Lessons on Stigma

Teaching about AIDS

Teaching about HIV/AIDS presents special challenges for the sociology curriculum. It would be hard to argue that a single disease has attracted greater stigma than HIV, despite the virus being neither especially contagious in the conventional sense of contagion (it cannot be caught by coughing or sneezing), nor even deadly if treated properly with antiretroviral drugs. Attitudes toward HIV typically reflect moral judgments rather than fears of contagion, with people living with HIV/AIDS (PLWHA) classified as deviant in the public imagination (Sonnex et al. 1987). This moral judgment presents a classroom challenge for two reasons: HIV is a controversial topic by any measure, and teaching about HIV calls for challenging commonly held prejudices and stereotypes.

HIV/AIDS has been called “the sociological epidemic” because issues of power, privilege, and the distribution of resources in society affect the social patterning of HIV/AIDS (Maticka-Tyndale 2001; Parker and Aggleton 2003). A sociological analysis of the intersections between power, inequality, and social structure makes HIV an ideal subject for developing critical thinking skills in the classroom (Moremen 2010). In writing about critical thinking as a course objective, Willis and Burns (2011) noted that sociology teaching seeks to disrupt students’ typical ways of knowing and to challenge commonsense views that might prevent them from learning. The overriding goal for the present course was to challenge assumptions that might keep students from learning why stigma is both harmful to PLWHA and a barrier to HIV prevention and treatment. The emphasis on HIV stigma in terms of C. Wright Mills’ (1959) concept of private trouble/public issue was especially important for teaching the course because while the stigma is often profoundly isolating at a personal level, it is also damaging for society as a whole (Lichtenstein 2012).

Sociologists who have taught courses on HIV or who include HIV instruction in other courses provide a rationale for why such classes should be offered. More than two decades ago, Weitz (1989) and Hunt (1990) reported independently that students were interested in the topic because of media publicity and because HIV represented a new epidemic with an uncertain trajectory. Kain (1987) described how instruction on the social aspects of HIV/AIDS could alert students to their own HIV risk and to the historical, economic, and cultural forces that affect health and illness. Klein (1993) observed that students often found it difficult to discuss such topics in the classroom and needed expert guidance in order to ask questions or raise concerns about the subject matter. The courses were offered when the HIV epidemic in the United States was barely a decade old and teaching about HIV was a novel experience for students and instructors alike.

Recent publications on teaching the sociology of HIV/AIDS are hard to find; Moremen’s (2010) article in Teaching Sociology is a rare exception. This decline in publications is a sign of the times: HIV/AIDS is no longer a major news story in the United States mainly because the extended lifespan of PLWHA through development of effective treatments (Gatell 2010) has led to complacency about HIV as a public health crisis (Henry J. Kaiser Family Foundation 2009). Nevertheless, around 6,000 AIDS-related deaths are reported in the United States each year, with a further 50,000 U.S. citizens diagnosed with HIV infection annually (Centers for Disease Control and Prevention 2012). It is noteworthy that, despite the medical advances and public complacency, stigmatizing ideas about HIV and social deviance are still fixed in the public imagination (Lichtenstein 2012). Moremen (2010) found that using sociological theory and engaging the students in active learning exercises helped to destigmatize the topic. For our own course, we used theory-based instruction, service learning, and research-in-community projects with the explicit goal of challenging stereotypes about PLWHA and HIV/AIDS. We also evaluated our success in a pre- and posttest assessment of student attitudes about HIV stigma. For both the curriculum and evaluation modules, we used Goffman’s (1963) dichotomous theory of stigma for attributions that are “felt” (perceived) and “enacted” (discriminatory), two concepts that are fundamental to understanding stigma and HIV/AIDS.

