HIV-Related Stigma and Discrimination in Puerto Rico: The Role of Sympathy on Attitudes Toward Persons Living with HIV/AIDS

  • Lisa R. Norman


As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Puerto Rico, it becomes increasingly important to address the issues of stigma and other discriminatory attitudes. This chapter presents the findings of my study which examined the attitudes toward PLWHA of a large sample of women living in public housing in Puerto Rico, including sympathy and support for PLWHA in the workplace and in school. A total of 1,138 women completed a self-administered 218-item survey made up of questions that measured HIV-related knowledge, attitudes, and behaviors. Levels of sympathy varied depending upon the target group, with HIV-infected drug users receiving the least sympathy. Most women reported that HIV-positive teachers should be allowed to teach and that HIV-positive children should be allowed to attend school. However, a significantly lower percentage reported that HIV-infected nurses should be allowed to continue working. Women who were more sympathetic toward PLWHA were more tolerant of PLWHA in the workplace and school, while those with inaccurate knowledge concerning HIV transmission were less tolerant. Also, those who knew a PLWHA were more tolerant. Levels of discriminatory attitudes in Puerto Rico are high and warrant both individual- and societal-level interventions.


Public Housing Religious Service Attendance Discriminatory Attitude Hierarchical Logistic Regression Analysis Public Housing Development 
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I would like to acknowledge that this study was sponsored by NCRR Grant U54RR19507. These analyses have been published previously in the journal AIDS Care, with the following reference: Norman, L.R., Abreu, S., Candelaria, E., and Sala, A. (2009). The effect of sympathy on discriminatory attitudes toward persons living with HIV/AIDS in Puerto Rico: A hierarchical analysis of women living in public housing. AIDS Care, 21(2), 140–149. This project was part of the Puerto Rico Comprehensive Center for the Study of HIV Disparities (PR-CCHD), as a collaborative effort of the University of Puerto Rico, Medical Sciences Campus, the Universidad Central del Caribe, School of Medicine, and the Ponce School of Medicine. I also want to thank Bob Ritchie from the RCMI Program Publications Office (Grant #2 G12 RR003050-­21) for his contribution to the editing of the manuscript. Lastly, I want to thank the staff of the public housing developments for assisting us in conducting our research and the females who volunteered to partake in the research study.


