Stereotypes About AIDS Scale

Abstract

The Stereotypes About AIDS Scale (SAAS) is an extensive, multidimensional psychometric instrument developed by Southeast Missouri State University researchers William E. Snell, Jr., Phillip D. Finney, and Lisa J. Godwin in 1991. Formulated during the height of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) public health crisis, the SAAS was designed to capture, quantify, and dissect the complex web of misinformation, prejudice, cognitive heuristics, and moral judgments surrounding the disease. The instrument evaluates 15 discrete subscales organized across four overarching domains: (a) Global Stereotypic Beliefs About AIDS (assessing educational needs, confidentiality rights, casual transmission fallacies, and homophobic etiologies); (b) Personal Attitudes About AIDS (evaluating interpersonal avoidance, perceived self-relevance, closed-mindedness, perceptions of media exaggeration, and divine moral retribution); (c) Medical Issues About AIDS (measuring occupational threat to medical staff, blood supply contamination anxieties, curative expectations, and mandatory testing attitudes); and (d) Sexual Issues About AIDS (assessing behavioral sexual risk associations and beliefs regarding condom efficacy). Responses are recorded on an authentic five-point bipolar Likert scale ranging from -2 (Disagree) to +2 (Agree), with an intermediate neutral anchor (0 = Neither agree nor disagree). Psychometric evaluations demonstrate moderate to high internal consistency across subscales, with Cronbach’s alpha coefficients spanning α = .75 to .85 for Section A, α = .72 to .87 for Section B, α = .64 to .83 for Section C, and α = .78 to .86 for Section D. Construct, convergent, and discriminant validities were substantiated through robust associations with AIDS-related anxiety, sexual communication strategies, behavioral inhibition, sex-role stereotyping, and defensive attribution paradigms. The SAAS remains a foundational instrument in health psychology, medical sociology, and epidemiology for investigating stigma mechanisms, evaluating educational interventions, and understanding socio-cognitive responses to emerging infectious epidemics.

Keywords

Stereotypes About AIDS Scale, SAAS, HIV/AIDS Stigma, Health Psychology, Health Belief Model, Sexual Communication, Psychometrics, Defensive Attribution, Medical Sociophobia, Social Stigmatization

Authors

The Stereotypes About AIDS Scale was developed and validated by a research team in the Department of Psychology at Southeast Missouri State University:

• William E. Snell, Jr., Ph.D. – Professor of Psychology, Southeast Missouri State University, Cape Girardeau, Missouri. Dr. Snell was a prolific psychometrician and social psychologist widely recognized for authoring multidimensional measurement tools in human sexuality, intimate relationships, emotional disclosure, and health psychology.
• Phillip D. Finney, Ph.D. – Department of Psychology, Southeast Missouri State University. Dr. Finney contributed significantly to empirical investigations of socio-cognitive attitudes, statistical measurement, and community behavioral health.
• Lisa J. Godwin, B.S. / M.A. – Department of Psychology, Southeast Missouri State University. Godwin collaborated on instrument conceptualization, item drafting, sample administration, and psychometric validation.

Correspondence regarding the initial development of the scale was directed to Dr. William E. Snell, Jr., Department of Psychology, Southeast Missouri State University, One University Plaza, Cape Girardeau, MO 63701.

Purpose

The late 1980s and early 1990s represented a tumultuous period in global public health characterized by widespread social anxiety, rapid epidemiological spread of HIV, and systemic stigmatization of affected populations. The purpose of the Stereotypes About AIDS Scale (SAAS) was to address an acute empirical need: the absence of a comprehensive, psychometrically sound, multidimensional assessment tool capable of untangling the diverse cognitive, affective, and behavioral stereotypes directed toward AIDS and people living with HIV/AIDS (PLWHA).

Prior to the introduction of the SAAS, empirical investigations into AIDS attitudes frequently relied on unidimensional indices or brief ad-hoc surveys. Such instruments typically conflated distinct social-cognitive phenomena, combining factual biomedical ignorance (such as beliefs that the virus could spread via casual contact like shaking hands or airborne transmission) with deep-seated moral antipathy, homophobic animus, personal defense mechanisms, and policy preferences. Snell, Finney, and Godwin (1991) recognized that public reactions to AIDS were not uniform or monolithic; an individual might possess accurate biomedical knowledge regarding transmission routes while simultaneously harboring moral disgust or endorsing coercive state actions such as mandatory quarantine or occupational expulsion. Conversely, an individual might hold non-judgmental, compassionate attitudes toward infected individuals while succumbing to irrational anxieties regarding medical procedures or casual workplace exposure.

