Lessons on Stigma: Teaching about HIV/AIDS

Author(s): Bronwen Lichtenstein and Jamie DeCoster

Source: Teaching Sociology, Vol. 42, No. 2 (APRIL 2014), pp. 140-150
Published by: American Sociological Association
Stable URL: https://www.jstor.org/stable/43187474
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 Teaching Sociology
2014, Vol. 42(2) 140-150

Lessons on Stigma: Teaching © American Sociological Association 20 1 3

DOI: 1 0. 1 1 77/0092055X 1 35 1 04 1 2

about HIV/AIDS ts.sagepub.com

fSAGE

Bronwen Lichtenstein1 and Jamie DeCoster2

Abstract
Teaching about the sociology of HIV/AIDS involves teaching about the causes and effects of sti
describe a Sociology of HIV/AIDS course at the University of Alabama in which stigma reduct
assessed as a primary objective. The syllabus involved theory-based instruction, class visits, service l
and student research on community attitudes toward HIV/AIDS. We report on how stigma affe
service learning and other elements of the course, calling for adjustments to our pedagogical a
We also report how the course was evaluated in a pretest/posttest assessment on attitudes towa
living with HIV/AIDS [PLWHA] (enacted stigma) and hypothetical reactions to being diagnosed w
(felt stigma). The results indicated greater tolerance for PLWHA following the class but also g
awareness of HIV stigma and its outcomes. We offer recommendations to help instructors avoid
related materials and events that could jeopardize service learning and course objectives for se
topics such as HIV/AIDS.

Keywords
course assessment, community-based learning, social problems, student engagement

TEACHING ABOUT AIDS analysis of the intersections between power,

inequality, and social structure makes HIV an ideal
Teaching about HIV/AIDS presents special chal-
subject for developing critical thinking skills in the
lenges for the sociology curriculum. It >vould be
classroom (Moremen 2010). In writing about criti-
hard to argue that a single disease has attracted
cal thinking as a course objective, Willis and Burns
greater stigma than HIV, despite the virus being
(2011) noted that sociology teaching seeks to dis-
neither especially contagious in the conventional
rupt students' typical ways of knowing and to chal-
sense of contagion (it cannot be caught by cough-
lenge commonsense views that might prevent them
ing or sneezing), nor even deadly if treated prop-
from learning. The overriding goal for the present
erly with antiretroviral drugs. Attitudes toward
course was to challenge assumptions that might
HIV typically reflect moral judgments rather than
keep students from learning why stigma is both
fears of contagion, with people living with HIV/
harmful to PLWHA and a barrier to HIV prevention
AIDS (PLWHA) classified as deviant in the public
and treatment. The emphasis on HIV stigma in
imagination (Sonnex et al. 1987). This moral judg-
terms of C. Wright Mills' (1959) concept of private
ment presents a classroom challenge for two rea-
sons: HIV is a controversial topic by any measure,
and teaching about HIV calls for challenging'University
com- of Alabama, Tuscaloosa, AL, USA
monly held prejudices and stereotypes. 2University of Virginia, Charlottesville, VA, USA

HIV/AIDS has been called "the sociological

Corresponding Author:
epidemic" because issues of power, privilege, and Lichtenstein, Department of Criminal Justice,
Bronwen
the distribution of resources in society affect the
University of Alabama, 430 Farrah Hall, Tuscaloosa, AL
870320-0320, USA.
social patterning of HIV/AIDS (Maticka-Tyndale
Email: blichten@ua.edu
2001; Parker and Aggleton 2003). A sociological

