HIV- and AIDS-Related Stigma: Psychosocial Aspects in a Representative Spanish Sample

Abstract

This study evaluates the prevalence of HIV stigma in Spain and analyzes some variables that may affect its existence. In 2008, we conducted a computer-assisted telephone survey of 1607 people, representative of the Spanish population. Two-wave random stratified sampling was performed, first selecting the home and then the person, depending on the rates of age and sex. About 50% of the population feels discomfort about potential contact with people with HIV and tries to avoid it and 20% advocate discriminatory policies involving physical or social segregation of people with HIV. The belief that HIV is easily transmitted through social contact (15%) and blaming people with HIV for their disease (19.3%) are associated with stigmatization. Degree of proximity to people with HIV, political ideology, educational level, and age are also associated with the degree of stigmatization. According to these results, we suggest that, in order to reduce stigma, we need to modify the erroneous beliefs about the transmission pathways, decrease attributions of blame to people with HIV, and increase contact with them. These interventions should particularly target older people, people with a low educational level, and people with a more conservative political ideology.

Full text

Spanish Journal of Psychology (2013), 16, e30, 1–8.
© Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid
doi:10.1017/sjp.2013.52
The importance of the stigma suffered by people with
HIV has been extensively documented (Herek, 1999;
Li, Liang, Wu, Lin, & Wen, 2009; Sullivan et al., 2010).
At the individual level, prejudice and discrimination
have a serious impact on the psychological health of
the people affected (Steward et al., 2011), impairing
their physical and psychosocial coping with the health
process (Li et al., 2011; Logie & Gadalla., 2009). At the
social level, fear of rejection foments concealing the
infection and such concealment hinders the diagnosis
and treatment (Young & Bendavid, 2010), often leading
these people to continue to perform risk practices (Clum,
Chung, & Ellen, 2009).
In Spain, two studies related to the social perspec-
tive of HIV have been carried out in recent years.
The first one, conducted by Spanish Aids Research
and Prevention Foundation (FIPSE, 2005), analyzes
the discrimination towards people with HIV in diverse
areas of social life. The second (Agirrezabal, Fuster, &
Valencia, 2009) analyzes the occupational integration
of people with HIV. The results of the first study
show that, although there is no discrimination in the
legislation of Spain, discrimination is nevertheless
present in daily life, where there are negative prac-
tices in diverse areas such as health care, employ-
ment, justice, or education. The study of occupational
integration shows that discrimination is also one of
the main difficulties for the integration of people with
HIV. In addition to these studies, the survey on sexual
habits (INE & SPNS, 2003) reports that one out of three
Spaniards would not study or work with a person
with HIV.
However, and despite the many signs of more or less
covert rejection of people with HIV in Spain, till now,
there have been no studies carried out with a represen-
tative sample of the Spanish population that assess
the degree of stigma and rejection of people with HIV
and that analyze the factors that contribute to it.
Therefore, this work has two main objectives. The
first one is exploratory and consists of describing how
Spanish society perceives several issues related to
HIV and AIDS. The second goal is to analyze some
variables that may help to understand why some indi-
viduals reject people with HIV. The determination of
the variables related to stigma and/or the sectors of
the population most prone to stigmatize is very useful
in order to design future campaigns to prevent rejection
of people with HIV.
HIV- and AIDS-Related Stigma: Psychosocial Aspects
in a Representative Spanish Sample
Maria J. Fuster
1
, Fernando Molero
1
, Lorena Gil de Montes
2
, Arrate Agirrezabal
2
, and Amaia Vitoria
3
1
Universidad Nacional de Educación a Distancia (Spain)
2
Universidad del País Vasco ( Spain)
3
Ministerio de Sanidad, Servicios Sociales e Igualdad (Spain)
Abstract. This study evaluates the prevalence of HIV stigma in Spain and analyzes some variables that may affect
its existence. In 2008, we conducted a computer-assisted telephone survey of 1607 people, representative of the
Spanish population. Two-wave random stratified sampling was performed, first selecting the home and then the
person, depending on the rates of age and sex. About 50% of the population feels discomfort about potential contact
with people with HIV and tries to avoid it and 20% advocate discriminatory policies involving physical or social
segregation of people with HIV. The belief that HIV is easily transmitted through social contact (15%) and blaming
people with HIV for their disease (19.3%) are associated with stigmatization. Degree of proximity to people with
HIV, political ideology, educational level, and age are also associated with the degree of stigmatization. According
to these results, we suggest that, in order to reduce stigma, we need to modify the erroneous beliefs about the
transmission pathways, decrease attributions of blame to people with HIV, and increase contact with them. These
interventions should particularly target older people, people with a low educational level, and people with a more
conservative political ideology.