Course Development

Our decision to develop a course on the sociology of HIV/AIDS was prompted by published data about stigmatizing attitudes toward sexually transmitted infections (including HIV/AIDS) among college students (Lichtenstein, Neal, and Brodsky 2008; Neal, Lichtenstein, and Brodsky 2010). The studies indicated that the students would often be unwilling to seek treatment because of embarrassment or fear of being socially disgraced. Based on these data, we felt that raising awareness about HIV/AIDS could provide a counterpoint to stigmatizing tropes about HIV/AIDS. The course was created to reframe such ideas through the lens of sociology, especially in relation to discriminatory attitudes toward PLWHA.

Two sociological texts provided a theoretical foundation for the course. We used Goffman’s (1963) Stigma: Notes on Spoiled Identity to explain how judging people according to moral conformity, physical traits, and race/ethnicity or nationality leads to stigmatizing ideas about “them” and “us.” Judgments about PLWHA have involved all three Goffman dimensions, thus making HIV stigma particularly harsh. We also used Mills’s (1959) The Sociological Imagination and his public action theory, linking Goffman’s theory on stigma to Mills idea’ that people who developed a sociological imagination would be able to engage in reflexive thought, perhaps as a precursor to social activism. The two theories were used to help students understand how HIV/AIDS was socially constructed within a matrix of power relations. This complex idea was explored in coursework and direct learning exercises that could lead the students to make connections between community values and social marginalization of PLWHA.

The University and Class Settings

Sociology of HIV/AIDS is an elective course for undergraduates at the University of Alabama. With a 2013 enrollment of 34,852 students, the 180-year-old university is the flagship educational institution of the state. The student body is mostly white (80 percent), although African Americans (13 percent), Hispanic Americans (4 percent), and Asian Americans (2 percent) constitute a sizeable racial/ethnic minority. Men and women students represent 46 percent and 54 percent of the total, respectively. We teach the course as a seminar for upper-level undergraduate students, a format that allows a high degree of interaction between the instructor and class.

The inaugural class, offered in 2008, was taught by the first author, a medical sociologist who specializes in research on the sociology of HIV/AIDS. The course was repeated twice in 2009, with course objectives for stigma reduction being evaluated in the pre- and posttest assessment for fall 2009. On all three occasions, a full complement of 20 students enrolled in the class, which was a designated writing elective. Writing courses for undergraduates are typically capped at 35 students because instructors must provide specific writing instruction and all assignments are essays and term papers rather than multiple choice quizzes and tests. Most students in the class were sociology minors who majored in criminal justice, psychology, nursing, or social work. While there is no major in sociology at the University of Alabama, there is an active sociology program with 16 lower- and upper-division courses, including 2 upper-division courses on the sociology of health and illness.

In the first two classes, course enrollment consisted of 14 whites and 6 African Americans and 11 whites and 9 African Americans, respectively. For the third occasion, with the same class size, the class consisted of 13 whites, 4 African Americans, and 3 Hispanics. Most students had enrolled for instrumental reasons, either because they needed the course to complete the sociology minor or because they required a writing class to graduate. When asked, none of the students expressed a specific interest in HIV/AIDS or a desire to focus on HIV as a career. Several students reported that friends and family members actively discouraged them from taking the course because the subject was “nasty” or because of fears they might become infected if they had contact with PLWHA. One student’s parents worried that their daughter would be labeled an “AIDS victim” simply by enrolling in the class. These reactions indicated a level of stigma that the course was designed to address by learning about HIV/AIDS as a social problem that attracted stigma on multiple levels.

Strategic Planning for Stigma Reduction

The first two courses offered activities with a community partner, an AIDS service organization (ASO), such as organizing special events, compiling or distributing HIV materials, and shadowing HIV educators in the community. At the suggestion of the ASO, the service-learning component for the assessed course in fall 2009 offered direct contact with clients as well. We were excited about this addition to service learning because, as stated by Morgan and Streb (2001), interactions between students and clients can be pedagogically useful in helping to break down stereotypes about stigmatized groups. Dolgon and Baker (2011) noted that service learning, which Overby (2011:109) defined as a model in which students engage in community projects with their instructor as a “guide on the side,” is a vehicle for stigma reduction, especially when direct exposure to a particular social problem is a life-changing experience and catalyst for social action.