Consequently, the SAAS was designed with multiple clinical, social, and research objectives:

• Deconstructing Multidimensional Stigma: To differentiate between biomedical misconceptions, interpersonal rejection behaviors, institutional policy endorsements, and moral-religious scapegoating.
• Informing Health Education Programs: To identify specific cognitive barriers that impede safe-sex practices, facilitate sexual risk denial, or foster resistance to public health interventions.
• Investigating Interpersonal Dynamics: To explore how stigmatizing stereotypes undermine proactive health communication, such as rational, direct discussions between prospective sexual partners regarding HIV testing and condom usage.
• Examining Behavioral and Affective Correlates: To quantify how cognitive stereotypes fuel irrational health anxieties, hypochondriacal panic, and sexual inhibition, or conversely, how cognitive distortions (e.g., viewing AIDS as strictly an out-group disease) produce unrealistic optimism and reckless behavior.
• Analyzing Intersecting Biases: To evaluate how pre-existing social prejudices, particularly homophobia and sexist gender stereotypes, intersect with and amplify public health stigma during an epidemic.

Psychological Construct

The SAAS conceptualizes “AIDS stereotypes” as cognitive structures, biased schemas, and heuristic shortcuts that individuals utilize to interpret, categorize, and react to the HIV/AIDS epidemic. Rather than treating stigma as an undifferentiated negative affect, the SAAS operationalizes the construct across four core domains comprising 15 specialized subscales:

1. Global Stereotypic Beliefs About AIDS (Section A)

This domain captures broad cultural narratives, institutional viewpoints, and epidemiological misconceptions prevalent in society:

• Need for AIDS-Related Education: Measures the conviction that systemic public and school-based health instruction is essential to curb transmission (e.g., belief that government and educational institutions must actively sponsor AIDS education).
• AIDS-Related Confidentiality: Assesses beliefs regarding the civil liberties and privacy rights of individuals with HIV/AIDS versus punitive endorsements of mandatory disclosure to employers, schools, and co-workers.
• Casual Transmission of AIDS: Quantifies adherence to scientifically debunked transmission myths, specifically that HIV can be contracted through casual, non-sexual, non-parenteral contact, such as sharing eating utensils, shaking hands, sitting in the same room, or providing CPR.
• AIDS Caused by Homosexuality: Gauges explicit homophobic attribution schemas, evaluating the belief that gay men are uniquely and exclusively responsible for the genesis, existence, and proliferation of the virus.

2. Personal Attitudes About AIDS (Section B)

This domain examines the respondent’s internal psychological defenses, behavioral intentions, and moral judgments:

• Desire to Avoid Afflicted Individuals: Assesses behavioral avoidance, social ostracism, and interpersonal aversion directed at people diagnosed with AIDS in personal, educational, or professional settings.
• AIDS Not Perceived as Self-Relevant: Measures psychological distancing and the “optimistic bias” or perceived invulnerability, capturing the belief that AIDS is exclusively someone else’s dilemma and poses no threat to oneself.
• Closed-Minded Approach to AIDS: Identifies cognitive rigidity, information avoidance, and communicative unwillingness (e.g., refusing to discuss the topic or asserting that children cannot comprehend health realities).
• The Issue of AIDS is Being Exaggerated: Reflects denialist tendencies and skepticism toward public health warnings, positing that the media and scientific bodies have inflated the severity of the epidemic.
• AIDS as a Moral Punishment: Captures punitive, moralistic, and theodical explanations, explicitly measuring the belief that AIDS represents divine retribution for sinful or immoral behavior.

3. Medical Issues About AIDS (Section C)

This domain investigates attitudes toward healthcare infrastructure, clinical risk, and institutional safety:

• Threat to Medical Staff: Measures fears of occupational contagion among physicians, nurses, and allied healthcare professionals, framing clinical contact with HIV patients as an unacceptably high-risk endeavor.
• Protecting the Blood Supply: Quantifies anxieties and protective beliefs concerning the integrity of national blood banking and transfusion systems.
• Cure for AIDS: Evaluates curative optimism versus scientific fatalism, assessing beliefs regarding whether modern medicine has already produced, or will inevitably produce, an absolute therapeutic remedy or vaccine.
• Mandatory AIDS Testing: Measures public endorsement of coercive diagnostic protocols, such as universal hospital screening or non-consensual testing of patients.