Received 9 July 2011; Revised 18 January 2012; Accepted 14 March 2012
Keywords: AIDS, HIV, stigma, discrimination, Spain.
Correspondence concerning this article should be addressed to
Maria J. Fuster. Universidad Nacional de Educación a Distancia
(UNED). Sociedad Española Interdisciplinaria del Sida (SEISIDA).
Calle Dr. Fleming, 3. 28036. Madrid (Spain).
E-mail: fuster.mariajose@gmail.com
This study was financed by the Sociedad Española Interdisciplinaria
del Sida (SEISIDA). We thank Greg Herek for his collaboration in this
research

2 M. J. Fuster et al.
Prejudice emerges when one group feels threatened
by another group, and infection by HIV has various
threatening characteristics. On the one hand, it is
perceived as a tangible threat to health, because it is
a serious infection, and closely associated with death
ever since its origin. Moreover, it is a transmittable
infection that is perceived as “contagious,” that is,
easily acquired through social contact. In fact, there
is empirical evidence of the association of fear of
transmission by casual contact with the stigma against
people with HIV (Cao et al., 2010; Sullivan et al., 2010)
Therefore, we expect that:
Hypothesis 1: People who perceive HIV to be more
threatening, that is, people who believe that HIV can
be transmitted by casual or social contact, will tend to
reject people with HIV.
Controllability of stigma has been considered par-
ticularly important by various authors (i.e., Crocker,
Major, & Steele, 1998) and the literature shows that the
more responsible a person or group is held for their
stigma, the greater the degree of rejection and the less
empathy they evoke (Decety, Echols, & Correl, 2010).
In this sense, the above-mentioned studies (Cao et al.,
2010; Sullivan et al., 2010) also found an association
between blaming people with HIV and the degree of
stigma expressed against them. Therefore, we expect
that:
Hypothesis 2: The interviewees who believe that
people with HIV are responsible for their condition
will tend to reject them to a greater extent.
There are numerous studies in the literature on prej-
udice (contact hypothesis) that note that, under certain
circumstances, a relationship with people from the
stigmatized group improves individuals’ opinion of
them (i.e., Pettigrew & Tropp, 2006). In the specific case
of HIV, the literature has shown that, in effect, scarce
contact with people with HIV is associated with more
rejection (Genberg et al., 2009). Therefore, in this case,
we expect that:
Hypothesis 3: People who feel closer to people with
HIV will have more positive attitudes towards this
collective.
Diverse studies have found differences in the mag-
nitude of expressed prejudice as a function of some
sociodemographic characteristics and the socialization
process. It was found that older people express more
rejection towards people with HIV (Cao et al., 2010).
There are also studies that have revealed the associa-
tion of a low educational level with attitudes of preju-
dice towards people with HIV (Cao et al., 2010; Sullivan
et al., 2010). Lastly, the literature shows that people who
were socialized with certain authoritarian values and
traditional beliefs express more prejudice towards cer-
tain groups, such as, for example, people of other ethnic
groups and homosexuals (Haddock, Zanna, & Esses,
1993; Wylie & Forest, 1992). The influence of political
ideology has also emerged in the concrete case of HIV-
associated stigma (Li et al., 2009). Therefore, we expect
that:
Hypothesis 4: The more advanced the age of the
people interviewed, the greater their degree of rejection
of people with HIV.
Hypothesis 5: Low educational level will be posi-
tively related to rejection of people with HIV.
Hypothesis 6: Conservative attitudes will be posi-
tively related to rejection of people with HIV.