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 Lichtenstein and DeCoster

two concepts that are fundamental toissue

trouble/public understand-
teachinging stigma
the and HIV/AIDS. course
often profoundly iso
also damaging for
COURSE DEVELOPMENT so
2012).
Our decision to develop a course on the sociology
Sociologists who have taught courses on HIV or
who include HIV instruction in other courses pro-
of HIV/AIDS was prompted by published data
about stigmatizing attitudes toward sexually trans-
vide a rationale for why such classes should be
mitted infections (including HIV/AIDS) among
offered. More than two decades ago, Weitz (1989)
college students (Lichtenstein, Neal, and Brodsky
and Hunt (1990) reported independently that stu-
2008; Neal, Lichtenstein, and Brodsky 2010). The
dents were interested in the topic because of media
studies indicated that the students would often be
publicity and because HIV represented a new epi-
unwilling to seek treatment because of embarrass-
demic with an uncertain trajectory. Kain (1987)
ment or fear of being socially disgraced. Based on
described how instruction on the social aspects of
HIV/AIDS could alert students to their own HIV these data, we felt that raising awareness about
risk and to the historical, economic, and cultural HIV/AIDS could provide a counterpoint to stigma-
forces that affect health and illness. Klein (1993) tizing tropes about HIV/AIDS. The course was cre-
observed that students often found it difficult to ated to reframe such ideas through the lens of
sociology, especially in relation to discriminatory
discuss such topics in the classroom and needed
attitudes toward PLWHA.
expert guidance in order to ask questions or raise
Two sociological texts provided a theoretical
concerns about the subject matter. The courses
foundation for the course. We used Goffman's
were offered when the HIV epidemic in the United
States was barely a decade old and teaching (1963) Stigma: Notes on Spoiled Identity to explain
how judging people according to moral conformity,
about HIV was a novel experience for students and
instructors alike. physical traits, and race/ethnicity or nationality
leads to stigmatizing ideas about "them" and "us."
Recent publications on teaching the sociology
of HIV/AIDS are hard to find; Moremen's (2010) Judgments about PLWHA have involved all three
Goffman dimensions, thus making HIV stigma par-
article in Teaching Sociology is a rare exception.
ticularly harsh. We also used Mills's (1959) The
This decline in publications is a sign of the times:
HIV/AIDS is no longer a major news story in the
Sociological Imagination and his public action
theory, linking Goffman's theory on stigma to
United States mainly because the extended lifespan
Mills' idea that people who developed a sociologi-
of PLWHA through development of effective treat-
cal imagination would be able to engage in reflex-
ments (Gatell 2010) has led to complacency about
HIV as a public health crisis (Henry J. Kaiser ive thought, perhaps as a precursor to social
activism. The two theories were used to help stu-
Family Foundation 2009). Nevertheless, around
6,000 AIDS-related deaths are reported in the dents understand how HIV/AIDS was socially con-
structed within a matrix of power relations. This
United States each year, with a further 50,000 U.S.
citizens diagnosed with HIV infection annually
complex idea was explored in coursework and
direct learning exercises that could lead the stu-
(Centers for Disease Control and Prevention 2012).
dents to make connections between community
It is noteworthy that, despite the medical advances
values and social marginalization of PLWHA.
and public complacency, stigmatizing ideas about
HIV and social deviance are still fixed in the public
imagination (Lichtenstein 2012). Moremen (2010) THE UNIVERSITY AND CLASS
found that using sociological theory and engaging
SETTINGS
the students in active learning exercises helped to
destigmatize the topic. For our own course, we Sociology of HIV/AIDS is an elective course for
used theory-based instruction, service learning, and undergraduates at the University of Alabama. With a
research-in-community projects with the explicit 2013 enrollment of 34,852 students, the 180-year-
goal of challenging stereotypes about PLWHA and old university is the flagship educational institution
HIV/AIDS. We also evaluated our success in a pre- of the state. The student body is mostly white
and posttest assessment of student attitudes about (80 percent), although African Americans (13 per-
HIV stigma. For both the curriculum and evalua- cent), Hispanic Americans (4 percent), and Asian
tion modules, we used Goffman's (1963) dichoto- Americans (2 percent) constitute a sizeable racial/
mous theory of stigma for attributions that are ethnic minority. Men and women students represent
"felt" (perceived) and "enacted" (discriminatory), 46 percent and 54 percent of the total, respectively.