4. Sexual Issues About AIDS (Section D)

This domain addresses the behavioral interface between HIV risk and sexual conduct:

• Relationship Between AIDS and Sexual Activity: Gauges awareness and cognitive representations of sexual transmission parameters, including partner numbers, intimacy dynamics, heterosexual vulnerability, and the disruption of casual recreational sex.
• Prevention of AIDS Through Condom Use: Measures beliefs regarding the prophylactic efficacy and protective barrier utility of condoms in mitigating viral transmission during sexual intercourse.

Theoretical Framework

The construction of the SAAS is anchored in several prominent social-psychological and health-behavior theories that elucidate how humans manage threat, categorize marginalized groups, and rationalize disease vulnerability.

1. Goffman’s Theory of Social Stigma

The primary sociological foundation stems from Erving Goffman’s (1963) classical formulation of social stigma as an attribute that deeply discredits an individual, reducing them from a whole, usual person to a tainted, discounted one. In Goffman’s paradigm, stigma manifests across three typologies: physical abominations of the body, blemishes of individual character (perceived moral weakness, unnatural passions, or dishonesty), and tribal stigma of race, nation, or religion. Snell and colleagues incorporated these theoretical classifications by demonstrating how AIDS was socially constructed not merely as a biological pathogen, but as a symbolic manifestation of “characterological blemish” and “tribal stigma” associated with historically marginalized groups (specifically homosexual men and intravenous drug users).

2. The Just World Hypothesis and Defensive Attribution

Melvin Lerner’s Just World Hypothesis (1980) and Elaine Walster’s Defensive Attribution Hypothesis provide the cognitive rationale for subscales measuring moral punishment, victim blaming, and perceived lack of self-relevance. To preserve the psychological belief that the world is inherently orderly, safe, and just, individuals often rationalize catastrophic illness by blaming the victims. Under this framework, attributing AIDS to personal sin or moral failure protects the observer’s sense of invulnerability: if AIDS only afflicts the “immoral” or the “deviant,” an individual who identifies as moral feels cognitively insulated from biological risk.

3. The Health Belief Model (HBM)

The architectural division between perceived susceptibility, perceived severity, and perceived barriers is closely aligned with the Health Belief Model (Rosenstock, 1974; Becker, 1974). The SAAS assesses perceived susceptibility through items measuring whether AIDS is seen as self-relevant or exclusively an out-group dilemma, while perceived barriers and self-efficacy are reflected in items addressing condom efficacy, communication willingness, and fears of casual transmission.

4. Terror Management Theory (TMT)

Developed by Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski (1986), Terror Management Theory suggests that mortality salience triggers intense defensive mechanisms designed to uphold cultural worldviews and self-esteem. In the context of the early AIDS epidemic, the relentless association of HIV with rapid physical deterioration and certain death elicited existential terror. The SAAS captures the resulting psychological defenses, such as trivializing the crisis (media exaggeration subscale), aggressive out-group derogation (homophobic attribution subscale), and interpersonal withdrawal (avoidance subscales).

Validity

The psychometric validation conducted by Snell, Finney, and Godwin (1991) established robust evidence for construct, convergent, and discriminant validity across diverse behavioral, emotional, and social criteria.

Construct and Convergent Validity

Construct validity was demonstrated by evaluating how specific SAAS subscales correlated with clinical and affective markers, particularly AIDS-related anxiety and behavioral sexual inhibition:

• Cognitive Avoidance and Anxiety: Respondents who endorsed negative, inaccurate stereotypes exhibited significantly higher levels of generalized AIDS anxiety. Paradoxically, individuals who scored high on the belief that AIDS was not self-relevant, who demonstrated closed-mindedness, and who claimed the media exaggerated the epidemic reported heightened underlying anxiety of sufficient magnitude to inhibit their normal sexual activity. This confirmed the psychodynamic and social-cognitive hypothesis that overt denial often masks intense subconscious health anxiety.
• Communication Competence: Convergent validity was established in relation to interpersonal sexual health strategies. Individuals who scored high on the Need for AIDS-Related Education subscale were significantly more likely to report using direct, assertive, and rational communication strategies when discussing sexual history and HIV precautions with prospective partners.