This article describes the assessed course in fall 2009, which unfolded as follows. In the first component, theoretical grounding and factual information raised awareness of HIV stigma as a social problem. In the second component, students engaged in service learning with the community partner as a means of connecting the dots between stigma theory and the lived experience of PLWHA. In the third component, students conducted interviews with so-called normals in order to gauge levels of HIV stigma in the community. The two experiential activities were analyzed in reflective papers in which students wrote about what they learned about felt or enacted stigma and their sociological interpretation of these phenomena. This theory-action-reflection model followed the Dolgon and Baker (2011) recommendation for theoretically-based experiential sociology that could prompt a lifelong interest in civic engagement.

The syllabus was organized into separate components. Weeks 1 to 4 were spent on lecture material, theory, and guest talks. In weeks 5 to 7, the students undertook service learning with the community partner. In weeks 8 through 11 students in groups of four made PowerPoint presentations focusing on HIV/AIDS in specific countries as part of a global focus. In weeks 12 to 15, the students prepared for and conducted community-based research on knowledge and attitudes toward HIV/AIDS. The assessment was administered as a pre- and posttest evaluation on the first and last days of class in order to evaluate our success in meeting course goals for stigma reduction.

Service Learning Projects

Planning for the service learning was facilitated by the first author’s affiliation with the ASO for fund-raising and community events. As our community partner, the ASO’s director proposed four types of projects for service learning for fall 2009: shadowing agency educators who convened Sisters Informing Sisters on Topics about AIDS HIV-prevention groups for African American women, distributing HIV materials to community groups, and organizing HIV educators to speak to schools, organizations, or students on campus. The fourth activity, which involved direct contact with clients for the first time, was to assist the agency’s driver in taking clients to medical appointments. These projects were designed to demystify HIV/AIDS and to reduce prejudice toward PLWHA “by learning about the humanity of the other” (Dolgon and Baker 2011:120).

The service-related activities unfolded in a stepwise fashion. In week 3 of the semester two educators from the ASO visited the class to speak about HIV prevention. The visit was informative, especially when the educators gave a primer on the biology of HIV/AIDS and role-played HIV-testing techniques. In the following class period, the students visited the ASO to meet the director and formulate their projects for class presentation. In week 4, a patient advocate, who was also a client, spoke to the class about living with HIV/AIDS. This visit was educational and inspiring; the speaker had overcome personal odds to become an HIV educator, author, and activist and was much in demand for speaking engagements about living (not dying) with HIV.

The students scheduled their service learning with our community partner in weeks 5 through 7 of the course. The service component did not fully work out as planned and serves as a caution for educators who engage in community collaborations, especially for sensitive topics such as HIV/AIDS. One student refused to visit the agency because she was afraid of touching contaminated surfaces. Another student, who did visit the agency, worried about the possibility of a PLWHA. wanting to shake hands with him. As he confided to the liaison, “I don’t want to meet anyone I have to shake hands with.” Several other students were absent without explanation. The students’ reactions took us by surprise; AIDS-related myths had been discussed in class, including the one about HIV being contagious. We thought the students’ fears had been allayed sufficiently to reduce their anxiety about visiting the ASO. We had also used several interventions to counter stigma, such as a class session on common myths and stereotypes, an online quiz from Avert.org (2012), and fact sheets that were distributed in class. The educators’ visit had further emphasized that HIV could not be caught from surfaces or by shaking hands. Nevertheless, the stigma persisted for some students and provided evidence of the difficulties of community engagement as described by Eby (1998) in terms of the challenge of introducing students to people who are different from themselves and of the tendency to perceive social difference in stereotypical terms.