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 1 42 Teaching Sociology 42(2)

We teach the courseHIV

as a seminar
educators in the community.for upper-
At the suggestion
undergraduate of the ASO,
students, the service-learning
a format component
that for the
allows a
degree of assessed
interaction course in fall 2009 offered
between the directinstructo
contact
class. with clients as well. We were excited about this
The inaugural class,addition
offeredto service learning because, as stated
in 2008, was by tau
by the first author, Morgan and Streb (2001),sociologist
a medical interactions between stu-who
cializes in research dents and
on the clients can be pedagogically of
sociology useful HIV/
in
The course was helping totwice
repeated break down stereotypes
in 2009, c about stigma-
with
objectives for stigmatizedreduction
groups. Dolgon and Baker (2011) notedevaluat
being that
the pre- and posttestservice learning, which Overby (201
assessment for 1 : 109)fall
defined 200
all three occasions, a
as a full complement
model in which students engage in communityof 20
dents enrolled in theprojects
class, with their instructor as
which wasa "guidea on design
the
writing elective. side," is a vehicle
Writing for stigma reduction,
courses for especially
undergr
ates are typically capped at to35
when direct exposure students
a particular social problem be
instructors must is a life-changing
provide experience and writing
specific catalyst for social inst
tion and all action.
assignments are essays and term p
rather than multiple This article describes
choice the assessed course
quizzes and in fall tests.

students in the class

2009,were sociology
which unfolded as follows. In the first minors
compo-
majored in criminal nent, theoretical grounding
justice, psychology,and factual information
nursin
social work. While raised awareness
there is no of HIV major
stigma as a social
in problem.
sociolo
the University of In the second component,
Alabama, there students
isengaged
an inactive
ser-
ology program withvice 16 lower-
learning and
with the community upper-div
partner as a means
courses, including 2 ofupper-division
connecting the dots between stigmacourses
theory and o
the livedillness.
sociology of health and experience of PLWHA. In the third compo-
nent, students
In the first two classes, conducted interviews
course with so-called
enrollment c
sisted of 14 whites and 6 African
normals Americans
in order to gauge levels of HIV stigma in and
whites and 9 AfricantheAmericans,
community. The two experiential activities were
respectively
the third occasion, analyzed in reflective
with the same papers in which studentssize,
class
class consisted of 1 3wrote
whites,
about what they4 African
learned Ameri
about felt or enacted
and 3 Hispanics. Most students
stigma and had enrolle
their sociological interpretation of these
phenomena.
instrumental reasons, either This theory-action-reflection
because they model ne
followed thethe
the course to complete Dolgon and Baker (2011) recommen-
sociology min
because they required dation a
for writing
theoretically-based experiential
classsociology
to grad
When asked, none ofthat thecould prompt
students a lifelong interest
expressedin civic a
cific interest in HIV/AIDS or a desire to focus on engagement.
HIV as a career. Several students reported that The syllabus was organized into separate com-
friends and family members actively discouraged ponents. Weeks 1 to 4 were spent on lecture mate-
them from taking the course because the subject rial, theory, and guest talks. In weeks 5 to 7, the
was "nasty" or because of fears they might become students undertook service learning with the com-
infected if they had contact with PLWHA. One stu- munity partner. In weeks 8 through 1 1 students in
dent's parents worried that their daughter would be groups of four made PowerPoint presentations
labeled an "AIDS victim" simply by enrolling in focusing on HIV/AIDS in specific countries as part
the class. These reactions indicated a level of of a global focus. In weeks 12 to 15, the students
prepared for and conducted community-based
stigma that the course was designed to address by
learning about HIV/AIDS as a social problem thatresearch on knowledge and attitudes toward HIV/
attracted stigma on multiple levels. 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
STRATEGIC PLANNING FOR
course goals for stigma reduction.
STIGMA REDUCTION
The first two courses offered activities with a com-
munity partner, an AIDS service organization SERVICE LEARNING PROJECTS
Planning
(ASO), such as organizing special events, compil- for the service learning was facilitated
by the first author's affiliation with the ASO for
ing or distributing HIV materials, and shadowing

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 Lichtenstein and DeCoster 1 43

