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AIDS Is a Government Conspiracy against Them?
Preventive Medicine 28, 451–457 (1999) Article ID pmed.1999.0463, available online at http://www.idealibrary.com on
LEAD ARTICLE Do Blacks Believe That HIV/AIDS Is a Government Conspiracy against Them?1 Elizabeth A. Klonoff, Ph.D.,*,2 and Hope Landrine, Ph.D.† *Behavioral Health Institute, California State University, 5500 University Parkway, San Bernardino, California 92407; and †Public Health Foundation, 13200 Crossroads Parkway North, City of Industry, California 91746
Background. We present the first study to explore the possibility that blacks believe that the human immunodeficiency virus was developed by the federal government in order to exterminate the black population. Methods. Five hundred twenty black adults sampled door to door in 10 randomly selected census tracts completed a written survey in exchange for $10. They indicated their degree of agreement with the statement, “HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people.” Results. Twenty-seven percent of blacks held AIDSconspiracy views and an additional 23% were undecided. Endorsing AIDS-conspiracy beliefs was not related to blacks’ age or income but was related to higher levels of education. Blacks who agreed that AIDS is a conspiracy against them tended to be culturally traditional, college-educated men who had experienced considerable racial discrimination. Conclusions. The prevalence and health-related implications of blacks’ AIDS-conspiracy beliefs must be fully investigated, and such beliefs must be addressed in culturally tailored, gender-specific AIDS prevention programs for blacks. q 1999 American Health Foundation and Academic Press
Key Words: AIDS; blacks’ beliefs; conspiracy theories; racism; discrimination. INTRODUCTION
Data from several social sciences indicate widespread, frequent racial discrimination against blacks [1,2,11]. Studies have found that blacks continue to be 1 Supported by funds provided by the National Institutes of Health, National Institute of Mental Health Grant 1R03-MH54672-01. 2 To whom correspondence and reprint requests should be addressed. Fax:(909) 880-5993. E-mail: [email protected].
discriminated against in a variety of arenas, ranging from face-to-face interactions [1,2,5,10] to discrimination in housing [1,5–8,11], employment [2–6,9,11], and health and social services [1,2,5–9,11,25]. Blacks report experiencing racial discrimination so frequently that depression or anger about racism is the most common problem presented by blacks in psychotherapy [24]. Hence, in two studies [11,14] we found that 98% of black adults reported experiencing some type of racial discrimination in the past year, with 83% reporting discrimination by waiters and store clerks, 55% reporting discrimination by health professionals, 50% reporting being called a racist name (e.g., “nigger”), and nearly 50% reporting being hit, shoved, harmed, or threatened with physical harm because of their race in the past year [11]. Many [9,11–15,17] have suggested that blacks have developed a profound distrust of whites in response to this racism and that such distrust is purposefully taught to successive generations [13–15,22] and so constitutes a cultural variable [11–15,26] that may have important implications for black health. Others have speculated that such racism has led blacks to be particularly distrustful of AIDS-related information and interventions [18,19]. Specifically, some health workers have anecdotally reported that many blacks believe that HIV is an artificially created virus and that AIDS prevention programs are a ruse for infecting the black population with it as part of a larger, government-sponsored conspiracy to exterminate the black population [17–21,23]. Informal surveys of blacks conducted by the Southern Christian Leadership Conference (SCLC) in 1990 and 1992 [17] are consistent with these anecdotal reports. These surveys found that 54% of blacks viewed AIDS blood tests and donating blood as a mechanism for purposefully infecting them with HIV, viewed AZT as a poison designed to execute blacks, saw the encouraged
