The Persistence of Prejudice: Voters Strongly Penalize Candidates with HIV

Abstract

Forty million people around the world and more than one million in the United States live with HIV. Despite the gains in the prevention and treatment of HIV due to medical advances and community advocacy, HIV/AIDS continues to claim lives and disproportionately affect marginalized communities. Stigma against people with HIV remains powerful. While individuals with HIV have gained some visibility in the media, the scarcity of politicians with HIV is striking. This article analyzes a possible reason: voter bias. We examine voters’ reactions to political candidates with HIV using original nationally representative survey experiments from the United States, the United Kingdom and New Zealand. Voters penalize candidates with HIV by 10–12 percentage points in the three countries. Prejudice, electability concerns, and the moral judgment that candidates are responsible for their HIV+ status explain bias. The lack of descriptive representation remains an obstacle to improved policy outcomes for this marginalized community.

This is a preview of subscription content, access via your institution.

Fig. 1

Notes

  1. 1.

    BBC, 16 January 2020: https://www.bbc.com/news/health-51122979.

  2. 2.

    World Economic Forum: https://www.weforum.org/people/ryuhei-kawada.

  3. 3.

    https://www.seattletimes.com/nation-world/nation/aldo-davila-set-to-be-guatemalas-1st-openly-gay-congressman/.

  4. 4.

    The Seattle Times, 20 June 2019: https://www.bbc.com/news/uk-england-sussex-46391287.

  5. 5.

    POZ, 29 October 2014: https://www.poz.com/article/hiv-positive-politics-26343-5691.

  6. 6.

    However, Magni and Reynolds (2018) found that voters did not penalize gay and lesbian candidates in the 2015 UK election.

  7. 7.

    Washington Blade, 25 July 2019: https://www.washingtonblade.com/2019/07/25/trump-administration-hiv-status-used-to-justify-family-separation-at-border/.

  8. 8.

    Kaiser Family Foundation, 30 November 2017: https://www.greaterthan.org/press-release-national-survey-of-young-adults-on-hivaids/.

  9. 9.

    Merck, 25 November 2019: https://www.multivu.com/players/English/8614851-merck-owning-hiv/.

  10. 10.

    The Washington Post, 5 August 2019: https://www.washingtonpost.com/opinions/2019/08/05/discriminating-against-hiv-positive-military-members-is-unproductive-our-military/.

  11. 11.

    Positive feelings toward gays and lesbians and support for gay rights are higher when people think that homosexuality is biological or genetic (Haider-Markel and Joslyn 2008).

  12. 12.

    Relatedly, voters in the US and Canada are less likely to support candidates facing depression because depression affects perceptions of candidates’ character (Loewen and Rheault 2019).

  13. 13.

    Partially in the case of New Zealand.

  14. 14.

    Stewart McKinney represented Connecticut’s fourth District in the House of Representatives (1971–87).

  15. 15.

    Sean Strub, a longtime HIV/AIDS activist, became mayor of Milford, PA in 2017.

  16. 16.

    As a comparison, Lesotho recorded 336 deaths per 100,000 in the same year: https://ourworldindata.org/hiv-aids#in-some-countries-hiv-aids-is-the-cause-of-more-than-1-in-4-deaths.

  17. 17.

    Healthline, 21 April 2020: https://www.healthline.com/health-news/cost-of-hiv-prevention-drug-discouraging-people-from-doing-prep-therapy.

  18. 18.

    The Guardian, 1 June 2018: https://www.theguardian.com/world/2018/jun/01/silent-epidemic-black-gay-men-in-us-face-50-50-risk-of-hiv.

  19. 19.

    New Zealand Doctor, 28 November 2018: https://www.nzdoctor.co.nz/article/undoctored/new-hiv-stigma-stats-cause-immediate-action.

  20. 20.

    Terrence Higgins Trust, 4 July 2019: https://www.tht.org.uk/news/almost-half-brits-would-feel-uncomfortable-kissing-someone-hiv.

  21. 21.

    Data and replication code are available on Dataverse at: https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/UIF9BL.

  22. 22.

