UNIVERSITY STUDENTS’ PERCEPTION OF PEOPLE LIVING

WITH HIV/AIDS: DISCOMFORT, FEAR, KNOWLEDGE AND A

WILLINGNESS TO CARE

J arm o H outsonen , PhD

Police College o f Finland

J ari K ylm A, P h D , RN, RUT University o f Tampere

University o f Tampere School o f Health Sciences

T eua K orhonen , P hD, RN

Helsinki Metropolia University o f Applied Sciences

M aritta VA lim Ak i , P hD, RN

University o f Turku Department o f Nursing Science, Faculty o f Medicine

T arja S uom inen , P h D

University o f Tampere School o f Health Sciences

People living with HIV/AIDS (PLWHA) are often subject to blame,

fear and avoidance, particularly if they are perceived as personally re­
sponsible for their infection due to their risky behaviour or life style
choices. Some people however, react to PLWHA with sympathy and
a willingness to care. This paper explores how university students (n
= 282) perceive different types of PLWHA, in terms of how comfort­
able it is to be in contact with them. Students were most sympathetic
towards children with HIV/AIDS, and felt most discomfort with in­
travenous drug users and prostitutes. Bi- and homosexuals with HTV/
AIDS were mostly positively perceived, while many respondents had
difficulties in expressing an opinion on haemorrhagic disease patients.
Discomfort was associated with a fear o f infection, unwillingness to
care for PLWHA and an ignorance of HIV/AIDS. Women and older
students tended to fear infection less than men and younger students.
We conclude that although over time the perception of PLWHA has
improved, there is still a need for enlightenment, particularly with re­
spect to the most vulnerable groups such as intravenous chug users,
haemorrhagic disease patients and prostitutes.
Keywords: Student, Types o f PLWHA, Care, Discomfort, Fear,
Knowledge

