Judgments of Personal Responsibility for HIV Infection: An Attributional Analysis

Now in the second decade of the epidemic, human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) continue to elicit judgments of personal responsibility and blame to an extent unseen in other illnesses. These judgments are largely due to the epidemiology of HIV infection; since the early 1980s when it was first identified, HIV transmission has been associated with certain groups that are subject to social censure, most notably gay and bisexual men and intravenous (IV) drug users and their sexual partners. Evidence that HIV may be spread through other means (that is, heterosexual transmission) has done little to diminish the presumption that infected people acquired the virus through socially disapproved acts. In addition, increasing attention is being given to HIV infection among homeless people (Crystal & Jackson, 1989; Froner, 1988), prisoners (Hammett, 1988), mentally ill people (Novick, 1990), and other groups on the social fringes. These people are stigmatized largely as a result of their social group membership and independent of their HIV status. As a result, HIV infection continues to be strongly linked to behaviors and social statuses that are subject to moralistic social judgments that hold people responsible for their plight (Shultz & Schleifer, 1983). Assigning personal responsibility for HIV infection, then, is a logical extension of the social judgment process that has been recognized in the literature. Haney (1988) noted, for example, that "AIDS carries with it a stigma of shame and pointed finger of blame, suggesting those of us who are sick are at fault for being infected". Similarly, Farmer and Kleinman (1989) pointed out that the AIDS epidemic "has reified an invidious distinction between 'innocent victims'--infants and hemophiliacs--and, by implication, 'the guilty'--persons with AIDS who are homosexuals or intravenous drug users". Thus, any behavior that oversteps the bounds of perceived social acceptability carries with it the burden of responsibility for any outcome of the behavior. Assigning personal responsibility for acquiring HIV to those who carry the virus may have a number of adverse consequences. Of particular concern has been a recognized tendency for the well population to maintain social distance. For example, Wolcott, Namir, Fawzy, Gottlieb, and Misuyasu (1986) found that people with AIDS were relatively socially isolated; the authors suggested that this isolation may have stemmed partly from attitudes of significant social network members toward the transmission behavior. Similarly, Macks (1987) noted that because of social stigma, many people with AIDS have been rejected by those around them or, fearing rejection, have isolated themselves. Albrecht, Walker, and Levy (1982) identified social distancing as resulting from the perception of stigma and noted the relationship between attributions of responsibility and social stigma. The net effect of such attitudinal judgments is that people in the HIV spectrum are not always accorded opportunities for full participation in an active and socially rewarding life and may, in fact, be actively deprived of emotional and physical comfort in time of need. In addition to social isolation and rejection, attributions of responsibility for HIV infection to those who are infected may have imposed additional challenges on health care policy makers, contributing to delays in policy and programmatic responses to the epidemic (Weiss & Hardy, 1990). For example, Rounds (1988) identified the blame attached to gay sex as presenting a significant barrier to the development of AIDS services in rural areas. Similarly, Novick (1990) suggested that HIV-infected people who belong to "disrespected" groups--such as IV-drug users, prisoners, or prostitutes--may be excluded from opportunities to take part in clinical trials or may not be afforded appropriate safeguards when they are included. To the extent that AIDS policy and programs are inhibited by social perceptions of people with HIV, another source of support for people in the HIV spectrum is seriously jeopardized. …