In retrospect, the students’ reactions should not have been surprising. HIV/AIDS is often described in a graphic, even catastrophic fashion, including in academic texts that Weitz (1989, 1992) warned instructors to avoid in teaching classes. After the visit, we reiterated three essential points in the classroom: HIV is difficult to acquire; people cannot catch HIV from surfaces, sneezing, or through nonsexual contact (except for syringe sharing); and HIV is highly treatable. We also adopted a breaking news segment for the class to highlight new discoveries such as the role of antiretroviral drugs in preventing HIV transmission to sexual partners (Granich et al. 2009). This highlighting of discoveries was useful in countering stereotypes about PLWHA as a threat to public health.

A second unexpected event involved the ASO itself. Although our liaison had organized contact between students and clients as a new activity, the agency board of directors—consisting of PLWHA, physicians, and community members—rescinded approval for the plan. We learned about this development two days before the site visit. Our liaison was apologetic but was frank about the board’s change of heart: The clients did not want to meet students because they (clients) feared being exposed to the public. So there we had it; while some students feared meeting with PLWHA, the clients were fearful of meeting the students. It was a lesson in how fear of the other can interfere with designated activities for service learning on HIV/AIDS and how a backup plan conceptualized before the beginning of fall 2009 would have been a useful substitute. In class, we framed the experience as an example of Goffman’s (1963) concept of passing, whereby stigmatized people were compelled to maintain a virtual identity in face of threats to their social status.

The goal of forging student-client relationships through mutually beneficial activities as a core principle of the service-learning model (Israel et al. 1998; Smith 2004) had to be reconsidered at this point. Our liaison then asked if the students could collect items for the ASO’s food pantry and hygiene closet. This substitute plan was acceptable to the students, and they set about collecting toys, diapers, and baby items for caregivers as well as toiletries and food baskets for clients who were unemployed or disabled. These gifts were featured in the ASO’s annual report as a community-based initiative. Although voluntarism has been critiqued for reinforcing social inequalities instead of transforming them (Eby 1998), the module did follow Smith’s (2004:741) model for “serving the poor rather than just studying them.” The donations also filled a critical need in providing clients with food parcels and personal items in a recessionary economy.

The students’ opinions of this activity were generally positive, although moralizing attitudes sometimes interfered with our aim of challenging stereotypes about PLWHA. In her service report, a student confided that religious ideals about sexual morality prompted her to “put a bible in the baskets because I am a firm believer that having faith in God will help anybody through a stressful situation and any sickness, and it could help them to lead a purer life.” Other students did not cross this line, but some class members reported similar experiences to this one:

I had to ask the president [of sorority] if I would be allowed to ask my sorority sisters to donate to the cause. She agreed only if I write her an email extensively explaining the details of the project. My guess is that she did not want our sorority to be associated with HIV/AIDS unless it was for a class assignment. Then I had trouble getting my best friends to donate. It took them all day to return my calls or text messages. Sadly, this was not the last of my troubles. One of my roommates walked past my room and asked about the baskets. When I told her, she jumped back and yelled “Gross, eew, that’s disgusting. Why are you doing it?” I was completely speechless. (Service Report No. 8)

Students who selected another activity or who sought extra credit organized HIV-prevention sessions for campus organizations, churches, and workplaces (these sessions were conducted by ASO personnel) or distributed HIV-prevention materials to the community. In most cases, these efforts involved knocking on doors rather than mail drops (the students went in pairs for safety purposes) and made for lively debriefing sessions when class members recounted experiences of being rejected or having doors close in their faces. The students’ comments included, “Some people were embarrassed, especially the younger ones,” “It was clear that [the resident] wasn’t happy because she had a sour look on her face and then turned her back on me,” and “When they [passersby] saw the flyers they literally stopped in their tracks and looked at me like I was crazy or had some sort of awful, highly contagious disease.”