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use of condoms as a stratagem to decrease black births, and interpreted the distribution of clean needles to addicts as an effort to increase substance abuse in the black community [17]. Tony Brown’s Journal, a popular, influential black discussion program on PBS (Public Broadcasting System), and articles in The Los Angeles Sentinel (the largest west coast black newspaper) and Essence (a national black magazine) also have suggested that HIV and AIDS prevention programs are the genocidal conspiracy of the federal government and of white health scientists [17]. Researchers have concluded that if blacks do indeed hold such conspiracy beliefs about HIV/AIDS, then these are not only the unfortunate consequences of historical and ongoing racism, but are also the regrettable result of the lamentable Tuskegee Syphilis Study [12,16,17,20–21,23]. Others have concluded that if blacks hold such conspiracy beliefs about HIV/AIDS, then those beliefs have important implications for prevention, and hence those beliefs (along with the Tuskegee Experiment) must be addressed explicitly in culturally tailored AIDS prevention programs for blacks [17,20,21]. But do blacks hold such conspiracy beliefs about HIV/AIDS? As indicated above, there is a great deal of speculation but no clear empirical evidence on this important issue. The only evidence indicating that blacks hold AIDSconspiracy beliefs stems from the anecdotal reports of health workers and from surveys conducted by the SCLC. While both are interesting, they shed no light on how widespread such beliefs might be because of small sample sizes (in the former case) and two small, highly religious samples that were far from representative of the black community (in the latter case); in both cases, no statistical analyses were presented. Thus, the purpose of this study was to conduct the first empirical investigation of AIDS-conspiracy beliefs among blacks. As such, the study was an exploratory one in which we sought to provide preliminary answers to these three questions: (1) What percentage of blacks believe that HIV is an artificially created virus designed to exterminate the black population? (2) Are such AIDSconspiracy beliefs among blacks limited to poor and uneducated blacks or are they more widespread? (3) Are such beliefs associated with participation in black culture or with the amount of racism that blacks have experienced (as others have suggested)? MATERIALS AND METHODS
Subjects Five hundred twenty Black adults (277 women, 243 men) participated. Their income range was 0–$150,000 annually (mean $16,883, s 5 $15,599), their age range was 18–79 years (mean 28.2, s 5 10.01), and their
education levels were 57 (11.5%) had less than a high school diploma, 140 (28.2%) had earned a high school diploma, 235 (47.3%) had taken some college courses, and 66 (13.1%) had earned undergraduate or graduate degrees. Their employment statuses were as follows: 183 (37.3%) worked full-time; 81 (16.5%) were full-time students; 73 (14.9%) were students who worked parttime; 63 (12.9%) worked part-time; 13 (2.7%) were fulltime housewives; 68 (13.9%) were supported by AFDC, SSI, or worker’s compensation; and 9 (1.8%) were retired. Procedure Subjects were sampled evenings and weekends for 4 months from 10 randomly selected middle- and working-class census tracts in San Bernardino County, California. Black research assistants (RAs) approached every household in each census tract and if a black adult answered the door, requested that s/he participate in an anonymous survey for $10. Subjects were given a survey and the RAs left, returning one hour later to retrieve it and pay the subject $10 for participating. Materials The main question in the survey read as follows: “HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people. How much do you agree with the above statement?”, to be answered on a scale that ranged from 1 (I totally disagree) to 5 (I totally agree). The remainder of the survey consisted of the Schedule of Racist Events [11], the African American Acculturation Scale [13,14,29], and demographic questions. The Schedule of Racist Events (SRE) measures the frequency of a variety of types of racial discrimination (e.g., in salaries, by store clerks; see Fig. 1) in blacks’ lives. Types of racial discrimination are conceptualized as culturally specific, stressful events (i.e., racist events) that are analogous to the generic (can happen to anyone) stressful life events (e.g., getting fired, getting married) that are measured by popular stress inventories such as the PERI-LES [26]. The SRE, however, also measures peoples’ appraisals of the stressfulness of the racist events, in a manner similar to the Perceived Stress Scale [27,28]. The logic behind the appraisal (vs the events) approach to measuring stress is that two people may experience the same negative event (getting fired, being called a nigger) with equal frequency, yet one may find it very stressful while the other dismisses it. Theoretically, the event would have a greater negative impact on the individual who appraised it as stressful [27]. Hence some stress researchers take the frequency of events and others the appraisal of events approach to stress measurement. The SRE uses both:
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FIG. 1. Sample items from the Schedule of Racist Events.
