Living With HIV/AIDS: A Psychosocial Perspective on

Coping With Prejudice and Discrimination1

Fernando Molero2 and Jolanda Jetten

María J. Fuster University of Queensland
Department of Social and Queensland, Australia
Organizational Psychology and
Spanish Open University (UNED) School of Psychology
Madrid, Spain University of Exeter
Exeter, UK

Juan A. Moriano
Department of Social and Organizational Psychology
Spanish Open University (UNED)
Madrid, Spain

We examined 2 strategies used by people with HIV (N = 68) to cope with the effects
of prejudice and discrimination: hiding of stigma and in-group identification. In
support of the first proposed path, we found that group-based discrimination
enhanced hiding of stigma. This reduces the perception of personal discrimination;
and this, in turn, is positively related to well-being. We also found evidence for a
second, more collective path by which those who are HIV-positive protect their
well-being. Perceived group-based discrimination was positively associated with
in-group identification, which, in turn, was positively related to collective action
intentions and well-being. The discussion focuses on how well-being can be pro-
tected through both individual- and group-level processes. jasp_729 609..626

In contemporary society, many groups suffer from prejudice and group-

based discrimination (e.g., immigrants, homosexuals, people with mental
illness, people with HIV). These groups are usually classified under the
general label of stigmatized groups, and their study has been of interest to
social scientists and health professionals.
In the last two decades, the study of stigma has become an important
research area for social psychologists as well. One of the central questions for
social psychologists concerns the way members of stigmatized groups cope

1
The authors thank two anonymous reviewers for their helpful comments on an earlier draft
of this paper.
2
Correspondence concerning this article should be addressed to Fernando Molero, Univer-
sidad Nacional de Educación a Distancia, C/Juan del Rosal, 10, 28040 MADRID-SPAIN.
E-mail: fmolero@psi.uned.es

609

Journal of Applied Social Psychology, 2011, 41, 3, pp. 609–626.

© 2011 Wiley Periodicals, Inc.
610 MOLERO ET AL.

with the prejudice and discrimination they encounter as a result of belonging

to a stigmatized group (Crocker & Major, 1989; Crocker, Major, & Steele,
1998; Heatherton, Kleck, Hebl, & Hull, 2000; Levin & van Laar, 2006;
Major & O’Brien, 2005). Importantly, most of the social psychological
research to date has focused on the experience of group members for whom
stigma is visible (e.g., race, gender). Even though this research has led to
greater understanding of the factors that help people to cope with the nega-
tive consequences of belonging to a visible stigmatized group, not much is
known about coping with stigma that can be hidden. To fill this gap, the
present research focuses on stigma among people with HIV and examines the
role of disclosure of stigma on coping with such stigma.

Stigma and Discrimination Against the HIV-Positive

HIV and AIDS remain a vast public health problem worldwide.

Although there have been medical advances to combat the disease, the
number of new infections has continued to increase (ONUSIDA, 2006). In
Spain, where the present research was conducted, it is estimated that
150,000 people are infected, although probably more than one quarter of
them have not yet been diagnosed. In 2005, 3500 new cases were registered
in Spain (Ministerio de Sanidad y Consumo, 2005). Because of the emer-
gence of new antiretroviral therapies, there has been a sharp decline in the
number of AIDS sufferers in Spain (a 60% reduction).
However, in spite of medical advances, there is evidence that the negative
view of people with HIV among the public remains (Brooks, Martín, Ortiz, &
Veniegas, 2004; Dijker, Kok, & Koomen, 1996; Herek, Capitanio, &
Widaman, 2002; Thomas et al., 2005). In Spain, a study by FIPSE (2005)
showed that although it is not legal to discriminate against people with
HIV, prejudice is pervasive, and those who are HIV-positive face discrimi-
nation in many aspects of their everyday lives. Specifically, the study
found that discrimination was relatively pervasive in many areas of life,
including healthcare, employment, justice, social welfare, reproductive and
family life, housing, education, financial services, and when accessing other
public services. This is also the conclusion from studies such as those of the
Instituto Nacional de Estadística (2004), which showed that one out of three
Spanish people indicate that they would not study or work with a person
with HIV.
The group of people with HIV differs from other stigmatized groups in at
least four ways. First, aside from the fact that HIV is an illness, it is also an
infection that can be transmitted. The fear of infection enhances avoidance of
contact with those who are infected. Second, and perhaps more importantly,
 COPING WITH HIV-RELATED STIGMA 611