The attempts to organize ASO-led sessions at schools or youth groups were also thwarted. Officials expressed frank opposition to the distribution of HIV-prevention materials, particularly for high school students whose sex education had to follow federal policies for abstinence-based curricula. One student reported, “I was very disappointed in not being able to talk to the girls [on my basketball team] because I learned in class that the main problem with HIV/AIDS is that people are not very educated about it.” Another student who described his former high school as being progressive was nonplussed when the principal turned him down. He stated in his service report,

I had to leave several messages with the principal of my old high school about handing out HIV brochures to teachers. When he got back to me, he said that parents would not approve of such a notion so he couldn’t let me do it. To me, they are just keeping kids ignorant.

Taken together, these experiences were instructive to students who had learned firsthand about the pervasiveness of HIV stigma and discrimination and who wrote compellingly about this problem in their service reports. However, they had yet to interview community members about HIV/AIDS—an experience that would soon reveal whether the setbacks in service learning were indicative of broader community attitudes toward HIV/AIDS.

Research Projects

Once the service module was over and field reports graded, it was time to turn to the research projects. These projects were direct learning experiences that offered “fertile ground on which to test theories acquired in the classroom and to concretize abstract thought” (Kupiec 1993:7). The projects were designed to encourage thoughtful reflection about community responses to HIV/AIDS and the role of stigma in framing these responses. We required students to design an interview sheet, conduct face-to-face interviews, analyze interview data by using theoretical concepts, and present their findings in well-written reports. One class period was allocated to creating a template for the interview sheets, which consisted of nine or more open-ended items and four to six demographic items. Students could modify the template if they wished, subject to instructor approval. Interview questions for the template consisted of the following items:

Each student recruited at least 10 participants from among friends and family, coworkers, or residents who lived locally in their same town or county. The number of respondents for each student ranged from 10 to 15. These student-researchers interviewed respondents on campus or in local workplaces or organizations, but some class members traveled home to interview their participants—an impressive feat in an already crowded schedule. While class projects are exempt from institutional review board requirements at the University of Alabama, we ensured that the students understood their ethical obligations for voluntary participation and confidentiality protections.

Each student had to analyze his or her own data for a research report. Preparation for this task consisted of creating a Word file for data management, making brief headings for each interview item, and inserting appropriate interview responses under each heading. This process allowed students to view the grouped responses at a glance. If the responses were similar (e.g., in the case of family members or sorority sisters), then the student noted how kinship or group affiliation might account for the results. However, if the respondents were unaffiliated but the results were the same, then the student concluded that these opinions reflected the generalized other of the community. If the responses diverged across a group, then the students matched individual responses with demographic information to identify differences by race/ethnicity, gender, age, education, or religiosity. These differences were then noted or interpreted in their reports. Some class members could not perform the analyses well, but the more adept students presented their results in sociological terms. Examples include, “The men were harsher toward HIV/AIDS than women, and they really didn’t like gays,” “My sisters and cousins are more accepting of PLWHA than my grandparents so I would guess there is a generation gap,” and “The more people knew about HIV/AIDS, the more tolerant they were and vice versa.”

The results reflected the stigma constructs that were theorized in class. AIDS iconography about “gays, drug users, and hookers” was almost universal among the participants, illustrating how public attitudes about HIV/AIDS remain firmly rooted in representations from the 1980s (Treichler 1999). The long-standing myth about mosquitoes’ transmitting HIV appeared, along with the belief that PLWHA intentionally infect other people. Many respondents believed that church attendance and sexual morality were synonymous and that church leaders had the right idea: sexual abstinence, monogamy, and religiosity protected against promiscuity and thus HIV. The respondents generally believed that sexual abstinence should be taught in high schools because condoms were both unreliable and encouraged teenagers to have sex. In template item number 9, respondents selected the diabetes event over the AIDS charity because “my mom (or other relative) has diabetes” or “they shouldn’t get it [HIV/AIDS] in the first place.” These answers were unsurprising in terms of common views about HIV and immorality but were useful in prompting the students to realize that stigma could affect even charitable giving.

