The Persistence of Prejudice: Voters Strongly Penalize Candidates with HIV


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.

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Fig. 1


  1. 1.

    BBC, 16 January 2020:

  2. 2.

    World Economic Forum:

  3. 3.

  4. 4.

    The Seattle Times, 20 June 2019:

  5. 5.

    POZ, 29 October 2014:

  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:

  8. 8.

    Kaiser Family Foundation, 30 November 2017:

  9. 9.

    Merck, 25 November 2019:

  10. 10.

    The Washington Post, 5 August 2019:

  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:

  17. 17.

    Healthline, 21 April 2020:

  18. 18.

    The Guardian, 1 June 2018:

  19. 19.

    New Zealand Doctor, 28 November 2018:

  20. 20.

    Terrence Higgins Trust, 4 July 2019:

  21. 21.

    Data and replication code are available on Dataverse at:

  22. 22.

    See, for instance, The New York Times, 3 January 2018:

  23. 23.

    Metro Weekly, 12 November 2020:

  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:


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Magni, G., Reynolds, A. The Persistence of Prejudice: Voters Strongly Penalize Candidates with HIV. Polit Behav (2021).

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