despite the fear of infection, a study by Herek and Capitanio (1998) showed
that negative attitudes toward people with HIV are based more on religious
and political values than on concerns for personal safety. That is, HIV is
stereotypically associated with marginalized and stigmatized groups in
society (e.g., gay and bisexual men, injecting drug users, sex workers). Third,
in contrast to members of many other stigmatized groups, people with HIV
are often perceived as responsible for their disease. Many authors have
pointed out that the perceived controllability of the stigma increases the
perceived legitimacy of discrimination toward stigmatized groups (Crocker
et al., 1998; Mak et al., 2006). Finally, and of central importance to the
present study, in many cases, people with HIV can choose whether or not
they reveal that they belong to the stigmatized group.

Coping With HIV-Related Stigma

The social psychological literature points to a range of strategies that

members of stigmatized groups may use to alleviate the negative effects of
group-based prejudice and personal discrimination. Among others, victims
of discrimination can attribute negative outcomes to prejudice (Crocker
et al., 1998), downplay the extent to which one is discriminated against
(Crosby, 1982, 1984), leave the negatively evaluated group behind to seek
membership in another higher status group (i.e., individual mobility;
Tajfel & Turner, 1979), hide their stigma, or identify with the stigmatized
group to try to improve the treatment of the group as a whole (i.e., col-
lective action). In this research, we focus on the latter two strategies and
examine the way individual hiding versus collective mobility relate to per-
ceptions of personal discrimination, collective action intentions, and, ulti-
mately, well-being.
Notably, all of the aforementioned coping strategies involve some costs
and benefits for the individual. For example, downplaying the severity of
group-based discrimination or hiding of stigma may help to preserve per-
sonal self-esteem, but this does not lead to any structural change in the status
of those with HIV and does not affect the extent to which discrimination
against those with HIV can be expected in the future. In contrast, engaging in
collective action may help the group as a whole to obtain certain objectives;
it may enhance the public’s understanding of the illness and may be a first
step in combating prejudice faced by the group as a whole. However, those
individuals engaging in collective action may become highly visible and
identifiable. As a result, they may increase the risk of being targeted by
members of the dominant group, and they may encounter more discrimina-
tion because they are perceived as extremists or troublemakers.
612 MOLERO ET AL.

Hiding Stigma

When it is possible, the hiding of stigma is perhaps one of the most

common strategies of coping with discrimination. People who decide to
conceal their stigma may, at least in the short term, avoid prejudice and
discrimination; and this allows for positive social interactions with others
who are not stigmatized (Frable, Blackstone, & Scherbaum, 1990; Jones
et al., 1984; Quinn, 2006; Smart & Wegner, 1999). For instance, a study by
Cole, Kemeny, and Taylor (1997) showed that, over time, rejection-sensitive
gay men experienced a significant acceleration of HIV signs (i.e., a drop in
their CD4 T lymphocyte level) and mortality. However, such accelerated
HIV progression was not observed in rejection-sensitive gay men who con-
cealed their homosexual identities. This result suggests that, in some cases,
hiding the stigmatized gay identity may protect those who suffer from HIV
from negative health effects.
However, there is also evidence that there are important costs associated
with long-term hiding. Research on the long-term health effects of hiding
sexual identity for gay men has found that concealing stigma is related to
higher rates of cancer. Furthermore, it has been found that there is a relation-
ship between hiding sexual identity and increased vulnerability to attract
infectious diseases (Cole, Kemeny, Taylor, & Visscher, 1996). In the same vein,
a study by Strachan, Murray, Russo, and Roy-Byrne (2007) showed that
consistent disclosure of both sexual orientation and HIV status independently
had a positive impact on CD4 cell counts. It is likely that the negative effects of
hiding are a result of inhibition of emotional expression and of feelings of
loneliness and isolation that are associated with hiding. For instance, Jetten,
Haslam, Iyer, and Haslam (2010) discussed how collective coping responses
are cut off when people hide their stigma. As a result, negative treatment is
perceived as an individual-level problem, and group members may not receive
and benefit from social support from other group members.

