September 25, 2006

AIDS Stigma and HIV Testing Policies

Posted at 6:07 am (Pacific Time)

As a footnote to my September 22 posting on the CDC’s proposal for routine HIV testing, here are some interesting findings from an experiment I embedded in my 1999 national survey on public opinion about HIV/AIDS.

The survey included a question about reporting HIV test results to government authorities. Poll respondents were randomly assigned to be asked one of three versions of the question. One version described the CDC’s preferred policy of compiling the names of people who test positive; the other two versions described anonymous reporting procedures.

While the public supported anonymous reporting to the government by about a 2-to-1 margin, they opposed name-based reporting 3-to-1. Regardless of which version of the question they were asked, more than one third of all respondents reported that concerns about AIDS stigma would affect their own decision to be tested for HIV in the future.

One characteristic of those who endorsed name-based reporting was especially interesting. Compared to other respondents, they expressed significantly more hostile feelings toward people with AIDS, gay men, lesbians, and injecting drug users. Thus, support for name-based reporting was strongly linked with AIDS-related stigma, so much so that the former appeared to be a proxy for the latter.

Thus, two key patterns emerged: (1) AIDS stigma plays a role in shaping attitudes about HIV-testing policies, and (2) many people’s concern about such stigma affects their own willingness to be tested.

These findings have implications that are relevant today as the CDC moves to implement its new guidelines for universal HIV testing. They underscore the importance of working actively to allay public concerns about stigma and suspicions about HIV testing and reporting policies.

To be effective, testing programs should not only include stringent confidentiality safeguards but should also make the public aware of those safeguards and of public health professionals’ ongoing commitment to eradicating AIDS stigma and discrimination. This commitment could be demonstrated through highly visible anti-stigma campaigns at the national, state, and local levels.

The study described here was published in the journal Health Psychology in 2003. More details about the study are available on my website.

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