fund-raising and thatcommunity

were distributed in class. The educators' visit
events.
munity partner, had
thefurtherASO's
emphasized that HIV could not be
director pr
types of projects caught
for from surfaces or by shaking
service hands.
learning
shadowing agency Nevertheless, the stigma persisted who
educators for some stu-con
Informing Sisters on evidence
dents and provided Topics about
of the difficulties of
prevention groupscommunity
for engagement
African as described byAmerEby
distributing HIV(1998) in terms of the challenge to
materials of introducing
commu stu-
dents to people
and organizing HIV who are different from themselves
educators to spea
organizations, orand students
of the tendency to perceiveon
social difference
campus in
activity, which stereotypical terms.
involved direct contact
for the first time, In retrospect,
wasthe students'
to reactions should
assist thenot ag
in taking haveto
clients been surprising.
medical HIV/AIDS is often described
appointm
projects were in a graphic, even catastrophic
designed to fashion, including
demystif
and to reduce in academic texts that
prejudice Weitz (1989, 1992)PLWH
toward warned
ing about the instructors to avoid
humanity of the other" in teaching classes. After the
Baker 2011:120).visit, we reiterated three essential points in the
The classroom:activities
service-related HIV is difficult to acquire; people can-
unfolded
wise fashion. In week
not catch HIV 3
fromof the
surfaces, sneezing, semeste
or through
tors from nonsexual
ASO thecontact (except forthe
visited syringe sharing);
class and to
HIV HIV is highly treatable.
prevention. The visit was inform We also adopted a breaking
cially when the news segment for the class to highlight
educators gave new discov-
a pr
eries such as theand
biology of HIV/AIDS role of antiretroviral
role-playeddrugs in pre-
techniques. In theventing HIV transmission to sexual
following partners per
class
dents visited the (Granich
ASO et al.to
2009). This
meet highlighting of discov-
the dire
eries was useful
mulate their projects for in countering
class stereotypes
presentabout
4, PLWHA as a threat
a patient advocate, who to public health.
was also a
tothe class about A second unexpected
living event involved
with the ASO
HIV/AID
was educational itself.
and Althoughinspiring;
our liaison had organized contactthe
overcome personalbetween students
odds and clients
to as a become
new activity, the a
tor, author, and agency board of directors
activist and- consisting
wasof PLWHA,
muc
for speaking physicians, and community about
engagements members - rescinded
livin
with HIV. approval for the plan. We learned about this devel-
The students opment two days before the
scheduled site visit. Ourservic
their liaison
with our was apologetic
community but was frank about
partner inthe board's
weeks
of the change
course. The of heart: The clients
service did not want to meet
component
students because
work out as planned and they (clients)
serves feared being as a
exposed to the public.
educators who engage inSo there we had it; while
communi
tions, especially some
for students feared meeting with PLWHA,
sensitive topics the
AIDS. One student clients wererefused to Itvisit
fearful of meeting the students. was
because she was aafraid
lesson in how fear ofofthe other can interfere with
touching c
surfaces. Another designated
student, activities for service
who learning
didon HIV/visi
worried about AIDS and
the how a backup plan conceptualized
possibility of a PL
ing to shake handsbefore with
the beginning him.
of fall 2009 would
As have been
he co
liaison, "I don't a want
useful substitute. to
In class, meet
we framed the experi-
anyo
shake hands with." Several other students were ence as an example of Goffman's ( 1 963) concept of
passing, whereby stigmatized people were com-
absent without explanation. The students' reactions
pelled to maintain a virtual identity in face of
took us by surprise; AIDS-related myths had been
threats to their social status.
discussed in class, including the one about HIV
being contagious. We thought the students' fears The goal of forging student-client relationships
had been allayed sufficiently to reduce their anxi-through mutually beneficial activities as a core
ety about visiting the ASO. We had also used sev- principle of the service-learning model (Israel et al.
eral interventions to counter stigma, such as a class1998; Smith 2004) had to be reconsidered at this
session on common myths and stereotypes, anpoint. Our liaison then asked if the students could
online quiz from Avert.org (2012), and fact sheetscollect items for the ASO's food pantry and hygiene

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 1 44 Teaching Sociology 42(2)