    See, for instance, The New York Times, 3 January 2018: https://www.nytimes.com/2018/01/03/nyregion/council-speaker-corey-johnson.html.

  23. 23.

    Metro Weekly, 12 November 2020: https://www.metroweekly.com/2020/11/roger-montoya-wins-election-after-republicans-attack-gay-adult-film-past/.

  24. 24.

    A small number of respondents saw a candidate who was 71 years old and HIV positive from birth. Upon reflection, this is implausible, but the number of respondents who saw this combination was very small, and none of our 4300 participants mentioned the potential anomaly. Furthermore, as a robustness check, we conducted the analysis eliminating candidates who were 71 years old. Results remain substantially unchanged. See footnote 25.

  25. 25.

    The online appendix reports an example of the experiment displayed to survey respondents in the United States (page A4).

  26. 26.

    When we eliminate candidates who are 71 years old, candidates with HIV face the following penalties: −11.4 percentage points (US), −10.4 (UK), −13.5 (NZ). Candidates with HIV since birth: −8.2 percentage points (US), −5 (UK), −7 (NZ).

  27. 27.

    As we explain below, a few respondents mentioned this point.

  28. 28.

    Recent work found that opposition to candidates from stigmatized groups is often driven by ethnocentrism or generalized antipathy toward cultural outgroups (Kalkan et al. 2018). Our survey does not include measures of ethnocentrism. However, we do have questions measuring contact or attitudes toward specific outgroups. One question asks whether respondents have LGBTQ friends or family members. This item measures close contact with LGTBQ people, which, in turn, can be expected to affect feelings and attitudes toward LGBTQ individuals. Table 3 reveals that respondents with LGBTQ friends or family members penalize candidates with HIV less severely in all the three countries than respondents without LGBTQ friends, even though the difference fails to reach statistical significance. Our American survey also includes an item measuring immigration attitudes, which asks respondents whether the number of immigrants in the countries should be reduced or increased. While the question does not directly measure affect toward immigrants, one could hypothesize a correlation between immigration attitudes as measured by this item and affect toward immigrants. Hence, we conducted a subset analysis to explore voter attitudes toward candidates with HIV for respondents who would like to reduce the number of immigrants and those who do not. Similarly to the subset analysis based on LGBTQ friends and family members, respondents with negative immigration attitudes penalize candidates with HIV more severely than respondents with positive immigration attitudes, but the difference is not statistically significant. The AMCEs for candidates with HIV are −13.2 [−16.3, −10.1] and −10.5 [−13.6, −7.5] for respondents with negative and non-negative immigration attitudes, respectively. The marginal means are 41.8 [39.1, 44.5] and 43.7 [41.1, 46.4].

  29. 29.

    Kaiser Family Foundation, 1 June 2011: https://www.kff.org/report-section/hivaids-at-30-section-1/.

References

  1. Adida, C. L., Davenport, L. D., & McClendon, G. (2016). Ethnic cueing across minorities: A survey experiment on candidate evaluation in the United States. Public Opinion Quarterly, 80(4), 815–836.

    Article  Google Scholar 

  2. Ayoub, P. M., & Garretson, J. (2017). Getting the message out: Media context and global changes in attitudes toward homosexuality. Comparative Political Studies, 50(8), 1055–1085.

    Article  Google Scholar 

  3. Barreto, M. (2010). Ethnic cues: The role of shared ethnicity in Latino political participation. Ann Arbor, MI: University of Michigan Press.

    Google Scholar 

  4. Beaulieu, M., Adrien, A., Potvin, L., & Dassa, C. (2014). Stigmatizing attitudes towards people living with HIV/AIDS: Validation of a measurement scale. BMC Public Health, 14(1), 1246.

    Article  Google Scholar 

  5. Bejarano, C. E. (2013). The Latina advantage: Gender, race, and political success. Austin, TX: University of Texas Press.

    Google Scholar 

  6. Bobo, L., & Gilliam, F. D., Jr. (1990). Race, sociopolitical participation, and black empowerment. American Political Science Review, 84(2), 377–393.