Role of Group Identification and Collective Action

Another strategy that members of devalued groups use to cope with the
effects of stigma is to increase identification with their group. This identifi-
cation offers psychological benefits that may help to overcome some of the
negative effects on well-being of being discriminated against. For instance,
stigma research has shown that group identification is associated with lower
levels of depression, more positive self-esteem, and increased general psycho-
logical adjustment (for a review, see Schmitt & Branscombe, 2002). The
positive consequences of group identification for well-being are outlined in
 COPING WITH HIV-RELATED STIGMA 613

the rejection-identification model, which specifies how these processes play a

role when coping with group-based discrimination (Branscombe, Schmitt, &
Harvey, 1999). This model suggests that the perception of group-based dis-
crimination reduces self-esteem and feelings of control among members of
the devalued group. However, a second process counteracts these negative
effects: Perceiving group-based discrimination also leads to increased reliance
on the stigmatized group (i.e., increased group identification). The model
predicts that by feeling included in the group, group identification can, at
least partially, alleviate the negative effects of perceived discrimination on
well-being.
In line with predictions, it has been found that those who perceived
discrimination against their group also identified more strongly with that
group than did those who perceived less group-based discrimination
(Branscombe et al., 1999; Dion & Earn, 1975; Schmitt, Branscombe,
Kobrynowicz, & Owen, 2002). Support for the model has been found among
a range of devalued groups, from African Americans (Branscombe et al.
1999) to women (Schmitt et al. 2002) to people with body piercings (Jetten,
Branscombe, Schmitt, & Spears, 2001) and older adults (Garstka, Schmitt,
Branscombe, & Hummert, 2004). However, to our knowledge, the rejection-
identification model has not been tested among people with HIV.
There is a close relationship between group identification and the willing-
ness to act on behalf of the group to achieve status enhancement for the group
as a whole (Ellemers, 2001). History provides many examples of groups that
aim to improve their position by means of collective action (e.g., feminism, gay
movement, striking miners in the UK). Collective action not only includes
militant forms of intergroup actions (e.g., revolts, strikes), but also more
moderate forms (e.g., participation in social movements, signing a petition).
We propose that strategies related to hiding of stigma cannot coexist with
engagement in collective action. Taking part in collective action requires,
almost by definition, revealing membership in the stigmatized group and also
often requires individuals to speak out publicly on behalf of the group
(Haslam, 2004). On the other hand, strategies relating to group identification
and collective action are not only compatible, they also often go hand in hand.
That is, self-definition and identification as a member of the stigmatized group
facilitates taking action on behalf of the group (Simon et al., 1998; Stürmer &
Simon, 2004a, 2004b). This, in turn, should enhance well-being.

The Present Research

The aim of the present research is to examine two strategies that

people with HIV use to cope with their stigma and with the consequences of
614 MOLERO ET AL.

Hiding path

-
Personal
Hiding
discrimination
-
+

Group
Well-being
discrimination

+
Identification path
+

Group + Collective
identification action

Figure 1. Hypothesized model.

engaging in these strategies for well-being. Following from our reasoning

outlined previously, we examine two paths that those with HIV use to cope
with group-based prejudice and to maintain well-being. These two paths are
represented schematically in Figure 1.
The first path (labeled as the hiding path) predicts that the more those who
are HIV-positive perceive group-based discrimination, the more they will
hide being HIV-positive. Increased hiding will be associated with lower per-
ceived personal discrimination; and this, in turn, should be positively asso-
ciated with well-being. The second path (labeled as the identification path)
predicts that perceived group discrimination is associated with enhanced
group identification. In turn, high identification will allow for and enable
collective action; and this, in turn, should increase the well-being of those
who are HIV-infected.