closet. This substitute plan

being rejected was
or having doors acceptable
close in their faces. t
students, and they The
set students' comments included,
about "Some people
collecting toy
pers, and baby itemswere
forembarrassed, especially the younger ones,"
caregivers as well as
ries and food baskets for clients who were "It was clear that [the resident] wasn't happy
because she had a sour look on her face and then
unemployed or disabled. These gifts were featured
turned her back on me," and "When they [pass-
in the ASO 's annual report as a community-based
initiative. Although voluntarism has been critiqued
ersby] saw the flyers they literally stopped in their
tracks
for reinforcing social inequalities instead of and looked at me like I was crazy or had
trans-
forming them (Eby 1998), the module did follow
some sort of awful, highly contagious disease."
Smith's (2004:741) model for "serving theThe
poor
attempts to organize ASO-led sessions at
schools
rather than just studying them." The donations or youth groups were also thwarted.
also
filled a critical need in providing clients with foodexpressed frank opposition to the distri-
Officials
parcels and personal items in a recessionary
bution of HIV-prevention materials, particularly
economy. for high school students whose sex education had
The students' opinions of this activity were gen-to follow federal policies for abstinence-based cur-
erally positive, although moralizing attitudesricula. One student reported, "I was very disap-
sometimes interfered with our aim of challengingpointed in not being able to talk to the girls [on my
stereotypes about PLWHA. In her service report, abasketball team] because I learned in class that the
student confided that religious ideals about sexual
main problem with HIV/AIDS is that people are
morality prompted her to "put a bible in the basketsnot very educated about it." Another student who
because I am a firm believer that having faith indescribed his former high school as being progres-
God will help anybody through a stressful situation
sive was nonplussed when the principal turned him
and any sickness, and it could help them to lead down.
a He stated in his service report,
purer life." Other students did not cross this line,
but some class members reported similar experi- I had to leave several messages with the
ences to this one:
principal of my old high school about
handing out HIV brochures to teachers.
I had to ask the president [of sorority] if I When he got back to me, he said that parents
would be allowed to ask my sorority sisters would not approve of such a notion so he
to donate to the cause. She agreed only if I couldn't let me do it. To me, they are just
write her an email extensively explaining keeping kids ignorant.
the details of the project. My guess is that
she did not want our sorority to be associated Taken together, these experiences were instructive
with HIV/AIDS unless it was for a class to students who had learned firsthand about the
assignment. Then I had trouble getting mypervasiveness of HIV stigma and discrimination
best friends to donate. It took them all day to and who wrote compellingly about this problem in
return my calls or text messages. Sadly, thistheir service reports. However, they had yet to
was not the last of my troubles. One of my interview community members about HIV/AIDS -
roommates walked past my room and askedan experience that would soon reveal whether the
about the baskets. When I told her, she setbacks in service learning were indicative of
jumped back and yelled "Gross, eew, that's broader community attitudes toward HIV/AIDS.
disgusting. Why are you doing it?" I was
completely speechless. (Service Report
No. 8) RESEARCH PROJECTS
Once the service module was over and field reports
Students who selected another activity or who graded, it was time to turn to the research projects.
sought extra credit organized HIV-prevention ses- These projects were direct learning experiences
sions for campus organizations, churches, and that offered "fertile ground on which to test theo-
workplaces (these sessions were conducted by ries acquired in the classroom and to concretize
ASO personnel) or distributed HIV-prevention abstract thought" (Kupiec 1993:7). The projects
materials to the community. In most cases, these were designed to encourage thoughtful reflection
efforts involved knocking on doors rather than mail about community responses to HIV/AIDS and the
drops (the students went in pairs for safety pur- role of stigma in framing these responses. We
poses) and made for lively debriefing sessions required students to design an interview sheet, con-
when class members recounted experiences of duct face-to-face interviews, analyze interview

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 Lichtenstein and DeCoster 1 45