534
 U n iv e rs ity S tu d e n ts ’ P e rc e p tio n o f P e o p le Living w ith H IV /A ID S / 5 3 5
Introduction
The UNAIDS Report on the Global AIDS
Epidemic (2012) estimated that at the end
o f 2011 there were about 34 million people
living with HIV. Approximately 2.5 million
people acquired HIV infection and about 1.7
million people died from AIDS-related causes
in 2011 (UNAIDS 2012). People living with
HIV/AIDS (PLWHA) are often subject to
blame, fear and avoidance, though there are
also those who perceive PLWHA with sympa­
thy and willingness to care (e.g. Paxton et al.,
2005; Weiss, Ramakrishna, & Somma 2006.)
Fear and avoidance due to illness may lead
to stigma. A stigmatized person may deviate
from the model of standard human being, and
therefore be negatively perceived (Goffman,
1990; Link & Phelan, 2001; Major & O’Bri­
an, 2005; Paxton et al,. 2005; Weiss, Ram­
akrishna & Somma, 2006; Wong & Wong,
2006; Heijnders & Van Der Meij, 2006). In a
post-welfare state, stigma such as that relating
to HIV/AIDS is largely founded on the idea
of personal responsibility (Scambler, 2006,
293). The responsibility for health lies with
the individual who is presumed to be able
to manage their health risks by making the
right choices and life style changes (Musso &
Wakefield, 2009). Perceptions of responsibil­
ity and dangerousness tend to lead to either
fear and avoidance, or pity and a willingness
to care (see Small, 1993; Lupton, 1999; Cobb
& De Chabert, 2002; Hegarty & Golden,
2008; Persson & Newman, 2008).
Background
Major and O ’Brian (2005, 395; see also
Link & Phelan, 2001; Parker & Aggleton,
2003) define stigma as an attribute that con­
veys a devalued social identity in some par­
ticular social relationship. Stigma does not
reside in the person as such, but in the way
members of the community oversimplify
certain social identities and evaluate them
negatively. This may result in discrimination
and the exclusion of the stigmatized person.
Stigma is a context-specific social construct
and Scambler (2006, 293) remarks that in the
post welfare state, stigma is often justified by
the idea of personal responsibility. Particular­
ly, health related stigma indicates a personal
responsibility because many illnesses such as
HIV/AIDS are regarded as being outcomes of
personal choice and a risky life style.
People acquire HTV in various ways, and
this has implications for the assessment of
the personal responsibility o f the unwell.
This is not a totally new development. In­
deed, Small (1993, 90) observes that the
link between an epidemic caused by a virus
and individual moral failure (particularly in
sexual behaviour) was established as early
as the 19th century. For instance, the vulnera­
bility to typhoid fever, cholera, tuberculosis,
cancer and in particular venereal diseases
was often associated with individual moral
deficiency and social marginality.
It is revealing that the terms HIV or AIDS
are often used as adjectives, together with
some other category attached to a person
(Lupton, 1999, 38). A category is a typifica-
tion, which simplifies the object of perception
and knowledge. However, we use categories
not only as cognitive tools for understanding
reality, but also to signify a person’s life-style
or choices that are liable to moral judgment.
Consequently, depending on the social cate­
gory of a person living with HIV/AIDS (e.g.
‘HIV man’, ‘HIV child’, ‘AIDS victim’, or
‘AIDS sufferer’), people are invited to adopt
a particular moral stance towards the PLWHA
(see also Persson, 2005).
Indeed, the research shows that the early
discourse on HIV/AIDS in the 1980s made
a distinction between the innocent victims
and the guilty risk-takers. The responsibility
of PLWHA is seen to depend on how much
control the person can have over the infection.
For instance haemorrhagic disease patients,
536 / College Student Journal
children, and those who became infected from
blood products were depicted as innocent vic­
tims, whereas drug addicts, homosexuals and
sex workers were considered as guilty and
therefore responsible for their state of affairs.
The latter types of PLWHA were deemed to
have taken a chance by being reckless in then-
behaviour (Lupton, 1999; Scambler, 2006;
Small, 1993). The difference between these
two modes of infection is that in the latter
cases the person is perceived as being respon­
sible for the outcome, because the activity is
self-initiated and would have been controlla­
ble. In the former cases, the infection came
from an external and uncontrollable source,
which removes the person’s responsibility
for the outcome. Thus, the social category
of PLWHA suggests information about then-
life-styles, relative risks for infection, and
their levels o f personal responsibility (Steins
& Weiner, 1999,488).
Steins and Weiner (1999) systematically
studied how perceived responsibility and
personality characteristics influence on the
emotional and behavioural reactions towards
PLWHA. They analysed the association be­
tween the transmission mode, personality
characteristics of the PLWHA, responsibility
and the perceivers’ emotional (anger or pity)
and behavioural (avoidance or willingness
to care) responses. People tend to be angry
to a person if he or she is held personally
responsible o f a negative event. By contrast,
people feel pity if a person is regarded free
from responsibility. It is also suggested that
these emotional reactions trigger different
behaviours towards the person. Pity increas­
es willingness to care, whereas anger tends
to channel behaviour into to avoidance.
(Steins & Weiner, 1999; see also Cobb &
De Chabert, 2002; Corrigan et al., 2003; He-
garty & Golden, 2008)
The distinction between the innocent and
the guilty has remained in HIV/AIDS discourse
since the very beginning, but the evaluation of
various social categories of PLWHA is chang­
ing (Persson 2005; Persson & Newman, 2008).
At the early stages of the HIV/AIDS epidemic
in the 1980s, gay men with HIV/AIDS were
regarded as guilty and responsible for then-
disease, because the infection was regarded as
a consequence of a conscious life-style choice
(Lupton, 1999; Small, 1993). In later times, ho­
mosexuality has become more widely socially
accepted, and according to Lupton (1999)
there was little evidence in the Australian press
during the mid-1990s that indicated gay men
were depicted as being guiltier than other peo­
ple with HIV/AIDS.
A person living with HTV/AIDS can be
seen as a source of infection—an AIDS carri­
er. An AIDS carrier is often described as lack­
ing self-control, of being negligent, or being
simply revengeful (Lupton, 1999, 46-48). In
the early 1990s, infected heterosexual males
were often considered to be innocent victims,
whereas infected women who ‘spread the
virus’ were not only regarded as guilty, but
also as a potential threat (Small, 1993, 103).
Today the guilty parties are often represented
as black African men with a ‘criminal intent
to spread the virus’ through unprotected het­
erosexual relationships (Persson & Newman,
2008). Furthermore, intravenous drug users
and prostitutes can be seen as potentially dan­
gerous sources of infection because of then-
presumed irresponsible behaviour and risky
life-styles—for example, the drug addicts
who might pass the virus to innocent children
by leaving their contaminated syringes in
playgrounds. Stigma, deviance, and negative
feelings of blame are dynamically changing
social processes (Parker & Aggleton, 2003,
14), and so consequently, the norms of devi­
ant behaviour, moral judgments and personal
responsibility may change over time.
The perception of dangerousness may
arouse a sense of fear and lead to social avoid­
ance. The more you fear the illness, the more
you try to avoid it and the less you want to
 U n iv e rs ity S tu d e n ts ’ P e rc ep tio n o f P e o p le Living w ith H IV /A ID S / 5 3 7
care the sick. By contrast, the more you are
familiar with the illness and its mechanism,
the less you fear infection and you are more
likely to empathise the victims and be willing
to care them (Corrigan et al., 2003; Paxton et
al., 2005). If knowledge serves to decrease
fear and avoidance, and increase feelings of
pity and the willingness to care for a sick
person, then educating the general public
with respect to HIV/AIDS would be likely to
improve the situation of PLWHA.
This paper looks to answer the following
questions:
1. How do students perceive different
types of PLWHA?
2. How are their feelings of discomfort
related to their fear of infection?
3. How is the fear of infection (and dis­
comfort) related to their knowledge of
HIV/AIDS, familiarity with PLWHA,
willingness to care for PLWHA, gen­
der, and age?
Methods and procedures
Design and setting
This study used a descriptive research de­
sign. The data was obtained from basic degree
students (N = 9715) at a Finnish university.
Research permission was obtained from the
department of student affairs at the universi­
ty. With approximately 15,000 students, this
multidisciplinary university offers teaching in
more than 100 major subjects. The sample (n
= 950) was randomly picked from the elec­
tronic student directory of registered basic
degree students with no exclusion criteria.
Instrument
The survey was an adapted version of
two North American questionnaires (Chng &
Moore, 1994; Held, 1993) first used in Fin­
land by Muinonen et al. (2002) among early
adolescents.
The first question pertains to how stu­
dents perceive different types of PLWHA.
The respondents were asked to give their
opinion about the statement T would feel
uncomfortable in contact with a [type of
PLWHA], who has HIV/AIDS.’ The types
we used were ‘child’, ‘bisexual’, ‘homo­
sexual’, ‘haemorrhagic disease patient’,
‘prostitute’, and an ‘intravenous drug user.’
The labels imply the manner o f infection,
responsibility and dangerousness as dis­
cussed in the theoretical section of this pa­
per. However, we did not specifically assess
the grounds by which students formulate
their opinion of comfort or discomfort, and
thus we do not know exactly if they regard
these types of PLWHA as responsible, inno­
cent victims, or threats.
The original 5-point Likert scale (agree
strongly, agree, cannot say, disagree, disa­
gree strongly) was transformed into three
options (agree, cannot say, disagree) in order
to avoid categories with few observations
(less than 5 %). To find the ranking order of
the types of PLWHA, we combined all single
tables into a 6 x 3 cross-table with six types
o f PLWHA in rows and three response alter­
natives in columns (Table 1).
The second question focused more close­
ly on how the perception of different types of
PLWHA is associated with the fear o f infec­
tion. We gauged response by use o f the state­
ment: ‘I would be/was afraid of getting HIV
if I were/was in contact with an HIV positive
person.’ Previous research suggests that
discomfort and fear are closely associated,
and our data showed that fear had a strong
association with the discomfort relating to
different types of PLWHA. The gamma val­
ues of six 3-way tables were: 0.649 (child),
0.644 (bisexual), 0.569 (homosexual), 0.509
(prostitute), 0.518 (haemorrhagic disease
patient) and 0.475 (IV drug user).
538 / College Student Journal