We required the students to identify three themes relating to discredited identity with which to frame their results. These themes were based on Goffman’s (1963) stigma typologies in which negative social judgments about physical appearance, personal character, and group affiliation relate to acts of discrimination. Only a few students provided interview quotes in which HIV/AIDS was associated with physical illness (e.g., “If you have AIDS you look wasted”). However, quotes relating to moral character and group affiliation were more common. Comments in the first category included the following: “Church-going people don’t get AIDS,” “If you have sex before marriage, you’re likely get AIDS,” and “In my view, the ones who get AIDS are sinful.” Comments in the second category included, “Only gay men, prostitutes, and drug users get HIV/AIDS,” “Prisoners get it because of the drugs,” and “Black men have sex on the down-low.” The concept of discredited identity, as illustrated through these stigma typologies, proved useful in explaining how stigma reinforced the moral status quo. The theory also prompted the realization that HIV stigma was a powerful mechanism for defining in-group/out-group behavior and for exerting control over people’s lives.

In their research reports, some students confessed to having similar beliefs before taking the class, even if they since had a change of heart. Stigma theory, as applied to community-based research, thus provided a useful tool for examining the students’ own attitudes and, as stated by Parker and Aggleton (2003), understanding society’s role in legitimizing ideas about punishment, guilt, shame, and otherness in relation to HIV/AIDS. An appreciation of the links between theory, HIV, and stigma did emerge from interviewing coworkers, friends, or family (individuals who represented the generalized other in attitudes toward HIV/AIDS).

A final debriefing session revealed that students had gained greater knowledge of HIV stigma as a social force and potential source of action, an outcome that was congruent with Lena’s (1995:108) statement about creating “awareness of profound social problems of our times and . . . the importance of civic education and civic responsibility in a democratic society.” Two students wrote that they were inspired to seek health-related careers, and several others stated that their own knowledge and attitudes toward HIV/AIDS had changed for the better. We were gratified to learn that the research projects had illuminated the enacted stigma aspect of Goffman’s (1963) stigma theory in this way and that some students had a transformative experience in terms of both seeing HIV stigma as a social construct and developing future career goals for civic engagement. These stated positive changes in HIV-related attitudes were then studied through the pretest/posttest stigma assessment, which is discussed next.

The Stigma Assessment

The assessment drew on a protocol that was developed from existing assessment instruments for sexually transmitted infection stigma (Lichtenstein et al. 2008; Neal et al. 2010). The University of Alabama’s institutional review board approved the protocol, recruitment script, participation information sheet, and consent form prior to administration. To protect student confidentiality, each protocol and consent form was assigned a unique identifier rather than the student-participant’s name. The students were informed that their grades would not be affected by refusal to participate.

The stigma assessment consisted of two types of Likert-style items. The first type assessed enacted stigma according to students’ comfort in being around PLWHA. The second type assessed felt stigma, or students’ hypothetical reactions to being diagnosed with HIV/AIDS. All stigma items used a scale from 1 to 10, with higher values corresponding to more discomfort with PLWHA and more felt stigma should the students be diagnosed with HIV/AIDS. We also elicited information about the respondents’ gender, race/ethnicity, parents’ education, sexual orientation, religiosity, and social conservatism.

Changes in Attitudes toward PLWHA (Enacted Stigma)

Pre- and posttest results for attitudes toward PLWHA appear in Table 1. By the end of the semester, there were two significant changes in participants’ beliefs: They were less afraid of kissing someone with HIV/AIDS and less likely to believe that PLWHA were promiscuous. Nonsignificant declines were observed in relation to fear of hugging, avoiding social contact with PLWHA, and telling friends about the PLWHA’s diagnosis. While participants expressed greater fear of being in the same room as PLWHA at posttest, the scores were low at both time points. The desire to avoid sex with PLWHA remained equally high in both pre- and posttest assessments, indicating that course instruction did not ease fears about being infected through sexual contact.

