members’ willingness to care for people with AIDS: A psychological assessment model. Social Work, 36(1), 43-53. Meisenhelder, J. (1989). Fear of contagion: A stress response to acquired immunodeficiency syndrome. Advances in Nursing Science, 11(2), 29-38. Michigan Department of Community Health (Fall 1996) Michigan Quarterly HIV Report, 11(1). Lansing, MI: HIV/AIDS Prevention and Intervention Section. Milligan, G. and Cooper, M. (1987). Methodology review: Clustering methods. Applied Pychological Measurement, 11(4), 329-354. Nunnally, J. and Bernstein, I. (1994). Psychometric Theory, 3rd Edition. New York: McGraw-Hill. Omoto, A. & Snyder, M. (1995). Sustained helping without obligation: Motivation, longevity of service, and perceived attitude change among AIDS volunteers. Journal of Personality and Social psychology, 68(4), 761 -686. Omoto, A. & Crain, A. (1995a). AIDS volunteerism: Lesbian and gay community-based responses to HIV. In G. M. Herek & B. Green (Eds). Psychological Perspectives on Lesbian and Gay Issues: Vol. 2. AIDS, Identity, and Community: The HIV Epidemic and Lesbians and Gay Men (pp. 187-209). Thousand Oaks: Sage. Omoto, A. & Crain, A. (1995b, May). Stigmatization and volunteerism: Are AIDS volunteers punished for their good deeds? Paper presented at the annual meeting of the Midwestern Psychological Association, Chicago, IL. Omoto, A. and Synder, M. (1990). Basic research in action: Volunteerism and society’s response to AIDS. Personality and Social Psychology Bulletin, 16(1), 152-165. Peloquin, S. (1990). AIDS: Toward a compassionate response. The American Journal of Occupational Therapy, 44(3), 271-278. Peters, L., Boer, D., Kok, G., & Schaalma, H. (1994). Public reactions towards people with AIDS: An attributional analysis. Patient Education and Counseling, 24, 323-335. Pfuhl, E.& Henry, S. (1986). Consequences of stigma. The Deviance Process (2nd ed.). Belmont, CA: Wadsworth, pp. 157-189. 178 Philipson, T., Posner, R, Wright, J. (1994). Why AIDS prevention programs don't work. Issues in Science and Technology, 10, 33-35. Pinner, R., Teutsch, S., Simonsen, L., Klug, L. Graber, J ., Clarke, M. & Berkelrnan, R. (1996). Trends in infectious diseases mortality in the United States. Journal of the American Medical Association, 275(3), 189-194. Powell-Cope, G. & Brown, M. (1992). Going public as an AIDS family caregiver. Social Science& Medicine, 34(5), 571-580. Range, L. 8: Starling, L. (1991). Is AIDS stigma related to knowledge, gender, or sexual orientation? College Student Journal, 25(4), 427-431. Risse, G. (1988). Epidemics and history: Ecological perspectives and social responses. In AIDS: The Burdens of History (Eds. Fee E. and Fox D. M). Berkeley, CA: University of California Press. Rook, K. (1984). Promoting social bonding strategies for helping the lonely and socially isolated. American Psychologist, 39, 1389-1407. Rosenberg, C. (1987). The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: University of Chicago Press. Sack, W., Seidler, J. & Thomas, S. (1976). The children of imprisoned parents: A psychological exploration. American Journal of Orthopsychiatry, 46, 618-628. Sarason, 1., Levine, H., Basham, R., Sarason, B. (1983). Assessing social support: The social support questionnaire. Journal of Personality and Social Psychology, 44(1), 127-139. Schwarzer, R., Dunkel-Schetter, C. & Kemeny, M. (1994). The multidimensional nature of received social support in gay men at risk of HIV infection and AIDS. American Journal of Community Psychology, 22(3), 319-339. Shmnaker, S. & Brownell, A. (1984). Toward a theory of social support: Closing conceptual gaps. Journal of Social Issues, 40, 11-36. Sigelman, C., Howell, J ., Cornell, D., Cutright, J. & Dewey, J. (1991). Courtesy stigma: The social implications of associating with a gay person. Journal of Social Psychology, 131(1), 45-56. Signal], H. & Landy, D. (1973). Radiating beauty: Effects of having a physically attractive partner on person perception. Journal of Personality and Social Psychology, 28, 218-224. 