    Article  Google Scholar 

  7. Bogart, L. M., Cowgill, B. O., Kennedy, D., Ryan, G., Murphy, D. A., Elijah, J., & Schuster, M. A. (2008). HIV-related stigma among people with HIV and their families: A qualitative analysis. AIDS and Behavior, 12(2), 244–254.

    Article  Google Scholar 

  8. Bosia, M. J. (2006). Written in blood: AIDS prevention and the politics of failure in France. Perspectives on Politics, 4(4), 647–653.

    Article  Google Scholar 

  9. Collet, C. (2005). Bloc voting, polarization, and the panethnic hypothesis: The case of little Saigon. The Journal of Politics, 67(3), 907–933.

    Article  Google Scholar 

  10. Epstein, S. (1996). Impure science: AIDS, activism, and the politics of knowledge. Berkeley, CA: University of California Press.

    Google Scholar 

  11. Feldman, D. B., & Crandall, C. S. (2007). Dimensions of mental illness stigma: What about mental illness causes social rejection? Journal of Social and Clinical Psychology, 26(2), 137–154.

    Article  Google Scholar 

  12. Fisher, S. D., Heath, A. F., Sanders, D., & Sobolewska, M. (2015). Candidate ethnicity and vote choice in Britain. British Journal of Political Science, 45(4), 883–905.

    Article  Google Scholar 

  13. Flores, A. R. (2015). Attitudes toward transgender rights: Perceived knowledge and secondary interpersonal contact. Politics, Groups, and Identities, 3(3), 398–416.

    Article  Google Scholar 

  14. Gant, L. M. (2010). HIV-related community organizing and grassroots advocacy. In C. C. Poindexer (Ed.), Handbook of HIV and social work: Principles, practice, and populations (pp. 159–172). Hoboken, NJ: Wiley.

    Google Scholar 

  15. Garretson, J. J. (2015). Does change in minority and women’s representation on television matter? A 30-year study of television portrayals and social tolerance. Politics, Groups, and Identities, 3(4), 615–632.

    Article  Google Scholar 

  16. Gay, C. (2001). The effect of black congressional representation on political participation. American Political Science Review, 95(3), 589–602.

    Article  Google Scholar 

  17. Gershon, S. A., & LavariegaMonforti, J. (2019). Intersecting campaigns: Candidate race, ethnicity, gender and voter evaluations. Politics, Groups, and Identities. https://doi.org/10.1080/21565503.2019.1584752.

    Article  Google Scholar 

  18. Gershon, S. A., Montoya, C., Bejarano, C., & Brown, N. (2019). Intersectional linked fate and political representation. Politics, Groups, and Identities, 7(3), 642–653.

    Article  Google Scholar 

  19. Golebiowska, E. (2001). Group stereotypes and political evaluation. American Politics Research, 29(6), 535–565.

    Article  Google Scholar 

  20. Golebiowska, E. (2003). When to tell? Disclosure of concealable group membership, stereotypes, and political evaluation. Political Behavior, 25(4), 313–337.

    Article  Google Scholar 

  21. Haider-Markel, D. P. (2010). Out and running: Gay and lesbian candidates, elections, and policy representation. Washington, D.C.: Georgetown University Press.

    Google Scholar 

  22. Haider-Markel, D. P., & Joslyn, M. R. (2008). Beliefs about the origins of homosexuality and support for gay rights: An empirical test of attribution theory. Public Opinion Quarterly, 72(2), 291–310.

    Article  Google Scholar 

  23. Haider-Markel, D., Miller, P., Flores, A., Lewis, D. C., Tadlock, B., & Taylor, J. (2017). Bringing “T” to the table: Understanding individual support of transgender candidates for public office. Politics, Groups, and Identities, 5(3), 399–417.

    Article  Google Scholar 

  24. Hainmueller, J., Hopkins, D. J., & Yamamoto, T. (2014). Causal inference in conjoint analysis: Understanding multidimensional choices via stated preference experiments. Political Analysis, 22(1), 1–30.