Discriminant and Group-Difference Validity

Snell et al. (1991) documented meaningful group-level differentiations that supported the scale’s discriminant capacity:

• Gender Discrepancies: Systematic gender differences emerged across the SAAS. Female respondents consistently exhibited more positive, non-judgmental, and medically accurate attitudes, demonstrating significantly lower agreement with punitive or homophobic subscales compared to male counterparts.
• Interaction with Sex-Role Stereotyping: The authors uncovered a profound intersection between gender role beliefs and AIDS stigma. Women who endorsed socially undesirable, traditional, or disparaging stereotypes about women (e.g., that women are inherently passive, intellectually vulnerable, or manipulative) were statistically more likely to endorse stigmatizing, punitive, and moralistic AIDS stereotypes on the SAAS. This supported the construct validity of the SAAS as a measure embedded within broader networks of authoritarian and stereotypic cognitive schemas.
• Public Policy Divergence: The scale successfully differentiated between educational support and coercive control. While both men and women expressed strong support for federal education initiatives, the subscales effectively delineated those who simultaneously supported civil rights protections from those who favored authoritarian interventions (e.g., universal mandatory testing and workplace termination).

Reliability

The internal consistency of the SAAS was evaluated by Snell, Finney, and Godwin (1991) using Cronbach’s alpha (α) across its four operational sections. Despite measuring complex, emotionally charged constructs, the individual subscales displayed moderate to high internal consistency reliability:

The lowest observed reliability coefficient (α = .64) occurred within Section C for subscales with fewer items (e.g., testing attitudes and curative beliefs), which is common in short cognitive scales assessing nascent medical technologies. Subscales with broader item representation, such as homophobic etiologies, casual transmission fears, and avoidance intentions, consistently exceeded the standard psychometric benchmark of α ≥ .80. These metrics indicate adequate item homogeneity and minimal measurement error, allowing researchers to utilize individual subscales independently or concurrently as a comprehensive battery.

Factor Analysis

The factorial validity of the SAAS was derived through exploratory factor analytic (EFA) procedures utilizing principal components analysis followed by orthogonal (Varimax) and oblique rotations during scale construction. The authors formulated items based on extensive reviews of public discourse, media broadcasts, clinical guidelines, and sociopolitical debates regarding AIDS in the late 1980s.

Item selection and factor retention were governed by strict psychometric criteria:

• Eigenvalues and Scree Tests: Factors retained within each of the four modular sections met the Kaiser-Guttman criterion (eigenvalues > 1.0) and showed distinct inflection points on Cattell’s scree plots.
• Factor Loadings: Individual items were retained only if their primary factor loading exceeded .40 on the target subscale, with minimal secondary cross-loadings (generally < .25) on adjacent factors.
• Modular Factor Separation: Rather than collapsing all 115 items into a single uninterpretable matrix, the authors performed compartmentalized factor extractions within each conceptual section:
• Section A (Global Beliefs): Confirmed a four-factor solution cleanly separating educational advocacy, civil liberties/confidentiality, casual contact misinformation, and homophobic causal attribution.
• Section B (Personal Attitudes): Extracted a five-factor structure delineating behavioral avoidance, perceived invulnerability, cognitive closed-mindedness, media skepticism/exaggeration, and moralistic retribution.
• Section C (Medical Issues): Produced a four-factor structure distinguishing occupational anxiety among healthcare workers, blood banking contamination, therapeutic curative beliefs, and institutional testing mandates.
• Section D (Sexual Issues): Resolved into a two-factor structure isolating general sexual risk awareness from specific beliefs in condom barrier efficacy.

Modern psychometric reviews note that this four-section modular design functions effectively in structural equation modeling (SEM) as four correlated second-order constructs or as 15 independent first-order indicators.