179 Singer, E., Rogers, T., & Corcoran, M. (1987). The polls: A report on AIDS. Public Opinion Quarterly, 51, 580-595. St. Lawrence, J., Husfeldt, 8., Kelly, J. Hood, H. & Smith, S. (1990:1). The stigma of AIDS: Fear of disease and prejudice toward gay men. Journal of Homosexuality, I9(3),85-101. St. Lawrence, J ., Kelly, J ., Owen, A., Hogan, 1, & Wilson, R. (1990:2). Psychologists’attitudes toward gays. Psychology and Health, 4, 357-365. Strasser, J. & Damrosch, S. (1992). Graduate nursing students’ attitudes toward gay and hemophiliac men with AIDS. Evaluation & The Health Professions, 15(4), 115-127. Stryker, J ., Coates, T. J ., DeCarlo, P., Haynes-Sanstad, K., Shriver, M. & Makadon, H. J. (1995). Prevention of HIV infection. Journal of the American Medical Association, 273(14), 1143-1147. Swap, W. (1977). Interpersonal attraction and repeated exposure to rewarders and punishers. Personality and Social Pyschology Bulletin, 3, 248-251. Trezza, G. (1994). HIV knowledge and stigmatization of persons with AIDS: Implications for the development of HIV education for young adults. Professional Psychology: Research and Practice, 25(2), 141-148. United States Conference of Mayors (1990). Local AIDS Services: The National Directory. Washington, DC: Author. United States Public Health Service. (1986). Coolfont report: A PHS plan 2 for the prevention and control of AIDS and the AIDS virus. US Public Health Service Report, 101, 341-348. Walkey, F, Taylor, A. & Green, D. (1990). Attitudes to AIDS: A comparative analysis of a new and negative stereotype. Social Science & Medicine, 30(5), 549-552. Web, 1. (1963). Hierarchical grouping to optimize an objective function. Journal of American Statistical Association, 58, 23-244. Weiner, B. (1988). An attributional analysis of changing reactions to persons with AIDS. In Robert A. Berk (Ed.), The Social Impact of AIDS in the United States, Cambridge, MA: Abt Books. Weiner, B., Perry, R., & Magnussan, J. (1988). An attributional analysis of reactions to stigmas. Journal of Personality and Social Psychology, 55(5), 738-748. 180 Westbrook. M., Legge, V. & Pennay, M. (1993). Attitudes towards disabilities in a multicultural society. Social Science & Medicine, 36(5), 615-623. Weyand, C. (1984). The associative stigma: Social degradation of a person because of hisstigrnatized father (Doctoral dissertation, University of Connecticut, 1983). Dissertation Abstracts International, 44, 3211-B. Williams, M. (1988). Gay men as ‘buddies’ to persons living with AIDS and ARC. Smith College Studies in Social Work, 38-52. World Health Organization. (1995). The Current Global Situation of the HIV/AIDS Pandemic. Geneva, Switzerland: World Health Organization. Young, R., Gallaher, P., Belasco, J ., Barr, A. & Webber, A. (1991). Changes in fear of AIDS and homophobia in a university population. Journal of Applied Social Psychology, 21 (22), 1848-1858. Young, R., Gallaher, P., Marriott, S. & Kelly, J. (1993). Reading about AIDS and cognitive coping style: Their effects of fear of AIDS and homophobia. Journal of Applied Social Psychology, 23(1 1), 91 1-924. CHIGAN STATE UNI V. V IIWI lllllilmlfllljl IlllllelHlljllIIZHHI