  1. Andrinopoulos, K., Kerrigan, D., Figueroa, J. P., Reese, R., & Ellen, J. M. (2010). HIV coping self-efficacy: A key to understanding stigma and HIV test acceptance among incarcerated men in Jamaica. AIDS Care, 22(3), 339–347.CrossRefGoogle Scholar
  2. Auerbach, C., & Beckerman, N. L. (2010). HIV/AIDS prevention in New York City: Identifying sociocultural needs of the community. Social Work in Health Care, 49(2), 109–133.CrossRefGoogle Scholar
  3. Ayala, G., & Diaz, R. (2001). Racism, poverty, and other truths about sex: Race, class, and HIV risk among Latino gay men. International Journal of Psychology, 35(2), 59–78.Google Scholar
  4. Batson, C. D., Fultz, J., Fortencbach, V. A., McCarthy, D. M., & Varney, L. L. (1986). Social evaluation and the empathy-altruism hypothesis. Journal of Personality and Social Psychology, 73, 510–516.Google Scholar
  5. Batson, C. D., Chang, J., Orr, R., & Rowland, J. (2002). Empathy, attitudes and action: Can feeling for a member of a stigmatized group help the group? Personality and Social Psychology Bulletin, 28, 1656–1666.CrossRefGoogle Scholar
  6. Becares, L., & Turner, C. (2004). Sex, college major, and attribution of responsibility in empathic responding to persons with HIV infection. Psychological Reports, 95, 467–476.Google Scholar
  7. Bravo, P., Edwards, A., Rollnick, S., & Elwyn, G. (2010). Tough decisions faced by people living with HIV: A literature review of psychosocial problems. AIDS Review, 12(2), 76–88.Google Scholar
  8. Centers for Disease Control (CDC). (1992). Hemophilia behavioral intervention evaluation project. Atlanta: Centers for Disease Control and Prevention, Behavioral Intervention Research Branch.Google Scholar
  9. Centers for Disease Control (CDC). (2009). HIV/AIDS surveillance report (Vol. 1). Atlanta: Centers for Disease Control and Prevention.Google Scholar
  10. Centers for Disease Control (CDC). (2011). HIV prevention in the United States. Retrieved May 12, 2011, from
  11. Clum, G., Chung, S. E., Ellen, J. M., & The Adolescent Medicine Trials Network of HIV/AIDS Interventions. (2009). Mediators of HIV-related stigma and risk behavior in HIV infected young women. AIDS Care, 21(11), 1455–1462.CrossRefGoogle Scholar
  12. Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum.Google Scholar
  13. de Bruyn, T. (1998). HIV/AIDS and discrimination. A discussion paper –the experience of specific populations. Montreal: Canadian HIV/AIDS Legal Network and Canadian AIDS Society.Google Scholar
  14. Diaz, N. V. (2008). HIV/AIDS stigma among health professional in Puerto Rico: Implications and strategies for action. Retrieved May 12, 2011, from
  15. Eisenberg, N., Fabes, R. A., Murphy, B., Karbon, M., Maszk, P., Smith, M., O’Boyle, C., & Suh, K. (1994). The relations of emotionality and regulation to dispositional and situational empathy-­related responding. Journal of Personality and Social Psychology, 66, 776–797.CrossRefGoogle Scholar
  16. Eisenberg, N., Guthrie, I., Cumberland, A., Murphy, B. C., Shephard, S. A., Zhou, Q., & Carlo, G. (2002). Prosocial development in early adulthood: A longitudinal study. Journal of Personality and Social Psychology, 82, 993–1006.CrossRefGoogle Scholar
  17. Ezedinachi, E. N., Ross, M. W., Meremiku, M., Essien, E. J., Edem, C. B., Ekure, E., & Ita, O. (2002). The impact of an intervention to change health workers’ HIV/AIDS attitudes and knowledge in Nigeria: A controlled trial. Public Health, 116(2), 106–112.Google Scholar
  18. Goffman, E. (1963). Stigma: The management of a spoiled identity. Edinburgh: Edinburgh University Press.Google Scholar
  19. Gonzalez-Rivera, M., & Bauermesiter, J. A. (2007). Children’s attitudes toward people with AIDS in Puerto Rico: Exploring stigma through drawings and stories. Qualitative Health Research, 17(2), 250–263.CrossRefGoogle Scholar
  20. Herek, G., & Capitanio, J. (1997). AIDS stigma and contact with persons with AIDS: Effects of direct and vicarious contact. Journal of Applied Social Psychology, 27(1), 1–36.CrossRefGoogle Scholar
  21. Herek, G., Capitanio, J., & Widaman, K. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92(3), 371–377.CrossRefGoogle Scholar
  22. International Center for Research on Women (ICRW). (2002). Understanding HIV-related stigma and resulting discrimination in Sub-Saharan Africa: Emerging themes from early data collection in Ethiopia, Tanzania, and Zambia. Washington, DC: International Center for Research on Women.Google Scholar