Data collection the variance of the table, but were used only
to interpret the results.
A postal survey was conducted. Ques­
tionnaires and introduction letters were ‘Knowledge of HIV/AIDS’ was con­
sent to students’ home addresses, obtained structed on the basis of modified scales from
Held’s (1993) instrument. The knowledge
from the student register. In the introduction
test about HIV and AIDS consisted of 25
letter was a short description of the study,
and information regarding confidentiality, items (Cronbach’s alpha 0.908) and the max­
imum from correct answers was 25 points.
anonymity and voluntary participation. The
For the purposes of analysis, we grouped the
opportunity to contact the researcher by
respondents into four categories from ‘K 1’
phone or email was also given. The ques­
(least knowledge) to ‘K 4 ’ (most knowledge).
tionnaires were returned to researchers at the
university in sealed and pre-paid envelopes. ‘Willingness to care’ was measured by the
question ‘are you willing to care for a person
The students had the possibility to return an
empty questionnaire. Return of the question­ with HIV/AIDS?’ (yes/no). ‘Known a PL­
WHA’ was measured by the question ‘have
naire was considered as giving consent to
you ever known a family member, friend or
participate in the study. 950 questionnaires
other close person with HIV/AIDS?’ (yes/
were sent out, with 333 returns (35 %). After
no). Age was categorized into four uneven
removing insufficiently completed question­
classes that roughly capture the range o f typ­
naires to avoid missing data, the final sample
ical Finnish university students: ‘the young’
size amounted to 282 students.
(<21), ‘the normal age of graduation’ (22-
Analysis 25), ‘mature students’ (26-34), and ‘second
career students’ (>35).
We cross-tabulated the variable of ‘fear of
We used Simple Correspondence Anal­
infection’ with the six variables concerning
ysis (SCA) as our statistical tool. SCA
discomfort towards PLWHA types. For cor­
searches the latent structure of the data table
respondence analysis, we stacked these six
and transforms it into a few (usually two or
cross-tabulations into one grand cross-tabu­
three) interpretable dimensions (axes), and
lation with 18 rows of discomfort and three
presents categories of variables as configura­
columns of fear (Table 2). The stacked table
tions of points in geometric plains. SCA fo­
shows associations between each type of PL­
cuses more on the patterns of the data and is
WHA and fear, without containing informa­
less concerned about traditional significance
tion about the interactions between the types
tests (Greenacre, 2007; Le Roux & Rouanet,
of PLWHA (Greenacre, 2007).
2010, 23-65).
We wanted to determine how the fear of in­
fection (and discomfort) is associated with the Results
willingness to care for PLWHA, familiarity
Students ’ perceptions o f different types o f
with HIV positive people, and knowledge of
PLWHA
HIV/AIDS, gender and age. Thus we includ­
ed ‘willingness to care’, ‘known a PLWHA’ Table 1 presents the relative frequencies of
and ‘knowledge of HIV/AIDS’ in addition to responses to the question concerning whether
‘gender’ and ‘age’ as supplementary variables they would feel comfortable in contact with
in our 1 8 x 3 cross-tabulation. Altogether we different types HIV/AIDS patients. On aver­
formed a 32 x 3 cross-tabulation, where the age, about 25 % of respondents find it uncom­
supplementary variables did not contribute to fortable to be in contact with a person who
 University Students’ Perception of People Living with HIV/AIDS / 539