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Table 1.

Students’ Attitudes toward People Living with HIV (N = 20).

Question	Pretest	Posttest
If someone I knew were diagnosed with HIV, I would	M (SD)	M (SD)	Test Significance
Be afraid of hugging them	3.10 (3.24)	2.50 (2.59)	t(19) = 0.78, p = .44
Be afraid of kissing them	6.89 (3.28)	4.26 (3.21)	t(18) = 3.69, p = .002 a
Be afraid of being in the same room	1.53 (1.31)	1.63 (2.09)	t(18) = −0.30, p = .77 b
Avoid having much to do with them	2.85 (2.74)	1.80 (1.70)	t(19) = 1.62, p = .12
Avoid having sex with them	9.85 (0.67)	9.85 (0.67)	t(19) = 0.00, p = 1.00
Tell my friends about their HIV status	4.50 (3.44)	3.55 (3.02)	t(19) = 1.38, p = .18
Believe they had been promiscuous	5.95 (3.22)	4.53 (2.09)	t(18) = 2.67, p = .02 a

a

Significant decrease in stigma.

b

Nonsignificant increase in stigma.

Changes in Attitudes toward Being Diagnosed (Felt Stigma)

The mean scores for responses to the six items asking participants to report their attitudes toward becoming a PLWHA appear in Table 2. Three items showed a significant change at posttest. Students reported that they would feel less ashamed and less embarrassed if they were diagnosed with HIV/AIDS and were less concerned about their reputations. Nevertheless, the scores for most items (feeling ashamed, embarrassed, dirty, and betrayed and fearing for reputation) scored toward the upper end of the stigma scale at both time points. For the health-related items, fear of being ill or dying of HIV/AIDS scored at the top end of the scale at both time points, with no significant reductions in stigma. Although most participants would be likely to see a doctor and notify a sexual partner, avoidance increased for these items at posttest. Participants were also less likely to disclose a positive HIV diagnosis to other people. The desire to end a relationship with someone who infected them remained high at posttest, as did feelings of betrayal—two results that involve strong feelings about the rules of sexual intimacy.

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Table 2.

Students’ Attitudes toward Becoming HIV Infected (N = 20).

Question	Pretest	Posttest
If I were diagnosed with HIV I would	M (SD)	M (SD)	Test Significance
Afraid for reputation
Feel ashamed	9.20 (1.20)	7.95 (3.08)	t(19) = 2.17, p = .04 a
Feel embarrassed	9.65 (0.81)	8.05 (2.89)	t(19) = 2.65, p = .02 a
Feel dirty	8.60 (2.04)	7.90 (2.81)	t(19) = 1.73, p = .10
Feel betrayed	9.25 (1.41)	8.85 (1.98)	t(19) = 1.00, p = .33
Feel that I had committed a sin	5.25 (3.58)	4.20 (3.17)	t(19) = 1.24, p = .23
Be concerned about my reputation	9.50 (1.24)	8.45 (2.24)	t(19) = 2.08, p = .05 a
Afraid for health
Fear having health problems now	9.80 (0.70)	9.30 (1.34)	t(19) = 1.49, p = .15
Fear having health problems later	9.90 (0.31)	9.60 (0.88)	t(19) = 1.45, p = .16
Be afraid of dying	9.45 (1.88)	9.10 (2.13)	t(19) = 0.54, p = .60
Afraid of disclosure
Not tell anyone	7.60 (2.60)	7.85 (2.72)	t(19) = −0.53, p = .60 b
Avoid seeing a doctor	2.20 (2.89)	2.40 (2.72)	t(19) = −0.38, p = .71 b
Be too embarrassed to see a   doctor	3.50 (3.14)	2.70 (2.60)	t(19) = 1.21, p = .24
Avoid notifying sexual partner	2.65 (3.27)	3.30 (3.69)	t(19) = −0.61, p = .55 b
Anger at being infected
End relationship with person   who infected me	8.50 (2.12)	8.35 (2.83)	t(19) = 0.19, p = .85

a

Significant decrease in stigma.

b

Nonsignificant increase in stigma.