Method
Sample and Procedure
The sample, representative of the Spanish population,
comprises 1607 people, providing a margin of error of
approximately 2.51% for a 95.5% confidence level (CI)
in a scenario of maximum dispersion. The age range of
the people interviewed was between 16 and 90 years
(M = 41.60, SD = 16.69). Among them, 49% were men
and 51% were women (the distribution of sample was
based on the National Statistics Institute from Spain).
With regard to the participants’ educational level, 4.36%
had no studies, 22.65% had primary studies, 39.45% had
secondary studies and 32.74% had university studies.
The data from the Instituto Nacional de Estadística
[National Statistics Institute] (2010) on the educational
level of the population displays a similar distribution
in the diverse categories. Thus, the largest percentage
of the population falls in the category of secondary
studies (45.21%), followed by higher studies (23.38%),
primary studies (20.22%), and lastly, people with no
studies (8.87%), and illiterate people (2.32%). However,
we observed that the percentage of people with higher
studies was larger in this study, and that the percentage
of people with secondary studies or without any studies
was slightly lower.
With regard to the socio-economic level of the partic-
ipants, 35% reported having a high or medium-high
level, almost 40% had a medium level, and 25% had
a low or medium-low level. With regard to political
ideology, somewhat more than 31% reported a left-
wing ideology, 33.5% said they were central, and 21.3%
informed they were right-wing. Of the people inter-
viewed, 58% did not know anybody with HIV.
The data were collected in the last quarter of 2008.
A two-stage semi-proportional stratified random sam-
pling was carried out. In the first stage, we selected
the home where we requested permission to perform
the survey. The homes were selected according to the
population by autonomous community—that is, 17
strata—and the size of the habitat or residence as a
function of 5 strata. In the second stage, we selected
the individual within the home as a function of the

HIV-Related Stigma in Spain 3
quotas of sex and age. We never carried out more
than one interview per home. We performed compu-
ter-assisted telephone interviews (CATI). A random
system dialed telephone numbers of homes from the
municipalities included in each sample cell.
1
When the person selected was not at home, we
tried to contact them three more times (on different
days and time slots) before marking them as “negative.”
At that time, a new home was selected. A maximum of
ten contacts was established with the selected people
for each interview performed. With regard to non-
responders, in general, the people contacted did not
explicitly refuse to be interviewed, but instead, they
usually postponed it several times or provided some
other excuse.
Instruments
The survey used in this investigation was mainly
based on the instrument used by Herek (Herek, 1999;
Herek & Capitanio, 1993; Herek, Capitanio, & Widaman,
2002). We also adapted items from surveys carried out
in the USA by the Kaiser Family Foundation (2006).
Firstly, in view of the fact that stigma is expressed
in different ways, the questionnaire measures diverse
facets of stigma. Thus, we included issues concerning:
The degree of discomfort concerning people with HIV and
the avoidance of contact with them in three hypothetical
situations (sending a child to a school where there are
students with HIV; working in an office where one of
the coworkers has HIV; shopping regularly in a store
in which an employee has HIV).
Discomfort in these three types of situations was
measured with a 4-point response scale, ranging from
1 (not at all uncomfortable) to 4 (extremely uncomfortable).
For the inferential analyses, we used the average score
resulting from discomfort in the three types of situations
(M = 1.6, SD = .63, α = .78).
Next, if the interviewees had admitted some degree
of discomfort, they were asked about their avoidance
intention through an item applied to the three above-
mentioned scenarios. In the shop scenario “And would
you try to shop in another store?”, in the school
scenario “And would you change your child’s school”,
and in the work scenario “And would you ask for your
coworker with HIV to be transferred to another place
at work, or would you ask to be transferred yourself?
All questions were answered ‘yes’ or ‘no’.
The advocacy of discriminatory policies
This variable was measured by means of the following
items: “In some places, people with HIV or AIDS should
be segregated by Law to protect public health” and
“The names of people infected with HIV or AIDS
should be made public so people who wish to could
avoid them.” These items had a 4-point Likert-type
response format, ranging from 1 (strongly disagree) to 4
(strongly agree). Both items were significantly correlated
(r =.39, p < .001), so for the analyses we used the average
score of both items (M = 1.64, SD = .83).