has H IV /A ID S. The unpleasantness o f types
o f PLW H A varies from 47.5 % (T V drug
u sers’) to 6.4 % ( ‘ch ild ’). M ore than 30 %
o f respondents w ould feel uncom fortable in
contact w ith a ‘p rostitute’ or a ‘haem orrhagic
disease p atient’ w ho has H IV /A ID S and stu­
dents have difficulties to form an opinion in
these cases (17.7 % and 21.3 % respectively).
To reveal the ranking order o f the six types
o f H IV /A ID S patients, w e perform ed SCA
on Table 1. The results o f the analysis are
presented in Figure 1. The total eigenvalue
(variance) is 0.1417, o f w hich the first axis
accounts for 90.12 %. T he first dim ension
o f the graph clearly opposes ‘disagree’ (con­
tributes 34.5 % ) on the left side, and ‘ag ree’

Table 1: Discomfort of Types of PLWHA (row profiles)

I would feel uncomfortable if in contact with [...] who Respondents’ opinion

has HIV/AIDS. Agree Cannot say Disagree
Child 6.4* 6.4 87.2 282
Bisexual 14.2 11.0 74.8 282
Homosexual 14.5 13.5 72.0 282
Prostitute 30.9 17.7 51.4 282
Haemorrhagic disease patient 31.9 21.3 46.8 282
Intravenous drug user 47.5 11.0 41.5 282
Average row profile 24.2 13.5 62.3 1692
* Figures are row percentages, that is, row profiles. The average row profile is calculated by first summing
up the column frequencies. Then each summed column frequency is divided by the sum of the average
row total frequency. Due to rounding, percentages do not necessarily sum up to 100.