Method

Participants

Study participants were all approached via non-government organiza-

tional services. The participants were 68 people with HIV (54 men, 14
 COPING WITH HIV-RELATED STIGMA 615

women) living in the Valencia and Benidorm areas in Spain. Participants’

ages varied, with 7.4% of the participants younger than 30 years, 66.2% of the
participants between 31 and 45 years, and 26.5% of the participants older
than 45 years. Of the 68 participants, 57.4% indicated that they contracted
the virus through sexual contact and 16.2% contracted it through sharing
syringes. The remainder of the participants (23.5%) indicated that they did
not know how they had contracted the virus.

Measures

The present study was introduced as an investigation into prejudice and

discrimination toward people with HIV. The participants completed indi-
vidually and voluntarily a booklet containing all measures while one of the
researchers was present.
Perceived group discrimination (prejudice). We used 12 items to assess
participants’ perception of discrimination against people with HIV. Some of
the items were adapted from Pettigrew and Meertens’ (1995) Subtle and
Blatant Prejudice Scale, which was supplemented by other items assessing
group-based discrimination specific to people with HIV. For example, par-
ticipants were asked to rate their agreement with items such as “Even when
people seem to accept people with HIV, there is always a certain level of
mistrust,” or “Workers in a company will never accept a person with HIV as
a colleague.” Respondents rated their level of agreement with the statements
on a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly
agree). The reliability of the items was satisfactory (a = .82), and the items
were averaged with higher scores, indicating greater perceived group-based
discrimination.
Perceived personal discrimination. We used seven items that were adapted
from ONUSIDA (2001) to assess perceived personal discrimination. Sample
items are “Have you ever felt personally rejected for being HIV-positive?” or
“Have you ever been rejected by any public or private institution for being
HIV-positive?”. Responses were rated on a 5-point scale ranging from 1
(never) to 5 (always). Inter-item reliability was acceptable (a = .86), and the
items were averaged.
Degree of hiding. We included two items to assess the extent to which
participants had revealed being HIV-positive to others. The items are “To
what extent do you think it is best not to tell other people you are HIV
infected?” (rated on a 5-point scale ranging from 1 [best not to tell anyone] to
5 [best to tell everyone]) and “To what extent do you tell other people you are
HIV-infected?” (rated on a 5-point scale ranging from 1 [I do not tell anyone]
to 5 [I tell everybody]). Both items were reverse-scored so that higher scores
616 MOLERO ET AL.

indicate greater hiding of stigma. The two items were averaged (r = .68,
p < .001).
Identification with other people with HIV. We used a seven-item scale,
adapted from Mael and Ashforth (1995) and Doosje, Ellemers, and Spears
(1995) to assess group identification. Sample items are “When someone
criticizes people with HIV, it feels like a personal insult,” and “I feel strong
ties with other people with HIV.” Responses were rated on a 5-point scale
ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate
greater identification with other people with HIV (a = .80).
Willingness to engage in collective action. We used two items to assess
collective action intentions: “To what extent are you willing to engage in
collective action supporting people with HIV?” and “To what extent are you
willing to become an active member of an association working for the rights
of people with HIV?”. Responses were rated on a 5-point scale ranging from
1 (not at all) to 5 (completely). These two items were averaged (r = .79,
p < .001) with higher scores indicating higher willingness to engage in collec-
tive action.
Well-being. Seven items tapped into several aspects of physical and psy-
chological well-being. Sample items are “How is your health?”; “What do
you think about your quality of life?”; and “In general, how would you
describe your mood?”. Items were rated on a 5-point scale ranging from 1
(very bad) to 5 (very good). The items were averaged (a = .78), with higher
scores indicating higher well-being.