Reflections on Course Goals for Stigma Reduction

The results of the stigma assessment led us to evaluate our course goals of reducing HIV stigma through theory-based instruction, service learning, and community research. Two anticipated outcomes were (1) increased tolerance toward PLWHA and (2) less shame and avoidance if diagnosed with HIV/AIDS. The goal of increased tolerance was achieved in terms of less desire to avoid PLWHA and less blame toward people who had been diagnosed with HIV. However, this empathy did not translate to feeling comfortable in the event of being diagnosed with HIV/AIDS. While less likely to react with embarrassment or shame, the students were also more afraid of being stigmatized, as evidenced by the desire to avoid telling other people. We interpret these results to mean that students were acutely aware of the social realities of living with HIV/AIDS—a sensibility that might have been reinforced by doing community-based projects in the socially conservative South. Instructors should be aware that teaching about the sociology of HIV/AIDS could make students more knowledgeable about HIV/AIDS but also more fearful of HIV stigma. Nevertheless, we felt a sense of achievement in engaging the students on an important social issue, in reducing stigma toward PLWHA on several measures, and in encouraging less self-blame in the event of being diagnosed with HIV/AIDS.

Concluding Comments

Let us summarize the lessons learned from the service learning and research projects. First, educators should not expect miracles in changing fear-based ideas about HIV/AIDS; it can be especially difficult to inspire students who are committed to conventional values. In the present case, fear of stigma was a powerful force for protecting self-identities as healthy and unspoiled. Second, in partnering with an ASO, educators should be prepared for unexpected developments when service learning is offered, especially for sensitive topics such as HIV/AIDS. Our experience suggests that instructors should have written confirmation of the activities being offered for service learning or risk having tasks that are lacking in educational value (Morgan and Streb 2001) or, like the charitable giving described earlier, have been critiqued for reinforcing existing social structures (Eby 1998). However, we believe that the experience was mutually beneficial for students and clients and also effective in highlighting the pervasiveness of HIV stigma and discrimination in society. Third, we learned that community research was effective in raising awareness about HIV stigma as a social problem and can recommend this activity to instructors who wish to use student-centered learning for this purpose. Finally, we learned that the stigma assessment was more valuable than oral and written class feedback in revealing students’ actual feelings about HIV stigma. The course is clearly a work in progress in hitting the right note for addressing HIV stigma in the classroom.

Despite the persistent stigma about HIV/AIDS, teaching a sociology course on HIV/AIDS offers considerable rewards for instructors and students alike. Instructors who teach these courses are often passionate about the topic, and their pedagogical efforts to destigmatize HIV/AIDS may be facilitated through the lens of sociology. Students who become engaged in the subject matter can become advocates for HIV prevention; many students will also find that their service learning experiences and research projects are useful for building resumes for employment and applications to graduate school. Sociology instructors should not be afraid to offer courses that explore the sociological aspects of HIV/AIDS, even in high-stigma contexts. It has been 20 years since Brabant (1991:491) wrote a now out-of-date conclusion about integrating HIV materials into existing courses because “the creation of courses on AIDS education may not be possible.” The greater threat to teaching about the sociology of HIV/AIDS is the waning interest in HIV/AIDS as a sociocultural phenomenon. Existing, published syllabi need to be modernized to keep pace with epidemiologic trends and learning techniques. Students would benefit from knowing how HIV stigma is socially constructed, why HIV epidemiology is a moving target in terms of incidence and prevalence, and most importantly, how the sociological imagination can be usefully employed in making connections between theory, practice, and social change for a treatable infection that is both produced and reproduced through social stigma.