Figure 1: Simple Correspondence Analysis (SCA) of Table 1. Discomfort of Types of

PLWHA
Argument: ‘I would feel uncomfortable if in contact with [...] who has HIV/AIDS.’
Categories: ‘Agree’, ‘Cannot say’, ‘Disagree’, Child (‘CHILD’), Bisexual (‘BI’), Homosexual (‘HOMO’), Prostitute
(‘PROST’), Haemorrhagic disease patient (‘HEMO’), Intravenous drug user (‘IV DURG’)
540 / College Student Journal

(contributes 60.7 %) on the right side. These
two categories are also well represented in the
first axis since their squared cosines are 0.97
and 0.99 respectively. The types of HIV in­
fected persons (child, bisexual, homosexual,
prostitute, haemorrhagic disease patient and
IV drug user) are clearly ordered from left
(most comfortable) to right (least comfort­
able). The categories of child, bisexual and
homosexual are on the ‘disagree’ side (left)
of the map, whereas prostitute, haemorrhagic
disease patient and IV drug user are on the
‘agree’ side (right). The strongest opposition
is between the categories of child and IV drug
user, which together contribute 67.9 % of the
variance in the first dimension.
The second dimension captures the re­
maining 9.88 % of the total variance and
depicts the opposition between those who
cannot formulate their opinion and those
who ‘agree’ with the statement. However, the
category of ‘cannot say’ contributes only 3.2
% of the variance in the second axis. People
tended to be particularly certain that they do
not feel comfortable with IV drug users (con­
tributes 46.3 %). On the other hand, 21.3 % of
respondents were uncertain about their opin­
ion regarding a haemorrhagic disease patient

Table 2: Fear of Infection and Discomfort of Types of PLWHA (row profiles)

I would be/was afraid of getting HTV if I were/was in contact
with HIV positive
I would feel uncomfortable if in contact with n
Agree Cannot say Disagree
[...] who has HIV/AIDS.
Child Agree 66.7 5.6 27.8 18
Cannot say 72.2 16.7 11.1 18
Disagree 30.5 7.7 61.8 246
Bisexual Agree 72.5 5.0 22.5 40
Cannot say 54.8 16.1 29.0 31
Disagree 25.6 7.6 66.8 211
Homosexual Agree 70.7 4.9 24.4 41
Cannot say 44.7 18.4 36.8 38
Disagree 26.6 6.9 66.5 203
Prostitute Agree 60.9 5.7 33.0 87
Cannot say 30.0 14.0 56.0 50
Disagree 22.1 7.6 70.3 145
Haemorrhagic disease patient Agree 58.9 4.4 36.7 90
Cannot say 33.3 20.0 46.7 60
Disagree 20.5 5.3 74.2 132
Intravenous drug user Agree 49.3 7.5 43.3 134
Cannot say 38.7 16.1 45.2 31
Disagree 18.8 6.8 74.4 117
Total 35.5 8.4 56.4 1692

* Figures are row percentages, that is, row profiles. The average row profile is calculated by first summing
up the column frequencies. Then each summed column frequency is divided by the sum of the average
row total frequency. Due to rounding, percentages do not necessarily round to 100.
 U n ive rs ity S tu d e n ts ’ P e rc ep tio n o f P e o p le Living w ith H IV /A ID S / 541

Figure 2: Simple correspondence analysis of Table 3. Fear of Infection and Discomfort of

Types ofPLWHA
Argument: ‘I would be/was afraid o f getting HTV if I were/was in contact with HTV positive.’
Categories: ‘Fear agree’, ‘Fear cannot say’, ‘Fear disagree’
Argument: ‘I would feel uncomfortable if in contact with [...] who has HIV/AIDS.’
Categories: Child agree (‘Child agr’), Child cannot say (‘Child cnnt’) Child disagree (‘Child dis’), Bisexual agree
( Bi agr ), Bisexual cannot say (‘Bi cnnt’), Bisexual disagree (‘Bi dis’), and so on for each type o f People living with
HIV/AIDS.