unaffiliated but the results were

data by using theoretical the same, then the
concepts, a
their findings instudent concluded that these opinions reflected
well-written report the
generalized
period was allocated to other of the community.
creating a If the
templ
interview sheets, responses
which divergedconsisted
across a group, then the
ofstu- ni
open-ended dents and
items matched individual
four responses
to with demo- de
six
items. Students could modify
graphic information the bytemp
to identify differences race/
wished, subject ethnicity,
to gender, age, education, approval
instructor or religiosity.
questions for the These differences were then
template noted or interpreted in
consisted of
ing items: their reports. Some class members could not per-
form the analyses well, but the more adept students
1 . How do people acquire HIV/AIDS? presented their results in sociological terms.
2. Who is most likely to be diagnosed and Examples include, "The men were harsher toward
why? HIV/AIDS than women, and they really didn't like
3. What should high school students be gays," "My sisters and cousins are more accepting
taught about HIV prevention? of PLWHA than my grandparents so I would guess
4. What are some common attitudes there is a generation gap," and "The more people
toward HIV/AIDS? knew about HIV/AIDS, the more tolerant they
5. What are some common attitudes were and vice versa."
toward condom use? The results reflected the stigma constructs that
6. What are some common attitudes were theorized in class. AIDS iconography about
toward homosexuality? "gays, drug users, and hookers" was almost univer-
7. What should church leaders do to com- sal among the participants, illustrating how public
bat HIV/AIDS? attitudes about HIV/AIDS remain firmly rooted in
8. How does HIV/AIDS affect people in representations from the 1980s (Treichler 1999).
your community? The long-standing myth about mosquitoes' trans-
9. If you were asked to donate to an AIDS mitting HIV appeared, along with the belief that
charity or a diabetes event, which PLWHA intentionally infect other people. Many
would you choose and why? respondents believed that church attendance and
sexual morality were synonymous and that church
leaders had the right idea: sexual abstinence,
Each student recruited at least 10 participants
monogamy, and religiosity protected against pro-
from among friends and family, coworkers, or resi-
dents who lived locally in their same town miscuity
or and thus HIV. The respondents generally
believed that sexual abstinence should be taught in
county. The number of respondents for each student
ranged from 10 to 15. These student-researchers high schools because condoms were both unreli-
interviewed respondents on campus or in local able and encouraged teenagers to have sex. In tem-
workplaces or organizations, but some class mem-plate item number 9, respondents selected the
diabetes
bers traveled home to interview their participants - event over the AIDS charity because "my
mom (or other relative) has diabetes" or "they
an impressive feat in an already crowded schedule.
shouldn't get it [HIV/AIDS] in the first place."
While class projects are exempt from institutional
review board requirements at the University These
of answers were unsurprising in terms of com-
mon views about HIV and immorality but were
Alabama, we ensured that the students understood
useful in prompting the students to realize that
their ethical obligations for voluntary participation
and confidentiality protections. stigma could affect even charitable giving.
Each student had to analyze his or her own data We required the students to identify three
themes relating to discredited identity with which
for a research report. Preparation for this task con-
to frame their results. These themes were based on
sisted of creating a Word file for data management,
Goffman's (1963) stigma typologies in which neg-
making brief headings for each interview item, and
inserting appropriate interview responses under ative social judgments about physical appearance,
each heading. This process allowed students personal
to character, and group affiliation relate to
view the grouped responses at a glance. If the acts of discrimination. Only a few students pro-
vided interview quotes in which HIV/AIDS was
responses were similar (e.g., in the case of family
associated with physical illness (e.g., "If you have
members or sorority sisters), then the student noted
how kinship or group affiliation might account forAIDS you look wasted"). However, quotes relating
the results. However, if the respondents were
to moral character and group affiliation were more

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 1 46 Teaching Sociology 42(2)

