from Medical Issues

Survey Examines Perceived And
Enacted Stigma Among Youth With HIV

August 4, 2006 - "Predicators of HIV-Related Stigma Among Young People Living with HIV," published in Health Psychology, (Vol. 25, No. 4, pgs. 501-509) examines both enacted stigma and perceived stigma among substance-abusing HIV-infected youth in Los Angeles, New York and New York City.

The study notes that HIV infection is highly stigmatized in our culture because the transmission methods are still negatively sanctioned; transmission behaviors are viewed as voluntary and unavoidable -- reinforced by religious beliefs; HIV is viewed as contagious and risk of contagion is overestimated; AIDs is considered a fatal disease; and HIV is concealable until the disease advances and becomes visibly apparent.

The study reviewed both enacted and perceived stigma among those youth living with HIV. Enacted stigma was defined as actual cases of discrimination based upon HIV status; while perceived stigma was defined as an individual's perception that he is being discriminated against because of HIV.

Eighty-night percent of those surveyed reported perceived stigma, while 31% reported enacted stigma experiences within a three-month period.

HIV stigma questions were characterized by factors of "avoidance, social rejection, abuse, and shame. In multivariate models, enacted stigma was associated with gay or bisexual identity, symptomatic HIV or AIDS, and bartering sex. Perceived stigma was associated with female gender, symptomatic HIV or AIDS, bartering sex, lower injection drug use, and fewer friends and family knowing serostatus."

The researchers also described "symbolic stigma," which has been defined as "a synergy between the stigma attached to AIDS as an illness and the stigma attached to the groups linked to AIDS in popular conceptions." The authors observed: "Thus, it has been suggested that various stigmata may layer onto HIV stigma and result in differential expression toward unpopular groups associated with increased risk or rates of HIV infection."

According to the authors: "Gay and bisexual identity did not predict perceived stigma, suggesting that the gay and bisexual YPLH [Young People Living With HIV) in this study have not significantly internalized feelings of blame for their HIV infection nor do they have fears and perceptions of HIV stigma. By contrast, bartering sex predicted enacted abuse stigma as well as perceived stigma (avoidance dimension and overall measure. YPLH who barter sex are likely to be among the most marginalized and powerless persons in the study, which is reflected in higher levels of perceived avoidance and enacted abuse."

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