Results

Preliminary analyses show that sex, age, or the way the virus was con-
tracted did not correlate with any of the reported main dependent variables.
Therefore, we did not control for any of these variables in the subsequent
analyses.
Inspection of means (see Table 1) shows that participants were generally
willing to participate in collective actions (M = 4.00, SD = 0.85). They also
identified with others who are HIV-positive (M = 3.48, SD = 0.85), and that
many of them did hide their stigma (M = 3.23, SD = 0.83).

Model Testing

We used structural equation modeling (SEM) to simultaneously examine

the relationships between the model constructs of group discrimination,
personal discrimination, hiding, group identification, collective action
 COPING WITH HIV-RELATED STIGMA 617

Table 1

Descriptives and Bivariate Correlations

Variable M SD 1 2 3 4 5
1. Group-based 3.32 0.74 —
discrimination
2. Personal 2.20 0.83 .28** —
discrimination
3. Group 3.48 0.85 .42** .27** —
identification
4. Hiding of stigma 3.23 0.83 .23* -.22* -.09 —
5. Collective-action 4.00 0.85 -.05 .11 .43*** -.36*** —
intentions
6. Well-being 3.42 0.59 -.22** -.33** -.01 -.15 .28**
Note. Range = 1–5.
*p < .05. **p < .01. ***p < .001.

intentions, and well-being. SEM is a statistical methodology that takes a

(confirmatory) hypothesis testing approach to the multivariate analysis of a
structural theory bearing on some phenomenon (Byrne, 2001). Further, SEM
is an appropriate method for analyzing the model’s relationships (Hair,
Black, Babin, Anderson, & Tatham, 2006).
We specified perceived group-based discrimination as the exogenous pre-
dictor variable; group identification, collective-action intentions, hiding, and
perceived personal discrimination as the mediators; and well-being as the
outcome variable. In our model, each latent variable was defined by only one
observable indicator (i.e., mean of the corresponding scale). The relations
among the latent dimensions and the observable indicators were restricted to
one, and the measurement errors of the model were eliminated. Note also
that in order to enhance intelligibility, neither the regression errors nor the
corresponding observable variables are shown in the figures. To determine
the fit of the proposed model, we report a number of absolute and relative fit
indexes (see Hu & Bentler, 1995), including chi-square goodness-of-fit test,
three incremental fit indexes (a comparative fit index [CFI], incremental fit
index [IFI], and goodness-of-fit index [GFI]), and two residual fit indexes
(root mean square residual [RMR] and root mean square error of approxi-
mation [RMSEA]).
In Table 2, the Hypothesized Model column represents the standardized
parameter estimates, the goodness-of-fit statistics, and the coefficients of
Table 2

Fit Indexes and Variance Explained for Tested Models

Only
Hypothesized Adjusted Only hiding-path identification-path Model without
model model model model mediator variables
618 MOLERO ET AL.

Goodness-of-fit statistics
c2 (df ) 18.85 (9), p = .02 5.78 (6), p = .44 11.15 (3), p = .01 4.90 (3), p = .17 5.74 (2), p = .05
2
c /df 2.09 0.96 3.71 1.63 2.87
CFI .65 1.00 .58 .89 .73
IFI .71 1.00 .64 .91 .79
GFI .90 .97 .92 .96 .95
RMR .15 .06 .10 .06 .06
RMSEA .18 .00 .20 .09 .16
Variance explained (100*R2)
Hiding 4% 6% 3% — 5%
Group 13% 19% — 18% 20%
identification
Personal 2% 16% 11% — —
discrimination
Collective-action 11% 21% — 19% —
intentions
Well-being 13% 21% 6% 2% 2%
Note. CFI = comparative fit index; IFI = incremental fit index; GFI = goodness-of-fit index; RMR = root mean square residual;
RMSEA = root mean square error of approximation.
 COPING WITH HIV-RELATED STIGMA 619