Social categories that are perceived in risk of HIV
To measure this variable, the interviewer read aloud
a series of target groups, asking interviewees to choose
up to the three they thought could more easily be
infected with HIV. The following response categories
were provided: homosexuals, men, drug consumers,
rich people, “promiscuous” people who practice sex
with various partners, women, immigrants, young
people, poor people, prostitutes; the response option
“none of the above” was also provided.
Secondly, we measured some variables that, according
to the literature, are relevant to the study of stigma.
The questionnaire measured:
Beliefs about the transmission of HIV through social
contact
We measured the beliefs about the probability of
becoming infected by HIV by sharing a glass with a
person with HIV, using public toilets, or if a person
with HIV coughs or sneezes nearby. All three items
had a 4-point Likert-type response format, ranging
from 1 (not at all likely) to 4 (very likely). For the inferential
analyses, we used the score resulting from adding the
three beliefs about the transmission of HIV (M = 1.73,
SD = .70, α = .73).
The attributions of responsibility and blame to people
with HIV
This variable was measured by means of the items:
“People with HIV or with AIDS are to blame for their
disease” and “People who have caught HIV through
sexual relations or through the use of drugs get what
they deserve”. These items had a 4-point Likert-type
response format, ranging from 1 (strongly disagree) to
4 (strongly agree). As both items were significantly
1
The Random Dialing system uses the information obtained from
the Telecommunications Market Commission. From this information,
a series of telephone numbers (landline and mobiles) are extracted in
proportion to the interviews to be carried out in each geographic
sphere. These are the seed numbers. From them, the system extracts
other numbers above and below them, as a function of a randomly
determined sequence. As the geolocalization of mobile phones cannot
be determined a priori, it first obtains the percentage of the sample
of homes that only have a mobile phone. The National Institute of
Statistics determined that 14% of the homes belonged to this category
at the time of the study. Then the CATI system completed the remaining
missing goal with landline phones. The system thus designed generates
the same probability for all the homes to be included in the sample.

4 M. J. Fuster et al.
correlated (r = .41, p < .001), we used the average score
in the analyses (M = 1.77, SD = .81).
Degree of proximity to people with HIV
We measured the degree of proximity of the interviewees
to people with HIV by means of an item with a 10-point
Likert-type response format, ranging from 0 (no relation-
ship at all) to 10 (close relationship) (M = 2.26, SD = 3.7).
Political ideology
This variable was measured with an item on a 10-point
Likert-type response format, ranging from 1 (extreme left-
wing) to 10 (extreme right-wing) (M = 4.95, SD = 2.48).
Lastly, the questionnaire included a section with
questions about age, sex, educational level, and occupa-
tion of the interviewee.
Data Analysis
In accordance with the goals of the study, the data
analysis includes descriptive and inferential techniques.
The descriptive results are given in weighted percent-
ages. In order to study the variables that contribute the
most to HIV-related stigma, we selected as indicators
of stigmatization two criterion variables: avoidance
intention and advocacy of discriminatory policies.
Given the different nature of the measurement of these
variables, to study the variables related to advocacy of
discriminatory policies, we carried out linear regression
analysis and to study the variables related to avoidance
intention, we applied the technique of binary logistic
regression. The independent variables were: socio-
structural variables (sex and age), variables related to
the socialization process (educational level and political
ideology), and variables related to the characteristics
of HIV-related stigma (perceived severity of AIDS,
proximity to people with HIV, beliefs about the trans-
mission of HIV through social contact, and blaming
people with HIV for having the infection).
Results
The results are presented taking into account the
proposed goals. Thus, firstly, we present the descrip-
tive results of the survey. Secondly, the results about
the variables that influence HIV-related stigma
Spanish population’s perception of people with HIV
Results show that 19.3% of the people interviewed
consider that people with HIV are to blame for their
infection, and 17% think that people who have contracted
HIV via sexual relations or drug consumption get what
they deserve, 95% CIs [17%, 21%] and [15%, 18%], respec-
tively. Besides, people think that prostitutes (72.2%),
drug users (66.5%), “promiscuous” people (60.6%)
and, to a lesser extent, homosexuals (39.1%) are the
social groups with most possibilities of becoming
infected by HIV (Figure 1).