  23. International Labour Organization (ILO). (2001). Code of practice on HIV/AIDS and the world of work. Geneva: International Labour Organization.Google Scholar
  24. Kassaye, P. R., Gore-Felton, C., Wyshak, G., Kadzirange, G., Woelk, G., & Katzenstein, D. (2009). Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe. AIDS Care, 21(12), 1517–1527.CrossRefGoogle Scholar
  25. Ministry of Health. (2004). National knowledge, attitudes, behaviors and practices survey. Kingston: National HIV/AIDS Control Programme.Google Scholar
  26. Norman, L. R., & Carr, R. (2005). Discriminatory attitudes toward persons living with HIV/AIDS in Jamaica: A hierarchical analysis of university students. AIDS & Public Policy Journal, 20(Spring/Summer), 40–50.Google Scholar
  27. Norman, L. R., Carr, R., & Jimenez, J. (2006). Sexual stigma and sympathy: Attitudes toward persons living with HIV in Jamaica. Culture, Health & Sexuality, 8(5), 423–433.CrossRefGoogle Scholar
  28. Parker, R., & Aggleton, P. (2000). HIV/AIDS related stigma and discrimination: A conceptual framework and an agenda for action. New York: Population Council.Google Scholar
  29. Peltzer, K., Nzewi, E., & Mohan, K. (2004). Attitudes towards HIV-antibody testing and people with AIDS among university students in India, South Africa and United States. Indian Journal of Medical Sciences, 58(8), 95–108.Google Scholar
  30. Puerto Rico Department of Health. (2009). HIV/AIDS surveillance report. San Juan: Department of Health.Google Scholar
  31. Roldan, I. (2007). AIDS stigma in the Puerto Rican Community: An expression of other stigma phenomenon in Puerto Rican culture. Interamerican Journal of Psychology, 41(1), 41–48.Google Scholar
  32. Rutledge, S. E., & Abell, N. (2005). Awareness, acceptance, and action: an emerging framework for understanding AIDS stigmatizing attitudes among community leaders in Barbados. AIDS Patient Care and STDs, 19, 186–199.CrossRefGoogle Scholar
  33. Sambisa, W., Curtis, S., & Mishra, V. (2010). AIDS stigma as an obstacle to uptake of HIV testing: evidence from a Zimbabwean national population-based survey. AIDS Care, 22(2), 170–186.CrossRefGoogle Scholar
  34. Sistema de Vigilancia SIDA. (2008). Casos de VIH confrimados. Retrieved May 12, 2011, from
  35. Skelton, J. (2006). How negative are attitudes toward persons with AIDS? Examining the AIDS-­leukemia paradigm. Basic and Applied Social Psychology, 28(3), 251–261.CrossRefGoogle Scholar
  36. Sober, E., & Wilson, D. (1998). Unto others. Cambridge, MA: Harvard University Press.Google Scholar
  37. Subramanian, T., Gupte, M. D., Dorairaj, V. S., Periannan, V., & Mathai, A. K. (2009). Psycho-­social impact and quality of life of people living with HIV/AIDS in South India. AIDS Care, 21(4), 473–481.CrossRefGoogle Scholar
  38. Varas-Diaz, N., Serrano-Garcia, I., & Toro-Alfonso, J. (2005). AIDS-related stigma and social interaction: Puerto Ricans living with HIV/AIDS. Qualitative Health Research, 15(2), 169–187.CrossRefGoogle Scholar
  39. Wikipedia. (2011). Public housing in Puerto Rico. Retrieved May 12, 2011, from
  40. World Bank. (2000). HIV/AIDS in the Caribbean: Issues and options (Report number 20491-­LAC). Washington, DC: Human Development Sector Management Unit, Latin American and the Caribbean Region.Google Scholar
  41. World Health Organization. (2000). Definitions of indicators and targets for STI, HIV and AIDS surveillance. STI/HIV/AIDS Surveillance Report, 16, 9–11.Google Scholar
  42. Woubalem, Z. (2005). Half-baked HIV/AIDS knowledge: Blessing or curse. Journal of Health and Promotion in Developing Countries, March, 2005.Google Scholar
  43. Zagumny, M. J., & Deckbar, R. (1995). Willingness to work and sympathy for HIV positive co-­workers: An experimental examination of model of transmission concern, and knowledge. Psychological Reports, 77, 571–576.CrossRefGoogle Scholar
  44. Zhou, Y. R. (2007). “If you get AIDS….you have to endure it alone”: Understanding the social constructions of HIV/AIDS in China. Social Science & Medicine, 65(2), 284–295.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Public Health ProgramPonce School of MedicinePoncePuerto Rico

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