determination of the hypothesized model. As displayed in Table 2, although

the associations were in the hypothesized direction, the hypothesized model
did not fit adequately for the sample data, with most of the fit indexes failing
to meet acceptable levels (Hu & Bentler, 1999), c2(9, N = 68) = 18.85, p < .05.
The comparative goodness of fit indexes measured by the CFI and IFI were
lower than .95. RMR and RMSEA were greater than .05, and only the GFI
reached the threshold of .90.
Based on modification indexes (Arbuckle, 2003), the model was respeci-
fied, allowing for additional direct paths from group discrimination to per-
sonal discrimination, and from hiding to collective action. The decrease in chi
square and the change from a significant to a nonsignificant chi square
suggests that the adjusted model fits the data better (Byrne, 2001; Hair et al.,
2006). In addition, the change in the other fit statistics (CFI, IFI, GFI, RMR,
and RMSEA) indicates a significant improvement in model fit.
Figure 2 depicts the estimates of the SEM analysis. The adjusted model
explains a significant amount of variance in well-being (R2 = .21). We found
support for both paths from perceived group-based discrimination to well-
being. First, in support of the hiding path hypothesis, higher perceptions of
group-based discrimination were associated with increased hiding. High
levels of hiding were associated with less perceived personal discrimination,
which, in turn, was associated with greater well-being. Second, in support of

-.26* Personal
Hiding
discrimination
R2 = .06 R2 =.16 -.36**
.24*

.37**

Group
-.31** Well-being
discrimination
R2 = .21

.44**

.24*

Group Collective
.37**
identification action
R2 = .19 R2 = .21

*p < .05. **p < .01.

Figure 2. Respecified model.

620 MOLERO ET AL.

the identification path, higher perceptions of group-based discrimination

were associated with increased identification. Higher group identification
was associated with greater willingness to engage in collective action. This,
in turn, was associated with greater well-being. Furthermore, the adjusted
model includes two additional direct paths: Higher perceived group discrimi-
nation was also associated with greater perceived personal discrimination.
Furthermore, hiding of stigma was associated with less willingness to engage
in collective action.
To provide more confidence in the proposed ordering of the variables, we
tested alternative models. First, we tested models whereby only the hiding
path or only the identification path was included to predict the relationship
between group-based discrimination and well-being. The fit indexes of both
alternative models were worse than the fit of the respecified model. In addi-
tion, the well-being variance that was explained was also lower, as compared
to the respecified model (see Table 2). Second, we tested a more parsimonious
model whereby the mediator variables of perceived personal discrimination
and collective-action intentions were dropped. However, for this alternative
model, the fit indexes were not as good as for the respecified model. Note-
worthy, too, is that there was no direct association between hiding and
well-being in this alternative model (b = -.12, p = .38), and no relationship
between group identification and well-being (b = -.02, p = .86).

Discussion

Stigmatized people are not passive recipients of prejudice and discrimi-

nation. Instead, they actively search for ways to reduce the negative effects of
stigma. In order to achieve this aim, they may adopt different strategies. In
this paper, we analyzed two such strategies. The first is an individual-level
route whereby concealing the stigma in response to stigma and the absence of
being personally targeted protects well-being. Specifically, the more those
who are HIV-positive hide stigma following the perception of group-based
discrimination, the less they face discrimination directed at them personally;
this, in turn, positively affects well-being. The second path is a more collective
path whereby becoming more identified with the minority group in response
to perceiving group-based discrimination enhances collective-action inten-
tions. This protects well-being from the negative consequences of group-
based discrimination.
We found support for both paths after we respecified the model allowing
for direct paths from group discrimination to personal discrimination and
from hiding to collective action. These added paths appear logical and can be
justified theoretically. That is, reiterating the close relationship between
group- and individual-level outcomes for members of stigmatized groups (see
 COPING WITH HIV-RELATED STIGMA 621