Regarding beliefs about the transmission of HIV, the
results showed that 15.1% of the population thinks that
it is fairly or very probable for a person to become
infected with HIV by sharing a glass with someone
who has the virus, 17.3% believes that they could
become infected with HIV by sharing public toilets
with someone who is infected with the virus, and
14.9% hold the belief that they can be infected with
HIV if a person with HIV coughs or sneezes nearby,
95% CIs [13%, 16%], [15%, 19%] and [13%, 16%],
respectively.
Results also show that 58.8% of the population
would feel between “somewhat” and “completely”
uncomfortable if a classmate of their child had HIV,
30.8% would be uncomfortable if one of their coworkers
had HIV, and 44.5% if would feel discomfort if an
employee who worked in a store where they bought
regularly had HIV, 95% CIs [56%, 61%], [28%, 33%]
and [42%, 46%], respectively. We also observed that,
among the people who express discomfort, 40% would
change their child’s school if they could, 31.1% would
ask for the coworker with HIV to be transferred to
another place at work, or they would ask for a transfer
if they could, and 52.3% would try to buy at another
store if possible, 95% CIs [36%, 43%], [27%, 35%] and
[48%, 56%], respectively.
Finally, the study reveals that 20% of the population
believes that, in some places, the law should oblige
people with HIV to be separated to protect public
health, and 18.1% of the population thinks that the
names of persons with HIV should be made public
so that the people who wish to avoid them can do so,
95% CIs [18%, 22%] and [16%, 20%], respectively.
Variables related to HIV-associated stigma:
predictors of advocacy of discriminatory policies for
people with HIV and of the intention to avoid them
Firstly, the results of the lineal regression analysis
showed that beliefs about transmission of HIV through
social contact, blaming people with HIV, the perceived
distance from them, higher age, and lower educational
level were the variables that significantly predicted the
advocacy of discriminatory policies for people with
HIV. Likewise, we found that right-wing political
ideology had marginally significant influence (Table 1).
The model explained 24% of the variance and had a
medium-high effect size (f
2
= .31) and very high power
(λ = 207.08). These results confirm all the hypotheses
of the study, except for the sixth one, which achieves
partial support.

HIV-Related Stigma in Spain 5
Secondly, the results of the binary logistic regression
showed that higher age, right-wing political ideology,
perceived distance from people with HIV, blaming
people with HIV, and beliefs about the transmission
of HIV were the variables that predicted the intention
to avoid people with HIV in the diverse daily life
scenarios reflected in the survey (work, shop, school).
The model of predictors obtained explained 23% of the
variance of the intention to avoid people with HIV and
presented a good fit to the data (see table 2). The results
of the classification showed that 72% of the inter-
viewees were correctly classified, which indicates that
prediction from the variables of the model is useful
for future classification. These results again confirm
the first, second, third, fourth, and sixth hypotheses.
Discussion
The results of this study carried out with a represen-
tative sample of Spanish society show the existence
of some level of negative and prejudiced view of
people with HIV in the population. The results reveal
that a large number of people interviewed feel discom-
fort concerning possible contact with people with HIV
in diverse situations of daily life. As expected, this
discomfort is also translated into a behavioral inten-
tion to avoid contact. In addition we observed more
serious discriminatory attitudes expressed through the
support of discriminatory policies seeking social or
even physical segregation of people with HIV. The
percentages found, although apparently shared by a
minority of the population, turn into many millions
when we consider the entire Spanish population.
Ultimately, in Spain, about 10 million people would
currently agree with the adoption of grossly discrim-
inatory and clearly unconstitutional policies towards
people with HIV. The percentages found in Spain
are higher than those obtained in the latest research
conducted by Herek in 1999 (2002). These authors, in
their analysis of the changing attitudes of American
society, report a decrease in negative attitudes towards
people with HIV from 1991 to 1999. Unfortunately,
in the case of Spain, we do not have previous studies
to compare the evolution of attitudes toward people
with HIV, although we assume that these attitudes
have become less negative in the last few years because
of the work carried out by institutions and organizations
to respond to HIV-related stigma.