It is an 18-item scale measuring the frequency with which blacks have experienced specific racist events and their appraisals of those. Each item is answered on a scale that ranges from 1 (the event never happened to me) to 6 (the event happens almost all of the time). Items are completed once for the frequency of the racist events in the past year, again for frequency of the events in one’s entire lifetime, and again for the appraisal of the stressfulness of each event, as shown by the examples in Fig. 1. These are treated as the subscales Recent Racist Events (range 18–108), Lifetime Racist Events (range 18–108), and Appraised Racist Events (range 17–102). Prior studies [11,14] revealed that SRE scores have
no relationship to blacks’ gender, age, income, or education, in a manner consistent with studies demonstrating that racist discrimination is independent of SES and other status variables [5–7,10,11]. The three SRE subscales have high internal consistency and 1-month, test–retest reliability (Fig. 1), as well as strong construct, group differences, and convergent validity, as detailed elsewhere [11,14]. The African American Acculturation Scale–Revised (AAAS-R) is a new, brief form of the African American Acculturation Scale [13,14]. The original AAAS consisted of 74 items that measured eight aspects (e.g., religious beliefs, health beliefs, values) of African American culture, and had high reliability and validity. The
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AAAS was too long for many subjects, and some African Americans disliked several of the questions. Hence, those items were dropped, and the new, shorter AAASRevised was created by factor analyzing the remaining items. The AAAS-R [29] consists of 47 items that comprise eight, empirically derived subscales (i.e., orthogonal factors) measuring eight dimensions of African American culture, as shown by the examples in Fig. 2. Subjects indicate how much they agree with each item on scales that range from 1 (I totally disagree/not at all true) to 7 (I strongly agree/absolutely true). High
scores (high agreement with the items) indicate a traditional cultural orientation (immersed in black culture) and low scores (disagreement with the items) indicate an acculturated cultural orientation (low or no immersion in black culture). Scores are calculated for each of the eight subscales and a total AAAS-R is calculated as well. The subscales and the entire AAAS-R have high internal consistency reliability (Fig. 2), clear construct, and criterion-related validity and correlate r 5 0.97 with the original version of the scale [29]. Blacks vary considerably in their scores, with some disagreeing with
FIG. 2. Sample items from the African American Acculturation Scale–Revised.
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TABLE 1 Blacks’ Agreement with AIDS as Conspiracy Agreement ratings
N (%)
1. Totally disagree
Grouped as
167 (32.7)
2. Disagree somewhat
Disagree group N 5 259 (50.8%)
92 (18)
3. Neither agree nor disagree
116 (22.7)
4. Agree somewhat
62 (12.2)
5. Totally agree
73 (14.3)
Neither Agree nor Disagree group N 5 116 (22.7%) Agree group N 5 135 (26.5%)
every statement (acculturated or assimilated blacks) and others agreeing with every statement (highly culturally traditional blacks). RESULTS
Patterns of agreement with the statement, “HIV/ AIDS is a man-made virus that the federal government made to kill and wipe out black people,” are summarized in Table 1. As shown, 50.8% disagreed, 22.7% neither agreed nor disagreed, and 26.5% agreed with the statement. The Disagree (n 5 259) and Agree (n 5 135) groups were used in all subsequent analyses, and the middle group was omitted. Analyses for the Sample as a Whole To examine the possible sociocultural correlates of agreeing that AIDS is a conspiracy against blacks, a logistic regression predicted AIDS-Conspiracy Agreement group (Agree vs Disagree) from these variables: age, education level (high school drop-out, high school
TABLE 2 Stepwise Logistic Regression Predicting AIDS Agreement Group from AAAS-R, Income, Age, Education, Gender, Recent Racial Discrimination, Lifetime Racial Discrimination, and Appraised Racial Discrimination 95% Confidence interval
Predictor and step entered
Odds ratio
Coefficient/ SE
1. AAAS-R total score 2. Gender (reference: women) Men 3. Lifetime discrimination 4. Education group (reference: college graduates) Less than high school High school graduates Some college
1.02 1.00 3.54 1.02
1.01, 1.03
4.61
2.01, 6.22 1.01, 1.04
4.39 2.83
1.00 1.08 0.41 1.10
0.38, 3.09 0.17, 0.99 0.52, 2.33
0.14 21.99 0.26