(contributes 33.1 %). There were also quite
many ‘cannot say’ answers in the case of a
prostitute (17.7 %).
We should also notice that the category of
‘cannot say’ is quite well represented in the
first axis, having a squared cosine of 0.35.
Both categories ‘cannot say’ and ‘agree’ are
on the right side o f the map, and their distance
in the first axis is 0.36 units. The distance
between ‘cannot say’ and ‘disagree’ is 0.48
units. Therefore, we can conclude that un­
certainty is closer to discomfort rather than
comfort with PLWHA.
Fear o f Infection and the Discomfort
Table 2 and Figure 2 present the results
of the second SCA concerning the fear of
getting HIV if in contact with an HIV pos­
itive person. The first dimension accounts
for 86.2 % o f the total eigenvalue (0.1357),
and opposes those who fear the infection
(contributes 60.1 %) and those who do not
(contributes 39.7 %). The second dimension
(eigenvalue 0.0187) and 13.8 % o f the ex­
plained variance is dominated by those who
are uncertain about their opinion.
On average, those who fear infection
tend to feel discomfort towards all types of
PLWHA, whereas those who do not fear
infection tend to sympathize with PLWHA.
In addition, Figure 2 shows that the analysis
reproduces almost exactly the same rankings
of the types of PLWHA as discovered in the
first correspondence analysis. It is also noted
that those students who are uncertain in their
assessment of fear, also tend to be uncertain in
their assessment of the discomfort pleasant­
ness of all types ofPLWHA.
542 / College Student Journal
All of the ‘agree’ and ‘disagree’ categories
concerning the feelings of discomfort towards
the types of PLWHA, except for ‘child’ con­
tributed strongly to the first dimension. In
addition, all ‘agree’ and ‘disagree’ categories
of the discomfort variable are very strongly
associated with the first dimension. All ‘can­
not say’ categories of types o f PLWHA, ex­
cept ‘prostitute’ are located on the ‘fear’ side
(right) of the map. Furthermore, ‘child cannot
say’ (0.91), ‘bisexual cannot say’ (0.77) and
‘homosexual cannot say’ (0.41) correlated
strongly with the first axis. This means that
those who were uncertain about their feelings
of discomfort towards child, bisexual and ho­
mosexual categories tended to fear infection
more than average.
The second dimension opposes those
respondents who were uncertain and those
who certainly fear or don’t fear infection. Of
the PLWHA types, ‘haemorrhagic disease
patient’ and ‘homosexual’ have the strongest
contribution to the second dimension (35.1 %
and 15.8 % respectively). Furthermore, hae­
morrhagic disease patient, prostitute, IV drug
Figure 3: Supplementary Variables Willingness to Care (‘Will no’, ‘Will yes’), Known
HIV Positive (‘Known yes’, ‘Known no’), and ‘Knowledge of HIV/AIDS’
(‘K T = least knowledge, ‘K2’, ‘K 3 \ ‘K4’ = most knowledge), and an active Variable o f Fear o f Infection (‘Fear
agree’, ‘Fear cannot say’, ‘Fear disagree’)
Axis 2 - 13 78 %
user and homosexual correlated strongly with
the second dimension.
Fear o f infection and knowledge o f HIV/
AIDS, familiarity with PLWHA, willingness
to care, gender and age
Figure 3 shows the location of supple­
mentary variables of ‘willingness to care’,
‘known a PLWHA’ and ‘knowledge of HIV/
AIDS’, together with an active variable of
‘Fear of infection.’ Unwillingness to care for
PLWHA and the fear of infection are clearly
associated. The categories of ‘will - no’ and
‘fear - agree’ are located on the right side of
the map, whereas ‘will - yes’ and ‘fear - dis­
agree’ are located on the opposite side. The
two categories of the supplementary variable
of ‘willingness to care’ correlate almost com­
pletely with the first dimension, as they both
have squared cosines of 0.95 (Table 3).
‘Known a PLWHA’ and fear of infection
have an association. If the respondent has
known a HIV positive person, they tended
to be less than averagely concerned about
infection. However, only 8.9 % of the sample
 University Students’ Perception of People Living with HIV/AIDS / 543

Table 3: Relative Frequencies of Supplementary Variables and Categories (/? = 282).