    Article  Google Scholar 

  25. Heath, O., Verniers, G., & Kumar, S. (2015). Do Muslim voters prefer Muslim candidates? Co-religiosity and voting behavior in India. Electoral Studies, 38, 10–18.

    Article  Google Scholar 

  26. Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92(3), 371–377.

    Article  Google Scholar 

  27. Highton, B. (2004). White voters and African American candidates for congress. Political Behavior, 26(1), 1–25.

    Article  Google Scholar 

  28. Horiuchi, Y., Smith, D. M., & Yamamoto, T. (2020a). Identifying voter preferences for politicians’ personal attributes: A conjoint experiment in Japan. Political Science Research and Methods, 8(1), 75–91.

    Article  Google Scholar 

  29. Horiuchi, Y., Markovich, Z.D., & Yamamoto, T. (2020b). Does conjoint analysis mitigate social desirability bias? Working paper. Retrieved Feb 8, 2021, from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3219323.

  30. Horiuchi, Y., Smith, D., & Yamamoto, T. (2018). Measuring voters’ multidimensional policy preferences with conjoint analysis: Application to Japan’s 2014 election. Political Analysis, 26(2), 190–209.

    Article  Google Scholar 

  31. Huddy, L., & Feldman, S. (2009). On assessing the political effects of racial prejudice. Annual Review of Political Science, 12, 423–447.

    Article  Google Scholar 

  32. Jones, P. E., & Brewer, P. R. (2019). Gender identity as a political cue: Voter responses to transgender candidates. The Journal of Politics, 81(2), 697–701.

    Article  Google Scholar 

  33. Jones, P. E., Brewer, P. R., Young, D. G., Lambe, J. L., & Hoffman, L. H. (2018). Explaining public opinion toward transgender people, rights, and candidates. Public Opinion Quarterly, 82(2), 252–278.

    Article  Google Scholar 

  34. Kalkan, K. O., Layman, G. C., & Green, J. C. (2018). Will Americans vote for Muslims? Cultural outgroup antipathy, candidate religion, and US voting behavior. Politics and Religion, 11(4), 798–829.

    Article  Google Scholar 

  35. Land, H., & Linsk, N. (2013). HIV stigma and discrimination: Enduring issues. Journal of HIV/AIDS and Social Services, 12(1), 3–8.

    Article  Google Scholar 

  36. Latner, J. D., O’Brien, K. S., Durso, L. E., Brinkman, L. A., & MacDonald, T. (2008). Weighing obesity stigma: The relative strength of different forms of bias. International Journal of Obesity, 32(7), 1145–1152.

    Article  Google Scholar 

  37. Leeper, T. J., Hobolt, S. B., & Tilley, J. (2020). Measuring subgroup preferences in conjoint experiments. Political Analysis, 28(2), 207–221.

    Article  Google Scholar 

  38. Loewen, P. J., & Rheault, L. (2019). Voters punish politicians with depression. British Journal of Political Science. https://doi.org/10.1017/S0007123419000127.

    Article  Google Scholar 

  39. Loepp, E., & Redman, S. M. (2020). Partisanship, sexuality, and perceptions of candidates. Journal of Elections, Public Opinion and Parties. https://doi.org/10.1080/17457289.2019.1711099.

    Article  Google Scholar 

  40. Magni, G., & Reynolds, A. (2018). Candidate sexual orientation didn’t matter (in the way you might think) in the 2015 UK General Election. American Political Science Review, 112(3), 713–720.

    Article  Google Scholar 

  41. Magni, G., & Reynolds, A. (2020). Forthcoming. Voter preferences and the political underrepresentation of minority groups: Lesbian gay and transgender candidates in advanced democracies. The Journal of Politics. https://doi.org/10.1086/712142.

    Article  Google Scholar 

  42. McConnaughy, C. M., White, I. K., Leal, D. L., & Casellas, J. P. (2010). A Latino on the ballot: Explaining coethnic voting among Latinos and the response of White Americans. The Journal of Politics, 72(4), 1199–1211.