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graduate, some college, college graduate), gender, income, level of acculturation (AAAS-R total score), lifetime (SRE lifetime score) and past year (SRE recent score) frequency of racial discrimination, and appraisal of the subjective stressfulness of that discrimination (SRE appraisal score). As shown in Table 2, level of acculturation was selected first; being culturally traditional (less acculturated) significantly increased the odds of being in the Agree group (Agree group AAAS-R score 233.76 versus 213.69 for Disagree group). Gender was selected next, with men 3.5 times more likely than women to be in the Agree group; 28.1% of the women in the sample, but 41.3% of the men, were in the Agree group. Frequency of lifetime racial discrimination was selected third and similarly increased the odds of being in the Agree group (Agree group SRE lifetime score 49.44 versus 40.81 for the Disagree group). Education was selected last, with high school graduates (18.7%) less likely than college graduates (28.1%) to be in the Agree group. Income and age were not related to AIDSConspiracy Agreement group. Thus, this analysis revealed that blacks who agree that AIDS is a genocidal conspiracy against them tend to be culturally traditional, male college graduates who have experienced frequent racial discrimination throughout their lives. Gender Differences The strong gender effect was unexpected and raised questions about the meaning of the other effects. Perhaps the men in this sample were more culturally traditional, experienced more lifetime racial discrimination, and were more educated than the women, such that effects for these three sociocultural variables were simply an artifact of the preponderance of men in the AIDSConspiracy Agreement group. To assess these possibilities, a x 2 compared the education levels of women and men but was not significant (x 2 (df 5 3) 5 3.21, P 5 0.36). Similarly, a MANOVA compared women’s and men’s total AAAS-R and lifetime discrimination scores and was significant (Hotelling’s T 5 0.082, exact F (2,363) 5 14.84, P 5 0.0005). However, women (229.75) scored significantly higher (more culturally traditional) than men (211.18) on the total AAAS-R (MS 5 31335.09, F (1,366) 5 19.92, P 5 0.0005), whereas men (47.10) reported significantly more frequent lifetime racial discrimination than women (42.33; MS 5 2062.56, F (1,366) 5 5.91, P 5 0.02). These analyses indicate that the regression effects for acculturation and discrimination were not simply an artifact of the large percentage of men in the Agree group. Instead, these findings suggest that the predictors of AIDS conspiracy views may differ for black women and men, with low levels of acculturation and high levels of lifetime discrimination predicting agreement for women and for
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men, respectively. To assess this possibility, separate regressions were conducted for women and men. Analyses for Women A stepwise, logistic regression predicted AIDS-Conspiracy Agreement group (Agree vs Disagree) for women only (n 5 164) from these variables: age, education, income, AAAS-R total score, and lifetime, past year, and appraisal of racial discrimination. The AAASR was the sole predictor selected; being culturally traditional increased the odds of black women agreeing that AIDS is a conspiracy against blacks (odds ratio 5 1.03; 95% CI 1.01, 104; coefficient/SE 5 4.46). Education, income, age, and racial discrimination were not predictors for black women. To elucidate precisely which aspects of African American culture are associated with AIDS conspiracy views among black women, a follow-up regression predicted black women’s AIDS-Conspiracy Agreement group from all eight AAAS-R subscales; discrimination, income, age, and education were omitted from this analysis because they were not significant in the prior one. Two cultural dimensions emerged: preferences for things African American (odds ratio 5 1.09;95% CI 1.06, 1.14; coefficient/SE 5 4.82) and traditional family practices (odds ratio 5 1.06;95% CI 1.01,1.12; coefficient/SE 5 2.30). A strong preference for black people and culture, coupled with an early life in a culturally traditional black family (i.e., an extended family that practiced cosleeping during one’s childhood), increased the odds of black women agreeing that AIDS is a government conspiracy against blacks. Analyses for Men A stepwise, logistic regression predicted AIDS-Conspiracy Agreement group (Agree vs Disagree) for men only (n 5 138) from these variables: age, education level, income, AAAS-R total score, and lifetime, past year, and appraisal of racial discrimination. Two racial discrimination variables were selected: lifetime racial discrimination (odds ratio 5 1.08; 95% CI 1.03, 1.13; coefficient/SE 5 3.33), and recent (past year) racial discrimination (odds ratio 5 0.94; 95% CI 0.90, 0.99; coefficient/SE 5 22.49). Frequent experiences with racial discrimination throughout one’s life (particularly early in life), coupled with few experiences of discrimination recently (in the past year), increased the odds of black men agreeing that AIDS is a conspiracy against the black community. Education, income, age, and acculturation were not predictors for black men. DISCUSSION
This study has three important findings. First, nearly 27% of black adults in this sample endorsed the view