Variable Category Relative frequency
Gender Man 17.4
Woman 82.6
Age -21 18.4
22-25 36.5
26-34 26.2
35- 18.8
Are you willing to care for a person with HTV/AIDS? Yes 66.7
No 33.3
Have you ever known a family member, friend or other close person Yes 8.9
with HIV/AIDS?
No 91.1
Knowledge about HTV/AIDS IK (lowest) 11.0
2K 35.8
3K 33.3
4K (highest) 19.9

knew someone with HIV. It is interesting to
note that this type of familiarity with HIV also
correlates slightly with the second dimension,
which indicates that knowing a PLWHA re­
duces the level of uncertainty in addition to
the level of fear (Table 3).
The association between knowledge, fear
and uncertainty is illustrated by the spread of
points of the variable - ‘knowledge of HIV/
AIDS.’ Figure 3 clearly shows that the points
indicating the levels of knowledge have an
orderly distribution in the first dimension
from right to left. The more knowledgeable
a person is, the less afraid they are of getting
an infection from being in contact with HIV
positive people. The most knowledgeable
categories (K 4 and K 3) are on the left side
o f the map close to the category of ‘Fear -
disagree.’ The knowledge categories are also
clearly ordered in the second dimension. The
least knowledgeable categories of K 1 and K
2 are located in the upper right part of the map
in the direction of ‘Fear - cannot say.’ Thus,
ignorance of HIV/AIDS tends to go hand in
hand with the uncertainty about the fear of
getting the virus if in contact with HIV posi­
tive people. These interpretations of Figure 3
are supported by the squared cosines present­
ed in Table 4.
In our final analysis, we show that women
and older students tended to fear infection less
frequently than men and younger students
(see Figure 4 and Table 4). Because fear and
discomfort are closely related, it also means
that women and older students tend to feel
more sympathy towards PLWHA. In addition,
the order of the categories in the second di­
mension shows that there is more uncertainty
among the youngest students (<21), whereas
the oldest students most often have a certain
opinion concerning the fear of infection.
We cannot analyse the interactions be­
tween supplementary variables in the SCA
of stacked tables. However we performed
some separate cross-tabulations and found a
statistically significant relationship between
age and gender, in which the men tended to
be younger than the women. There were no
significant relations between age and the
level of knowledge. Instead, there was a veiy
544 / College Student Journal

significant association between age and the
respondent’s familiarity with an HIV positive
person (x2 =41,209, df= 3, p = 0.000). No-
one in the youngest age group was closely
acquainted with a person with AIDS, but
about third of the oldest age group had such
an experience. There was also a statistically
significant association between age and a
willingness to care for an HIV positive person
(X2 =8,129, df= 3, p = 0.043). On average, the
oldest age group was more willing to care for
a person with H1V/AIDS than the other age
groups (83% vs. 63.2%).

Table 4: Squared Cosines and Relative Weights of Supplementary Variables

Variable Category Squared Cosine Squared Cosine Relative Weight
1" dimension 2°d dimension

Gender Man 0.83 0.00 17.38

Woman 0.83 0.00 82.62
Age -21 0.12 0.24 18.44
22-25 0.69 0.02 36.52
26-34 0.00 0.00 22.58
35- 0.74 0.10 18.79
Will Yes 0.95 0.00 66.67
No 0.95 0.00 33.33
Known Yes 0.85 0.08 8.87
No 0.34 0.04 88.18
Knowledge 1 (least) 0.45 0.20 10.99
2 0.14 0.40 35.82
3 0.07 0.13 32.33
4 (most) 0.72 0.11 19.89

