Chapter 1
Relationships Between Homophobia, HIV/AIDS Stigma, and HIV/AIDS Knowledge
Tracy Luchetta
Persons with HIV/AIDS have been and continue to be the targets of stigma due to their illness status as well as the association of the disease with already stigmatized groups (Herek and Glunt, 1988). Indeed, a significant minority of respondents in a representative random sample of adults in the United States expressed negative feelings toward persons with AIDS (PWAs). For example, between one-fourth and one-third of respondents admitted feelings of anger, disgust, and fear, and nearly half of all respondents stated that they would avoid the owner of a neighborhood grocery store if he or she had AIDS (Herek and Capitanio, 1993). Stigmatization of persons with HIV/AIDS cannot be explained adequately by the same processes underlying negative reactions to other stigmatized illnesses. In a meta-analysis of empirical studies that included measures of AIDS-related stigma compared to stigma associated with comparably serious illnesses, Crawford (1996) found a greater degree of stigma associated with AIDS when compared to cancer, hepatitis, herpes, heart disease, and drug abuse.
In this chapter, I briefly discuss the constructs of stigma and homophobia and identify possible theoretical links between AIDS-related stigma and negative attitudes toward lesbians and gay men using Herekâs neo-functional approach to explanations of sexual prejudice. Next, I summarize the current empirical literature concerning the relationships between attitudes toward lesbians and gay men, the tendency to stigmatize persons with AIDS, and current medical knowledge of AIDS. Finally, I present findings from a study of college studentsâ attitudes toward lesbians, gays, and PWAs and their general knowledge about HIV/AIDS.
THE CONCEPT AND FUNCTIONS OF STIGMA
The definition of stigma as a mark or brand of shame has been elaborated by social scientists to refer to the social label conferred upon individuals or groups by virtue of their possession of a characteristic indicative of a deviant condition (Goffman, 1963). Goffmanâs and othersâ subsequent conceptualizations of stigma focus on the social contexts in which characteristics or attributes are transformed into grounds for social discredit and disqualification, and on the processes by which individuals become stigmatized (Jones et al., 1984). Therefore, stigmatization is essentially a relational construct; a stigmatized person must be marked or labeled as deviating from a social standard or norm, and the label must be socially constructed as negatively valued. An attributional component is inherent in most formulations of the stigma construct; the mark is regarded as the result or manifestation of a personal attribute, disposition, or trait. In other words, the stigmatized individual is perceived as guilty in some way for having caused or maintained their âmarkedâ condition, even when no evidence for their culpability is readily apparent. When evidence of personal responsibility is lacking, observers tend to rely on stereotypical beliefs to make such attributions.
In the case of illness-related stigma, this conceptualization explains the greater degree of stigma attached to PWAs when compared to those with other infectious life-threatening illnesses, such as hepatitis (Crawford, 1996), as well as the relatively smaller degree of stigma accorded to PWAs who have contracted HIV through medical means of transmission, such as blood transfusion, rather than through sexual contact or intravenous (IV) drug use (DâAngelo et al., 1998; Leone and Wingate, 1991). In both comparisons, the group accorded greater stigma is held personally responsible for its condition because it has engaged in behaviors labeled deviant by the culture, such as same-sex sexual contact and illegal drug use.
Stereotyping is related to the stigma process in many important ways. Stereotypes are generally defined as overgeneralized, widely held, and typically negative beliefs about a social category or group. Stereotypes contribute to the stigmatization process in at least two ways. The first, as previously mentioned, occurs when stereotypical beliefs about a marked social category or group are used to justify attributing personal responsibility for the origin or maintenance of the stigmatized condition, even though causal evidence is lacking or ambiguous. For example, obese persons may be perceived as responsible for bringing on or maintaining their condition through voracity, in the absence of evidence of an uncontrollable cause, such as a medical condition or disorder. This stereotypeâthe belief that obese persons are insatiable overeatersâis an example of the phenomenon referred to as the fundamental attribution error, which is the tendency to view othersâ behavior as resulting from internal traits or characteristics rather than from external circumstances. This is a particularly Western cultural tendency (Miller, 1984; Morris and Peng, 1994) and serves to protect those who make such errors in judgment from perceiving themselves as vulnerable to the plight of less fortunate others or to the affliction of those who carry a potentially stigma-inducing mark.
A second and critical function of stereotypes in the stigmatization process is to explain or rationalize the negative affect that accompanies the devaluation of the stigmatized person (Jones et al., 1984). A theoretical framework for understanding the relationship between negative affect and the devaluation component of stigma can be found in the contemporary literature on attitudes. Attitudes are generally defined as overall evaluations of objects based on cognitive (e.g., stereotypical beliefs), affective (e.g., negative feelings about the object), and behavioral (e.g., tendencies toward avoidance or aggression) information. Negative beliefs about members of stigmatized groups serve to justify the affective component of attitudes toward them. According to Jones et al. (1984), â[negative] affect predisposes the individual to perceive and emphasize negative characteristics and attributions to explain oneâs discomfort or hostilityâ (p. 10).