that HIV is an artificially created virus designed by the federal government to exterminate the black population. Although this is far less than the 54% found in the Southern Christian Leadership Conference surveys [17], 27% is nonetheless an appreciable percentage and so is a significant finding. Hence, studies with large, random samples are needed to finally assess, rather than continue to speculate about, the prevalence of such views in the black community. The second important finding was that endorsing AIDS-conspiracy beliefs was not related to blacks’ incomes. Likewise, blacks who endorsed AIDS-conspiracy beliefs were more likely to be college graduates than high school graduates, with higher levels of education increasing the chances of agreeing with such views. These findings for social status are significant because they indicate that AIDS-conspiracy beliefs are not limited to poor and/or uneducated blacks as one might expect. In addition, the finding that those who endorsed AIDS-conspiracy views tended to be college graduates who no doubt understand how AIDS is transmitted suggests that some blacks may reject biomedical information in favor of conspiracy theories that are consistent with their experiences in a racist world [12]. This is precisely what many have speculated and feared [16–21,23]. The third important finding was that different sociocultural variables predicted AIDS-conspiracy beliefs for black women vs men, and men were more likely to hold such views. For women, being culturally traditional was the predictor, whereas for men, a history of frequent racial discrimination was the predictor, with education, age, and income not associated with the beliefs of either gender. Together, these three findings suggest that AIDSconspiracy beliefs among blacks must be acknowledged and addressed in culturally tailored AIDS prevention and education programs. This is particularly the case for college-educated blacks who are not only more likely to endorse conspiracy beliefs, but also may be inclined to reject biomedical information inconsistent with those views. In addition, there may be a need to increase AIDS education and prevention programs for black men given that they were 3.5 times more likely than black women to endorse AIDS-conspiracy beliefs. Such programs also may need to be gender-specific, with those for black men acknowledging the racism they experience as a powerful variable in their suspicions about AIDS and those for women acknowledging their strong cultural and family ties as a similar variable. It is important to note that blacks who endorsed versus rejected AIDS-conspiracy views did not differ in their degree of residential racial segregation, religiosity, or distrust of whites in general (AAAS-R subscales), and
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so these issues may be less important in culturally tailoring programs than blacks’ cultural ties and experiences with racism. However, because precisely how to improve AIDS prevention and education programs for blacks in light of AIDS-conspiracy beliefs cannot be discerned without further investigation of the social and cultural correlates of those beliefs, the comments above are speculative. Our purpose in this paper was not to investigate the AIDS-prevention implications of blacks’ AIDS-conspiracy views. Rather, it was to begin the process of empirically assessing the extent to which such views exist at all. By presenting the first empirical evidence indicating that some blacks do indeed hold AIDS-conspiracy beliefs, we mean to highlight the need for researchers to (finally) examine those. One concern about this study is that the manner in which we asked the AIDS-conspiracy question may have led blacks to endorse it. Given that 50% of subjects rejected the AIDS-conspiracy view, however, and that the result that 27% endorsed it is far lower than found in prior surveys [17], we doubt that our methodology determined our findings. Because our purpose here, however, is to encourage the long-overdue, empirical studies of this topic, we advocate research not only with samples more representative than ours, but using different methodologies for assessing AIDS-conspiracy views as well. Such studies might also assess the extent to which AIDS-conspiracy views among blacks are associated with knowledge of the Tuskegee study of untreated syphilis among black men. Many have speculated that knowledge of that study is related to suspicion of AIDS prevention programs [12,16,17,20,21,23]; perhaps such knowledge explains why college-educated blacks and black men were those likely to endorse AIDS-conspiracy beliefs here. Empirical analysis of blacks’ knowledge of that study and of its role in their beliefs about AIDS prevention also is long overdue. REFERENCES 1. Bell D. Faces at the bottom of the well: the permanence of racism. New York: Basic Books, 1992. 2. Dovidio JF, Gaertner S. Prejudice, discrimination, and racism. Orlando: Academic Press, 1986. 3. Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Social Sci Med 1990;30:1273–81. 4. Idson TL, Price HF. Analysis of wage differentials by gender and ethnicity in the public sector. Rev Black Polit Econ 1992;20: 75–97. 5. Feagin JR. The continuing significance of race: antiblack discrimination in public places. Am Sociol Rev 1991;56:101–16. 6. Feagin JR., Feagin CB. Discrimination American style: institutional racism and sexism. Englewood Cliffs (NJ): Prentice Hall, 1978.