    Article  Google Scholar 

  43. Miller, B. J., & Lundgren, J. D. (2010). An experimental study of the role of weight bias in candidate evaluation. Obesity, 18(4), 712–718.

    Article  Google Scholar 

  44. Moskowitz, D., & Stroh, P. (1994). Psychological sources of electoral racism. Political Psychology, 15(2), 307–329.

    Article  Google Scholar 

  45. Oliver, J. E., & Lee, T. (2005). Public opinion and the politics of obesity in America. Journal of Health Politics, Policy and Law, 30(5), 923–954.

    Article  Google Scholar 

  46. Philpot, T. S., & Walton, H. (2007). One of our own: Black female candidates and the voters who support them. American Journal of Political Science, 51(1), 49–62.

    Article  Google Scholar 

  47. Piston, S. (2010). How explicit racial prejudice hurt Obama in the 2008 election. Political Behavior, 32(4), 431–451.

    Article  Google Scholar 

  48. Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and update. Obesity, 17(5), 941–964.

    Article  Google Scholar 

  49. Reeves, K. (1997). Voting hopes or fears? White voters, black candidates and racial politics in America. New York, NY: Oxford University Press.

    Google Scholar 

  50. Reynolds, A. (2019). The children of Harvey milk: How LGBTQ politicians changed the world. New York, NY: Oxford University Press.

    Google Scholar 

  51. Roehling, P. V., Roehling, M. V., Brennan, A., Drew, A. R., Johnston, A. J., Guerra, R. G., et al. (2014). Weight bias in US candidate selection and election. Equality, Diversity and Inclusion An International Journal, 33(4), 334.

    Article  Google Scholar 

  52. Rozin, P., Markwith, M., & McCauley, C. R. (1994). The nature of aversion to indirect contact with other persons: AIDS aversion as a composite of aversion to strangers, infection, moral taint and misfortune. Journal of Abnormal Psychology, 103(3), 495–504.

    Article  Google Scholar 

  53. Sigelman, C. K., Sigelman, L., Walkosz, B. J., & Nitz, M. (1995). Black candidates, White voters: Understanding racial bias in political perceptions. American Journal of Political Science, 39(1), 243–265.

    Article  Google Scholar 

  54. Teele, D., Kalla, J., & Rosenbluth, F. M. (2018). The ties that double bind: Social roles and women’s underrepresentation in politics. American Political Science Review, 112(3), 525–541.

    Article  Google Scholar 

  55. Terkildsen, N. (1993). When white voters evaluate black candidates: The processing implications of candidate skin color, prejudice, and self-monitoring. American Journal of Political Science, 37(4), 1032–1053.

    Article  Google Scholar 

  56. Voisin, D. R., Bird, J. D., Shiu, C. S., & Krieger, C. (2013). ‘It’s crazy being a black, gay youth’. Getting information about HIV prevention: A pilot study. Journal of Adolescence, 36(1), 111–119.

    Article  Google Scholar 

  57. Voss, D. S., & Lublin, D. (2001). Black incumbents, white districts: An appraisal of the 1996 congressional elections. American Politics Research, 29(2), 141–182.

    Article  Google Scholar 

  58. Weiner, B. (1993). On sin versus sickness: A theory of perceived responsibility and social motivation. American Psychologist, 48(9), 957–965.

    Article  Google Scholar 

  59. Weiner, B., Osborne, D., & Rudolph, U. (2011). An attributional analysis of reactions to poverty: The political ideology of the giver and the perceived morality of the receiver. Personality and Social Psychology Review, 15(2), 199–213.

    Article  Google Scholar 

  60. Weiner, B., Perry, R. P., & Magnusson, J. (1988). Anattributional analysis of reactions to stigmas. Journal of Personality and Social Psychology, 55(5), 738–748.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Gabriele Magni.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 576 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Magni, G., Reynolds, A. The Persistence of Prejudice: Voters Strongly Penalize Candidates with HIV. Polit Behav (2021). https://doi.org/10.1007/s11109-021-09687-w

Download citation

Keywords

  • HIV
  • AIDS
  • Representation
  • Candidates
  • Voter bias
  • Minority groups