Figure 4: Supplementary Variables of Gender (‘Man’, ‘Woman’) and Age (‘-21’, ‘22-25’,
‘26-34’, ‘35-’), and an active Variable of Fear of Infection (‘Fear agree’, ‘Fear cannot
say’, ‘Fear disagree’)
 U n ive rs ity S tu d e n ts ’ P e rc ep tio n o f P e o p le Living w ith H IV /A ID S / 5 4 5
Discussion
We studied how students at a Finnish
university perceived different categories of
PLWHA. On average, about a quarter (24.2
%) of respondents would feel uncomfortable
if they came into a contact with PLWHA.
Almost half of the students perceived an in­
travenous drug user negatively, while very
few respondents found it uncomfortable to
be in contact with a HIV positive child (6.4
%). A prostitute and a haemorrhagic disease
patient were also perceived more negatively
than the overall average. A clear majority of
respondents perceived bisexual and homo­
sexual subjects with HIV/AIDS in positive
terms. Over one-fifth of students could not
assess their feelings of discomfort in the case
of a haemorrhagic disease patient.
Discomfort was linked to the fear of ac­
quiring infection. Those who feared infection
tended to feel discomfort with PLWHAs as a
whole, whereas the sympathisers did not fear
infection. Uncertainty about fear was closely
associated with the uncertainty of having an
opinion about the feelings of discomfort to­
wards certain types of PLWHA. Particularly,
uncertainty concerning the unpleasantness of
haemorrhagic disease patients, prostitutes,
IV drug users and homosexuals was corre­
lated with fear. Furthermore, those who had
difficulties to formulate their opinion about
a child or a bisexual tended to fear infection
more than average.
Next we analysed if fear (and indirectly
discomfort) was associated with a willingness
to care for PLWHA, familiarity with an HIV
positive person, and the level of knowledge
of HIV/AIDS. Our results show that fear (and
indirectly discomfort) reduces the willingness
to care for PLWHA. In addition, familiarity
with PLWHA and a good knowledge o f HIV/
AIDS reduces fear, and thus is likely to in­
crease the sympathy felt towards PLWHA.
The lack of knowledge and personal expe­
rience of an HIV positive person increases
respondents’ uncertainty about fear (and in­
directly discomfort). Finally, in regard to age
and gender, men and younger students tended
to fear infection more than women and older
students and uncertainty was seen to decrease
with age.
Our research results demonstrate for the
first time in a statistically systematic way, how
people’s perceptions tend to place different
types of PLWHA into a ranking system. The
ranking implies a moral judgement, but we
did not directly study whether the perceptions
are based on the assessment of responsibility
and a fear of PLWHA, as has been suggested
by previous research. Our results show that
the situation of bisexuals and homosexuals
has become much improved since the 1980s,
although many still look down on intravenous
drug users and prostitutes.
HIV and AIDS arouse negative feelings in
general, but people tend to perceive various
types of people with HIV/AIDS differently
in terms of their moral worth. We know that
HIV itself does not have any morals and that
people should be treated equally and in the
best possible manner, regardless their mode
of infection. It is worrying however, that dis­
criminatory attitudes and behaviour towards
certain categories of HIV positives may also
be observed in health care settings (Heijnders
& Van Der Meij, 2006; Paxton et al., 2005;
Weiss, Ramakrishna & Somma, 2006; Wong
& Wong, 2006).
Although there has been progress in terms
of improved attitudes, we should be more
concerned about the position of the most
vulnerable groups of PLWHA, such as in­
travenous drug users, haemorrhagic disease
patients and prostitutes. Our results from stu­
dents suggest that a better knowledge of HIV/
AIDS and familiarity with PLWHA might
reduce the fear of infection and so increase
sympathy towards PLWHA. Direct contact
with PLWHA together with some educational
programs, could decrease negative attitudes
546 / College Student Journal

and discriminative behaviors, but there is no

clear evidence that this approach produces re­
sults (Foreman & Breinbauer, 2003). Yet, it is
always important to correct false beliefs about
the disease and any unnecessary fears about
infection (Parker & Aggleton, 2003; Weiss,
Ramakrishna & Somma, 2006). Therefore we
need to arouse public sympathy towards the
sick and emphasize that the disease is just one
aspect of the person’s identity.
The final data base cannot be regarded
as representative of the population of basic
degree students, and the results should be
evaluated as preliminary. The questionnaires
were mailed to each subject’s home address,
obtained from the student register and it was
noticed that it was not possible to reach some
students at the address given. Also, the ques­
tionnaire was rather long and basic degree
students might not be used to participating in
surveys. There were also those who may not
have been interested in or did not value the
research topic and chose not to respond.

Conclusion
Although the perception of PLWHA has
improved over the years, there is still a need
for enlightenment, particularly with to the
most vulnerable groups such as intravenous
drug users, haemorrhagic disease patients and
prostitutes.
 U n iversity S tu d e n ts ’ P e rc e p tio n o f P e o p le Living w ith H IV /A ID S / 5 4 7

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