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7. Massey DS., Denton NA. American apartheid: segregation and the making of the underclass. Cambridge (MA): Harvard Univ. Press, 1993. 8. Polednak A. Segregation, poverty, and mortality in urban African Americans. New York: Oxford Univ. Press, 1997. 9. Cose E. The rage of the privileged class. New York: Harper Collins, 1993. 10. Landrine H., Klonoff EA., Alcaraz R., Scott J., Wilkins P. Multiple variables in discrimination. In: Lott B, Maluso D, editors. The social psychology of interpersonal discrimination New York: Guilford, 1995:183–224. 11. Landrine H., Klonoff EA. The Schedule of Racist Events: a measure of racial discrimination and a study of its negative physical and mental health consequences. J Black Psychol 1996;22: 144–68. 12. Klonoff EA., Landrine H. Distrust of whites, acculturation and AIDS knowledge among African Americans. J Black Psychol 1997;23:50–7. 13. Landrine H, Klonoff EA. The African American Acculturation Scale. J Black Psychol 1994;20:104–27. 14. Landrine H., Klonoff EA. African American acculturation: deconstructing race and reviving culture. Thousand Oaks (CA): Sage, 1996. 15. Helms J. Black and white racial identity. New York: Greenwood, 1990. 16. Jones JH. Bad blood: the Tuskegee Syphilis Experiment, a tragedy of race and medicine. New York: The Free Press, 1981. 17. Jones JH. Bad blood: the Tuskegee Syphilis Experiment. New and expanded edition. New York: The Free Press, 1993. 18. Kalichman SC., Kelly J., Hunter TL., Murphy DA., Tyler R. Culturally-tailored HIV-AIDS risk-reduction messages targeted to African-American urban women. J. Consult Clin Psychol 1993; 91:291–5. 19. Mays VM., Cochran S. Issues in the perception of AIDS risk and risk reduction activities by Black and Hispanic/Latina women. Am Psychol 1988;43:949–57. 20. Silver G. AIDS: the infamous Tuskegee Study. Am J Public Health 1988;78:1500–1. 21. Thomas SB., Quinn SC. The Tuskegee Syphilis Study 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community. Am J Public Health 1991; 81(11):1498–504. 22. Thompson VL. Socialization to race. J Black Psychol 1994; 20:175–88. 23. Brandt A. AIDS: from social history to social policy. In: Fee E, Fox D, editors. AIDS: the burdens of history. Berkeley: Univ. of California Press, 1988:147–71. 24. National Institute of Mental Health. Research highlights: extramural research. Washington: U.S. Govt. Printing Office, 1983. 25. Harrison F. Racial and gender inequalities in health and health care. Med Anthropol Q 1994;8:90–5. 26. Dohrenwend BS., Krasnoff L., Askenasy AR., Dohrenwend BP. Exemplification of a method for scaling life events: the PERI Life Events Scale. J Health Social Behav 1978;19:205–29. 27. Cohen S. Contrasting the Hassles Scale and the Perceived Stress Scale: who’s really measuring appraised stress? Am Psychol 1968;41:716–8. 28. Cohen S., Kamarck T., Mermelstein R. A global measure of perceived stress. J Health Social Behav 1983;24:385–96. 29. Landrine H., Klonoff EA. Problematic items, newspaper reporters, and stereotype threat: investigating African American culture in the context of cultural racism. J Black Psychol. In press.
LEAD ARTICLE Do Blacks Believe That HIV/AIDS Is a Government Conspiracy against Them?1 Elizabeth A. Klonoff, Ph.D.,*,2 and Hope Landrine, Ph.D.† *Behavioral Health Institute, California State University, 5500 University Parkway, San Bernardino, California 92407; and †Public Health Foundation, 13200 Crossroads Parkway North, City of Industry, California 91746
Background. We present the first study to explore the possibility that blacks believe that the human immunodeficiency virus was developed by the federal government in order to exterminate the black population. Methods. Five hundred twenty black adults sampled door to door in 10 randomly selected census tracts completed a written survey in exchange for $10. They indicated their degree of agreement with the statement, “HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people.” Results. Twenty-seven percent of blacks held AIDSconspiracy views and an additional 23% were undecided. Endorsing AIDS-conspiracy beliefs was not related to blacks’ age or income but was related to higher levels of education. Blacks who agreed that AIDS is a conspiracy against them tended to be culturally traditional, college-educated men who had experienced considerable racial discrimination. Conclusions. The prevalence and health-related implications of blacks’ AIDS-conspiracy beliefs must be fully investigated, and such beliefs must be addressed in culturally tailored, gender-specific AIDS prevention programs for blacks. q 1999 American Health Foundation and Academic Press
Key Words: AIDS; blacks’ beliefs; conspiracy theories; racism; discrimination. INTRODUCTION
Data from several social sciences indicate widespread, frequent racial discrimination against blacks [1,2,11]. Studies have found that blacks continue to be 1 Supported by funds provided by the National Institutes of Health, National Institute of Mental Health Grant 1R03-MH54672-01. 2 To whom correspondence and reprint requests should be addressed. Fax:(909) 880-5993. E-mail: [email protected].