Our investigation also analyzed the extent to which
some characteristics and ideologies that define HIV-
related stigma occur in the population. We observed
that HIV is considered a health threat by the population
because it is perceived as an infection that is easily
contracted by casual or social contact. This is seen in
Figure 1. percentages of the population that think that diverse
social groups are at risk of acquiring the HIV infection.
Table 1. Linear regression analysis showing the predictors of advocacy of discriminatory policies against people with HIV
Advocacy of discriminatory
policies
Variable B Beta t 95% CI
Constant .409 1.48 [.38, .43]
Sex −.012 −.008 −.22 [−.11, .09]
Age .007** .129 3.58 [.00, .01]
Studies −.098** −.132 −3.77 [−.14, −.04]
Political Ideology
†
.019 .061 1.76 [−.00, .04]
Perceived HIV Severity .014 .022 .64 [−.02, .05]
Proximity to people with HIV −.020* −.081 −2.38 [−.03, −.00]
Blaming people with HIV .334** .292 8.15 [.25, .41]
Incorrect belief about HIV transmission pathways .266** .232 6.51 [.18, .34]
R
2
.24
F(df) 26.52(8)*** [.24, .28]
Note: N = 667. CI = Confidence interval.
*p < .05; **p < .01; ***p < .001;
†
p < .1.

6 M. J. Fuster et al.
the interviewees’ erroneous beliefs about the possi-
bility of contracting the infection by sharing a glass
or the public toilets with a person with HIV, or if this
person coughs or sneezes nearby. The association of
fear of casual transmission and public attitudes of
rejection has been revealed by previous research (Cao
et al., 2010; Herek et al., 2002; Sullivan et al., 2010).
In Spain, the survey of health and sexual habits (INE
& SPNS, 2003) found percentage lower than 9% for
these beliefs. However, the populational sphere included
people between 18 and 49 years of age. In this sense, it
is important to note that, in the present study, approx-
imately one third of the people interviewed were older
than 49 years, and it is precisely in older people where
more negative attitudes were found.
The people interviewed thought that the people at
higher risk of acquiring the infection were prostitutes,
people who used drugs, “promiscuous” people, and
homosexuals. These responses do not coincide with
the current epidemiological data and could indicate
the persistence of stereotypes associated with the
infection. The data of the system of information about
new diagnoses of HIV in Spain during the 2003-2009
period (Ministerio de Sanidad, Política Social e Igualdad
[Ministry of Health, Social Policy, and Equality] and
Ministerio de Ciencia e Innovación [Ministry of Science
and Innovation], 2010), reveal a decrease in the diag-
noses of female prostitutes, which dropped from
4.6% in the year 2000 to 3.5% in 2009. Likewise, a
progressively decreasing tendency was observed in
the new diagnoses of HIV in people who use drugs.
In fact, in 2009, the incidence in this collective of
people was only 8%. This report also shows that 77% of
the new diagnoses of HIV are sexual in origin, with a
higher incidence in men’s homosexual relations than
in heterosexual relations (42.5 and 34.5%, respectively).
Lastly, although the group of immigrants was only
mentioned in 5% in the surveys, the data from the new
diagnoses reveal that people from other countries make
up a relevant part of the new diagnoses (37.6%).
The association between HIV and stigmatized groups
may lead part of the population to blame people with
HIV for having contracted the infection or to consider
it as punishment for certain behaviors, such as drug
consumption or sexual promiscuity. The percentage of
blame found in this study is similar to that found in
China in recent research by Sullivan et al. (2010) but
much lesser to the found in the United States some
years ago (Herek et al., 2002).
Beliefs about the transmission of HIV through social
contact and blaming people with HIV for their infec-
tion play an important role in the existence of stigma
and discrimination. In this sense, as we predicted in
the first and second hypothesis, these two variables
are predictors of the intention to avoid people with
HIV and of the advocacy of discriminatory policies.