common. Comments sexually

in the first
transmitted category
infection stigma (Lichtensteininc
the following: "Church-going people
et al. 2008; Neal et al. 2010). The University don'
of
AIDS," "If you have Alabama's
sex institutional
before marriage,
review board approved the yo
likely get AIDS," and "In
protocol, my script,
recruitment view, the
participation ones
informa-
get AIDS are sinful." tion
Comments in
sheet, and consent form the
prior second
to administra-
egory included, tion. To
"Only protect men,
gay student confidentiality,
prostitutes each
drug users get HIV/AIDS," "Prisoners
protocol and consent form was assigned a uniquege
because of the drugs," and
identifier "Black
rather men have
than the student-participant's se
the down-low." The concept of
name. The students werediscredited iden
informed that their grades
as illustrated
through
would notthese
be affected bystigma typolo
refusal to participate.
proved useful
explaining in
how consisted
The stigma assessment stigma of two reinfo
types
the moral status quo.ofThe
Likert-style
theoryitems. Thealso
first type assessed
prompte
realization that HIV stigma was a
enacted stigma according powerful
to students' comfort in me
being around PLWHA. The second type
nism for defining in-group/out-group assessed
behavio
for exerting control felt
over people's
stigma, or lives.
students' hypothetical reactions to
In their research reports, some
being diagnosed with HIV/AIDS.students
All stigma items c
fessed to having similar
used a scalebeliefs before
from 1 to 10, with takin
higher values cor-
class, even if they responding
sinceto had a change
more discomfort with PLWHA of and h
Stigma theory, as applied to the
more felt stigma should community-b
students be diagnosed
research, thus with HIV/AIDS.
provided a usefulWe also elicited
tool information
for exam
the students' own attitudes and,
about the respondents' asrace/ethnicity,
gender, statedpar- by P
and Aggleton (2003), understanding
ents' society's
education, sexual orientation, religiosity, and
in legitimizing social conservatism.
ideas about punishment, g
shame, and otherness in relation to HIV/AID
appreciation of the links between theory, HIV
Descriptive interviewing
stigma did emerge from Characteristics cowor
Most participants
friends, or family (individuals were female,
who white, heterosexual,
represente
generalized other in religious,
attitudes toward
and from educated HIV/A
families. Of the 20 par-
A final debriefing session revealed
ticipants providing information at boththat stude
time points,
16 (80 percent) were female of
had gained greater knowledge and 4 (20
HIVpercent) stigm
were
social force and potential
male. Of the source of
participants, 1 3 (65 action,
percent) were non- an
Hispanic whites,with
come that was congruent 4 (20 percent) were African
Lena's (1995
American, 3 (15
statement about creating percent) were Hispanic,of
"awareness and allprof
(100 percent)
social problems of our times self-defined
and as heterosexual.
... the More impor
of civic thancivic
half of the responsibility
education
and participants came from relativelyin a
ocratic Two well-educated
society."
students families, wrote
with 1 2 (60 percent)
that report-
they
inspired to seek health-related careers,
ing that their fathers had at and
least a college degree and se
8 (40 percent)
others stated that their own reporting that their mothers
knowledge had at attit
and
toward HIV/AIDS least achanged
had college degree. Participants
forwere fairly reli-
the better
were gratified to gious
learn ( M= 6.80,the
that SD = 2.35 on a scale from 1 project
research = not
illuminated the at all religious
enacted stigma to 10 = extremely
aspect religious) of
and polit-
Goffm
(1963) stigma theory ically
in moderate
this( M= way5.90, SD and
= 2.27 on athat
scale fromsome
dents had a 1 = not at all conservative
transformative experience to 10 = extremely
in term
both seeing conservative).
HIV stigma as a social construct
developing future career goals for civic engagem
These stated positive changes in HIV-related
Changes in Attitudes toward PLWHA
tudes were then studied through the pretest/pos
stigma assessment, (Enacted Stigma)
which is discussed next.
Pre- and posttest results for attitudes toward PLWHA
appear in Table 1 . By the end of the semester, there
THE STIGMA ASSESSMENT
were two significant changes in participants' beliefs:
The assessment drew on a protocol that was devel-
They were less afraid of kissing someone with HIV/
oped from existing assessment instruments for
AIDS and less likely to believe that PLWHA were

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 Lichtenstein and DeCoster 1 47

Table I. Students' Attitudes toward P

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. 1 0 (3.24) 2.50 (2.59) t( 1 9) = 0.78, p = .44

Be afraid of kissing them 6.89 (3.28) 4.26 (3.21) t( 1 8) = 3.69, p = .002a
Be afraid of being in the same room 1 .53 ( 1 .3 1 ) 1 .63 (2.09) t( 1 8) = -0.30, p = .77b
Avoid having much to do with them 2.85 (2.74) 1 .80 ( 1 .70) t( 1 9) = 1 .62, p = . 1 2
Avoid having sex with them 9.85 (0.67) 9.85 (0.67) t( 1 9) = 0.00, p = 1.00
Tell my friends about their HIV status 4.50 (3.44) 3.55 (3.02) t( 1 9) = 1 .38, p = . 1 8
Believe they had been promiscuous 5.95 (3.22) 4.53 (2.09) t( 1 8) = 2.67, p = .02a
Significant decrease in stigma.
Nonsignificant increase in stigma.