To introduce a discussion of the purposes and functions of social stigma, I refer to a definition of stigma offered by Alonzo and Reynolds (1995) that synthesizes much of the contemporary discussion of the impact of stigma on stigmatized persons:
⌠the stigmatized are a category of people who are pejoratively regarded by the broader society and who are devalued, shunned or otherwise lessened in their life chances and in access to the humanizing benefit of free and unfettered social intercourse, (p. 304)
The stigma process marks the boundaries between members of ingroups and deviants, who are then devalued and dehumanized, thus justifying prejudice and promoting in-group solidarity. Therefore, social stigmatization is one mechanism by which systems of sociocultural oppression are enacted and rationalized in social discourse.
THE CONCEPT AND FUNCTIONS OF NEGATIVE ATTITUDES TOWARD LESBIANS AND GAY MEN
The term homophobia was first introduced in 1967 to describe irrationally negative attitudes toward homosexual persons (Weinberg, 1972). Since that time, much evolution has occurred in the conceptualization and measurement of the construct. Various definitions can be found in the literature, which results in some controversy and confusion in terminology. One usage, which is narrowly based on the etymological structure of the word, defines homophobia as an âunreasoning fear of or antipathy toward homosexuals and homosexualityâ (Random House Websterâs College Dictionary, 1995, p. 642) and as the âdread of being in close proximity with a homosexualâ (e.g., Bouton et al., 1987; Hudson and Ricketts, 1980; MacDonald, 1976). However, Herek (1986) and Kite (1994) argue that a fear-based definition of homophobia is problematic.
One problem in placing negative reactions toward homosexuals within the definitional scope of a phobic aversion is that homophobic persons do not always attempt to avoid being near a homosexual. This is apparent in instances of violence and hostility toward homosexuals. (After all, acrophobics donât attempt to destroy tall buildings or enact anti-skyscraper legislation.) While fear may be a component in negative attitudes toward homosexuals, a fear-based definition neglects other attitudinal components. Second, such a narrow definition fails to recognize the connections between negative attitudes toward homosexuals and other negative attitudes, perceptions, and prejudices. For example, homophobia has consistently been demonstrated to be related to a variety of attitudes and beliefs, including gender role attitudes, religious fundamentalism, and authoritarianism (Herek, 1994, 1995).
Other theorists favor broader conceptualizations of the term, and the extended parameters of the construct range from an attitude of condemnation against or prejudice toward gay men and lesbians to any negative attitude toward homosexuality. Alternative terminology includes homonegativity (Hudson and Ricketts, 1980) and heterosexism (Herek, 1986, 1995) to better represent the cultural context and attitudinal antecedents encompassed in theory and research about reactions to lesbians and gays. This expansion of the definition is favored by some and criticized by others. Kite (1994) argues that a more comprehensive definition allows for the â⌠consideration of reactions to lesbians and gay men as part of a broader framework of stereotyping and prejudiceâ (p. 28). Others point out that such all-encompassing definitions obscure the multidimensionality of the construct (OâDonohue and Caselles, 1993; Schwanberg, 1993). I argue for the position favoring a comprehensive conceptualization on the grounds that a complete understanding of the concept must take into consideration the cultural ideology that supports and is reflected by individual attitudes (Herek, 1995; Pharr, 1988). Consistent with this view is Herekâs preference for the terms âhetero-sexismsâ or âhomophobias.â This terminology recognizes the multidimensional nature of the construct and encompasses psychological heterosexism or homophobia, which emphasizes individual attitudes, and cultural heterosexism, which is reflected in institutional practices and norms that privilege heterosexuality over other forms of sexual expression and lifestyles (Herek, 1998).
Herek (1995) takes a functional approach to understanding individual differences in levels of psychological heterosexism and identifies various benefits of or needs served by holding negative attitudes toward gays and lesbians. The first function is an experiential one in the sense that attitudes are formed as a way of deriving meaning from experiences. Presumably, greater contact with openly gay men and lesbians would result in more favorable attitudes because such contact would allow persons to form attitudes based on actual experience rather than stereotypes. This prediction has been empirically supported by studies showing that interpersonal contact with lesbians and gay men is consistently related to more positive attitudes (Herek, 1994). However, this particular function would seem insufficient to explain most peopleâs attitudes toward gays and lesbians because sexual orientation is not typically a conspicuous marker in mundane social interactions, nor are gay men or lesbians likely to indiscriminately disclose their identity status to individuals who may hold unfavorable attitudes toward them. Furthermore, the assumption that experience unidirectionally influences attitude formation is problematic without experimental (versus anecdotal) evidence. In studies relying solely upon self-report data, recollection of the valence of encounters with a particular group is likely to be contaminated by pre-existing stereotypes and prejudice. Finally, persons with pre-existing negative attitudes toward a particular group may proactively avoid contact with members of that group.
A second function of psychological heterosexism, according to Herek, involves strengthening oneâs social identity through either the expression of important personal values or the expression of values and beliefs of a group from whom one desires approval and acceptance. Ultimately, the social identity function of attitudes serves to increase feelings of self-esteem.
The third function of heterosexist attitudes is ego-defensive, referring to the reduction of anxiety one achieves by unconsciously projecting his or her internal conflicts (in this case, conflicts concerning sexuality and gender) onto an external target. This function appears to be the individual counterpart to one of the principle functions of the ideology of cultural heterosexism: â⌠the promotion by society in general of heterosexuality as the sole, legitimate expression of sexuality and affectionâ (Bohan, 1996,...