Branscombe et al., 1999), it is not surprising that there is a close association

between perceived discrimination because of a stigma that is personally
defining and important to them as persons and the extent to which people
perceive they are discriminated because of their membership in a stigmatized
group. In a similar vein, and consistent with previous research, the more
people hide their stigma, the less able they are to act on behalf of a group and
to engage with others on the basis of their group membership.
The readjusted model shows, as proposed by the rejection-identification
model (Branscombe et al., 1999), that group discrimination leads to group
identification. In turn, as many authors have pointed out (e.g., Simon et al.,
1998; Stürmer & Simon, 2004a, 2004b) group identification makes collective
action possible, and higher collective-action intentions are associated with
better well-being among those who are HIV-positive. Noteworthy, too, is
that our data suggest that there is no direct relationship between group
identification and well-being. This finding, however, is not surprising when
considering the nature of this devalued group and the pervasiveness of the
discrimination against those who are HIV-positive. The costs (social rejec-
tion) of being identified as a member of this group may only be counteracted
when there is also engagement in collective action: Action rallies people
around the same collective cause together, and this greater sense of “group-
ness” allows for and facilitates receiving and benefiting from social support,
which, in turn, protects well-being. It thus appears that for people with HIV,
social identification has an indirect effect on well-being through engagement
in collective actions.
We tested three alternative models to examine the robustness of the
hypothesized model and to rule out alternative processes that could account
for the relationship between perceived group-based discrimination and well-
being. We separately tested models in which only the hiding or only the
identification path was included. We also tested a simpler, more parsimoni-
ous model in which only hiding and group identification were included as
mediators of the relationship between group-based discrimination and well-
being. The fit indexes of each of these alternative models was worse than the
fit of the respecified model, and these models explained less well-being vari-
ance than did the respecified models. This provides further assurance for the
respecified model as outlined in Figure 2.
The finding that identification did not correlate with any of the variables
specified in the hiding path suggests that, at least among the participants in
this study, the two paths are relatively independent and separate. However,
the negative relationship between hiding and collective-action intentions
provides indirect evidence for a negative relationship between the two
paths. From this, it can be inferred that the hiding path is associated
with low identification, while the identification path is associated with high
622 MOLERO ET AL.

identification. Our sample was too small to examine the moderating role of
group identification, but future research should examine this to determine
the precise relationship between the two paths.
Another question to explore in future research is the extent to which it is
possible to distinguish different motivations to hide and whether such moti-
vations matter when predicting the relationship between group-based dis-
crimination and well-being. Indeed, hiding may reflect guilt and shame for
being HIV-positive or a strategic response to avoid negative outcomes, but it
is also possible that people decide freely when and to whom to reveal their
condition. In the latter case, hiding is not incompatible with high group
identification and collective action. Thus, the motivation to hide or to reveal
may be more important when predicting the path to well-being than the
actual degree of concealment of the stigmatized identity.
The results of the present study are of practical importance and have the
potential to inform the design of future interventions aimed at enhancing
well-being among people with HIV. Our results suggest that it would be
important to take into account the implications that concealment of stigma
may have on well-being and coping by people with HIV. Concealing stigma
may be useful in the short term, but prevents people from seeking out social
support and developing closer ties with others facing a similar stigma.
However, the costs of revealing being HIV-positive should not be underesti-
mated, either. Helping people to buffer themselves from the negative conse-
quences of revealing their stigma may be important, and one way of doing
that is by pointing at the social support that can be gained from others when
stigma is revealed.
At a societal level, our finding that there was a significant relationship
between collective action and well-being is important because engagement in
collective strategies is the only way in which the situation of the group as a
whole can be improved. Interestingly, too, this finding fits the motto of
UNAIDS (2002): “Through association and activism, advocacy, and partici-
pation in the establishment and implementation of policies, actions of people
with HIV may be a radical force for change and break down barriers that
impede the full realization of human rights.” Thus, the finding that collective
engagement is associated with positive outcomes (i.e., well-being) may prove
to be an important message to promote such greater collective involvement of
people with HIV.

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