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, indicat-
ing that course instruction did not ease fears about
being infected through sexual contact.
Changes in Attitudes toward Being
Diagnosed (Felt Stigma)
The mean scores for responses to the six items ask-
ing 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 reputa-
tions. Nevertheless, the scores for most items (feel-
ing 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, avoid-
ance increased for these items at posttest.
Participants were also less likely to disclose a posi-
tive HIV diagnosis to other people. The desire to in reducing stigma toward PLWHA on several mea-
end a relationship with someone who infected them sures, and in encouraging less self-blame in the
remained high at posttest, as did feelings of event of being diagnosed with HIV/AIDS.
betrayal - two results that involve strong feelings
about the rules of sexual intimacy.
REFLECTIONS ON COURSE
GOALS FOR STIGMA
REDUCTION
The results of the stigma assessment led us to evalu-
ate our course goals of reducing HIV stigma through
theory-based instruction, service learning, and com-
munity 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 embar-
rassment 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,

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 1 48 Teaching Sociology 42(2)

Table 2. Students' Attitudes toward Becomin

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( 1 9) = 2. 1 7, p = .04a
Feel embarrassed 9.65 (0.8 1 ) 8.05 (2.89) t( 1 9) = 2.65, p = .02a
Feel dirty 8.60 (2.04) 7.90 (2.8 1 ) t( 1 9) = 1 .73, p = . 1 0
Feel betrayed 9.25 ( 1 .4 1 ) 8.85 ( 1 .98) t( 1 9) = 1 .00, p = .33
Feel that I had committed a sin 5.25 (3.58) 4.20 (3.17) t( 1 9) = 1.24, p = .23
Be concerned about my reputation 9.50 ( 1 .24) 8.45 (2.24) t( 1 9) = 2.08, p = .05a
Afraid for health

Fear having health problems now 9.80 (0.70) 9.30 ( 1 .34) t( 1 9) = 1 .49, p = . 1 5
Fear having health problems later 9.90 (0.3 1 ) 9.60 (0.88) t( 1 9) = 1 .45, p = . 1 6
Be afraid of dying 9.45 ( 1 .88) 9. 1 0 (2. 1 3) t( 1 9) = 0.54, p = .60
Afraid of disclosure

Not tell an/one 7.60(2.60) 7.85 (2.72) t(l9) = -0.53, p = ,60b

Avoid seeing a doctor 2.20(2.89) 2.40(2.72) t( 1 9) = -0.38, p = ,7lb
Be too embarrassed to see a 3.50 (3. 1 4) 2.70 (2.60) t( 1 9) = 1 .2 1 , p = .24
doctor

Avoid notifying sexual partner 2.65 (3.27) 3.30 (3.69) t( 1 9) = -0.61, p = .55b
Anger at being infected
End relationship with person 8.50 (2.12) 8.35 (2.83) t( 1 9) = 0. 19, p = .85
who infected me

Significant decrease in stigma.

bNonsignifìcant increase in stigma.

CONCLUDING COMMENTS community research was effective in raising aware-

ness about HIV stigma as a social problem and can
Let us summarize the lessons learned from the ser- recommend this activity to instructors who wish to
vice learning and research projects. First, educators use student-centered learning for this purpose.
should not expect miracles in changing fear-basedFinally, we learned that the stigma assessment was
ideas about HIV/AIDS; it can be especially diffi- more valuable than oral and written class feedback
cult to inspire students who are committed to con- in revealing students' actual feelings about HIV
ventional values. In the present case, fear of stigma stigma. The course is clearly a work in progress in
was a powerful force for protecting self-identities hitting the right note for addressing HIV stigma in
as healthy and unspoiled. Second, in partneringthe classroom.
with an ASO, educators should be prepared for Despite the persistent stigma about HIV/AIDS,
unexpected developments when service learning is teaching a sociology course on HIV/AIDS offers
offered, especially for sensitive topics such as HIV/ considerable rewards for instructors and students
AIDS. Our experience suggests that instructors alike. Instructors who teach these courses are often
should have written confirmation of the activitiespassionate about the topic, and their pedagogical
being offered for service learning or risk having efforts to destigmatize HIV/AIDS may be facili-
tasks that are lacking in educational value (Morgan tated through the lens of sociology. Students who
and Streb 2001) or, like the charitable giving become engaged in the subject matter can become
described earlier, have been critiqued for reinforc- advocates for HIV prevention; many students will
ing existing social structures (Eby 1998). However, also find that their service learning experiences and
we believe that the experience was mutually bene- research projects are useful for building resumes
ficial for students and clients and also effective in for employment and applications to graduate
highlighting the pervasiveness of HIV stigma and school. Sociology instructors should not be afraid
discrimination in society. Third, we learned that to offer courses that explore the sociological

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 Lichtenstein and DeCoster 1 49

aspects of HIV/AIDS, even in high

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