Instrument / Measurement Tool

• Instrument Name: Stereotypes About AIDS Scale (SAAS)
• Authors: William E. Snell, Jr., Phillip D. Finney, and Lisa J. Godwin (1991)
• Target Population: Adolescents, university students, and adult populations across community, clinical, and organizational settings.
• Structure: The overall SAAS is divided into four modular thematic sections containing a total item pool of 115 statements (Section A = 30 items; Section B = 35 items; Section C = 30 items; Section D = 20 items). In standard research protocols, Section A (30 items) is frequently administered independently as an index of global stereotypic beliefs.
• Response Format: A 5-point Likert format utilizing balanced directional scoring:
  • A = Agree (+2)
  • B = Slightly agree (+1)
  • C = Neither agree nor disagree (0)
  • D = Slightly disagree (−1)
  • E = Disagree (−2)
• Administration Time: Approximately 35 to 45 minutes for the complete four-section battery (115 items), or 8 to 12 minutes for Section A alone.
• Administration Modes: Paper-and-pencil scan sheets (optical mark recognition), in-person surveys, or computerized/online administration platforms.
• Scoring and Reversal Procedures:
  • Several items are reverse-scored prior to calculating subscale metrics: A8, A20, A21, C2, C12, and D4. For reverse items, responses are inverted (+2 becomes −2, +1 becomes −1, 0 remains 0, −1 becomes +1, and −2 becomes +2).
  • Subscale scores are derived by calculating the mean response value of the constituent items for each subscale. Scores range from −2.00 to +2.00, where positive values denote agreement with the measured stereotype/attitude, zero denotes neutrality, and negative values denote disagreement.
• Subscale Item Composition:
  • Section A – Need for AIDS-related education: Items A4, A6, A12, A18, A20, A22, A24, A28, A30
  • Section A – AIDS-related confidentiality: Items A2, A3, A8 (rev), A9, A14, A21 (rev), A26, A27
  • Section A – Transmission of AIDS: Items A5, A11, A15, A17, A23, A29
  • Section A – AIDS is caused by homosexuality: Items A1, A7, A13, A19, A25
  • Section B – Desire to avoid those afflicted with AIDS: Items B1, B22, B23, B24, B34, B35
  • Section B – AIDS not perceived as self-relevant: Items B5, B6, B7, B8
  • Section B – Closed-minded approach to AIDS: Items B13, B16, B17
  • Section B – The issue of AIDS is being exaggerated: Items B3, B10, B25, B29
  • Section B – AIDS as a moral punishment: Items B9, B32, B33
  • Section C – Belief that AIDS is a threat to medical staff: Items C3, C4, C6, C11, C12 (rev), C18
  • Section C – Protecting the U.S. blood supply system: Items C2 (rev), C5, C7, C17, C25, C27
  • Section C – Cure for AIDS: Items C9, C10, C23
  • Section C – AIDS testing should be conducted: Items C13, C14
  • Section D – Relationship between AIDS and sexual activity: Items D1, D2, D4 (rev), D5, D6, D7, D8, D9, D10, D11, D12, D13
  • Section D – Prevention of AIDS through condoms: Items D3, D10, D17, D18, D19

Permissions & Fee and Test Year

The Stereotypes About AIDS Scale was developed and published in 1991 by William E. Snell, Jr., Phillip D. Finney, and Lisa J. Godwin. The instrument was placed in the academic and public research domain for scholarly, pedagogical, and non-commercial scientific applications. The scale was formally presented in the peer-reviewed journal Contemporary Social Psychology.

No commercial licensing fees or royalty payments are required to administer the scale for non-profit psychological, sociological, or biomedical research. Investigators wishing to utilize the instrument in empirical studies, health program evaluations, or educational interventions may do so freely, provided appropriate scholarly attribution is accorded to Snell, Finney, and Godwin (1991). Inquiries regarding historical archives or academic permissions should refer to the Department of Psychology, Southeast Missouri State University.

References

• Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2(4), 324–473. https://doi.org/10.1177/109019817400200407
• Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
• Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public self and private self (pp. 189–212). Springer. https://doi.org/10.1007/978-1-4613-9564-5_10
• Herek, G. M. (1990). The illness correlation: AIDS and the fear of gay men. In D. A. Feldman (Ed.), Culture and AIDS (pp. 41–58). Praeger.
• Herek, G. M., & Capitanio, J. P. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42(7), 1130–1147. https://doi.org/10.1177/0002764299042007006
• Lerner, M. J. (1980). The belief in a just world: A fundamental delusion. Plenum Press. https://doi.org/10.1007/978-1-4684-3602-0
• Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403
• Snell, W. E., Jr., Finney, P. D., & Godwin, L. J. (1991). Stereotypes about AIDS. Contemporary Social Psychology, 15(1), 18–38.
• Walster, E. (1966). Assignment of responsibility for an accident. Journal of Personality and Social Psychology, 3(1), 73–79. https://doi.org/10.1037/h0022733

Items of the Scale