Moreover, in addition to these variables, results
showed that other variables related to certain sociode-
mographic characteristics and to the socialization
process play a relevant role in the existence of preju-
dices. Higher age and right-wing political ideology
emerged as predictors, both of the intention to avoid
people with HIV and to advocate discriminatory policies
towards this collective, and low educational level
predicts higher degree of agreement with this type of
policies. These results coincide with those obtained
by Díez Nicolás (2005), who found that, in the case of
immigrants, xenophobic attitudes were higher among
older people, people with a low educational level,
and people who self-identified as right-wing. Li and
collaborators (2009) also found a relation between
political ideology and HIV-associated stigma.
Table 2. Binary logistic regression analysis showing the predictors of the intention to avoid people with HIV in diverse daily life scenarios
(work, shop, school)
Intention to avoid people with HIV
Variable B Wald gl Exp(B) 95% CI
Constant −3.8 182.2 1 .022
Age .013 12.1** 1 1.01 [1.00, 1.02]
Political ideology .081 9.7* 1 1.08 [1.03, 1.14]
Proximity to people with HIV −.068 10.3* 1 .93 [.896, .974]
Blaming people with HIV .408 25.5** 1 1.50 [1.28, 1.76]
Incorrect belief about HIV transmission pathways .876 86.1** 1 2.40 [1.99, 2.88]
R
2
Nagalkerke
.23
Hosmer– Lemeshow Test χ
2
(8)
= 7.95, p = .43
Note: N = 1351. CI = Confidence interval.
*p < .01; **p < .001.

HIV-Related Stigma in Spain 7
Lastly, the results have shown that social distance
from people with HIV affects the existence of prejudice.
Besides the psychosocial theories, which reveal the
essential role of increasing contact with the stigmatized
groups in general (Pettigrew & Tropp, 2006), there are
also studies specifically carried out with people with
HIV that have shown that proximity to these people
is a predictor of feelings of sympathy towards them
and a source of reduction of prejudice (Norman, Carr, &
Jiménez, 2006).
These results confirm the rest of the study hypotheses
and they coincide with previous investigations in other
countries (Cao et al, 2010; Herek et al., 2002; Sullivan
et al., 2010).
The image that Society holds of people with HIV has
important repercussions for them. Among them are
social isolation and the difficulty to embark on a family
or occupational life project in the same conditions as
the rest of the population. In this sense, the study
shows that very few people would become involved
in a couple relation (6.5%) or an occupational relation
(7%) with a person with HIV, and almost 20% of the
interviewees even declared that they would not have
any kind of relation with them.
An exceptional effort is needed to reduce stigma.
In the line of the results shown by this study, we need
to correct the erroneous beliefs about the transmission
pathways, change the population’s stereotyped image
of HIV, decrease the attributions of responsibility and
blame to people with HIV, and increase contact with
them (Yiu, Mak, Ho, & Chui, 2010). These interventions
should particularly target older people, people with a
low educational level, and with a more conservative
political ideology.
The present study represents an important step
forward by showing which variables are contributing
to the stigma and discrimination of people with HIV
and which groups of people in Spain express it to a
greater extent. Knowing towards what and whom
interventions should be aimed is an essential step in
order to reduce stigma.
The discussion of the results may be qualified by
some methodological considerations. The analysis
reported were performed under the assumption of
simple random sampling procedures, which may
somehow constraint some of the interpretations we
make in this study.
Also, as usual in studies employing surveys, this
study may have limitations derived from the rate of
non-responders. This may have repercussions in the
sense that some sociodemographic characteristics of
the surveyed people differ from the population and,
therefore, they reduce the representativeness of the
sample. According to the literature, these differences
consist of the fact that the responders usually have a
higher educational level, higher socioeconomic status,
are women, single, etc. Some of these issues were
observed in the characteristics of the sample of this
study, such as the fact that the percentage of people
who had higher studies was larger than the datum
reported by the Instituto Nacional de Estadistica,
([National Statistics Institute], 2010). This difference
could affect the results because, in this and in other
studies (Cao et al., 2010; Sullivan et al., 2010), it was
found that the people with a higher educational level
express a lower degree of rejection. For this reason, the
data provided should be interpreted in the light of
these limitations.
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