discriminated against in a variety of arenas, ranging from face-to-face interactions [1,2,5,10] to discrimination in housing [1,5–8,11], employment [2–6,9,11], and health and social services [1,2,5–9,11,25]. Blacks report experiencing racial discrimination so frequently that depression or anger about racism is the most common problem presented by blacks in psychotherapy [24]. Hence, in two studies [11,14] we found that 98% of black adults reported experiencing some type of racial discrimination in the past year, with 83% reporting discrimination by waiters and store clerks, 55% reporting discrimination by health professionals, 50% reporting being called a racist name (e.g., “nigger”), and nearly 50% reporting being hit, shoved, harmed, or threatened with physical harm because of their race in the past year [11]. Many [9,11–15,17] have suggested that blacks have developed a profound distrust of whites in response to this racism and that such distrust is purposefully taught to successive generations [13–15,22] and so constitutes a cultural variable [11–15,26] that may have important implications for black health. Others have speculated that such racism has led blacks to be particularly distrustful of AIDS-related information and interventions [18,19]. Specifically, some health workers have anecdotally reported that many blacks believe that HIV is an artificially created virus and that AIDS prevention programs are a ruse for infecting the black population with it as part of a larger, government-sponsored conspiracy to exterminate the black population [17–21,23]. Informal surveys of blacks conducted by the Southern Christian Leadership Conference (SCLC) in 1990 and 1992 [17] are consistent with these anecdotal reports. These surveys found that 54% of blacks viewed AIDS blood tests and donating blood as a mechanism for purposefully infecting them with HIV, viewed AZT as a poison designed to execute blacks, saw the encouraged
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use of condoms as a stratagem to decrease black births, and interpreted the distribution of clean needles to addicts as an effort to increase substance abuse in the black community [17]. Tony Brown’s Journal, a popular, influential black discussion program on PBS (Public Broadcasting System), and articles in The Los Angeles Sentinel (the largest west coast black newspaper) and Essence (a national black magazine) also have suggested that HIV and AIDS prevention programs are the genocidal conspiracy of the federal government and of white health scientists [17]. Researchers have concluded that if blacks do indeed hold such conspiracy beliefs about HIV/AIDS, then these are not only the unfortunate consequences of historical and ongoing racism, but are also the regrettable result of the lamentable Tuskegee Syphilis Study [12,16,17,20–21,23]. Others have concluded that if blacks hold such conspiracy beliefs about HIV/AIDS, then those beliefs have important implications for prevention, and hence those beliefs (along with the Tuskegee Experiment) must be addressed explicitly in culturally tailored AIDS prevention programs for blacks [17,20,21]. But do blacks hold such conspiracy beliefs about HIV/AIDS? As indicated above, there is a great deal of speculation but no clear empirical evidence on this important issue. The only evidence indicating that blacks hold AIDSconspiracy beliefs stems from the anecdotal reports of health workers and from surveys conducted by the SCLC. While both are interesting, they shed no light on how widespread such beliefs might be because of small sample sizes (in the former case) and two small, highly religious samples that were far from representative of the black community (in the latter case); in both cases, no statistical analyses were presented. Thus, the purpose of this study was to conduct the first empirical investigation of AIDS-conspiracy beliefs among blacks. As such, the study was an exploratory one in which we sought to provide preliminary answers to these three questions: (1) What percentage of blacks believe that HIV is an artificially created virus designed to exterminate the black population? (2) Are such AIDSconspiracy beliefs among blacks limited to poor and uneducated blacks or are they more widespread? (3) Are such beliefs associated with participation in black culture or with the amount of racism that blacks have experienced (as others have suggested)? MATERIALS AND METHODS
Subjects Five hundred twenty Black adults (277 women, 243 men) participated. Their income range was 0–$150,000 annually (mean $16,883, s 5 $15,599), their age range was 18–79 years (mean 28.2, s 5 10.01), and their
education levels were 57 (11.5%) had less than a high school diploma, 140 (28.2%) had earned a high school diploma, 235 (47.3%) had taken some college courses, and 66 (13.1%) had earned undergraduate or graduate degrees. Their employment statuses were as follows: 183 (37.3%) worked full-time; 81 (16.5%) were full-time students; 73 (14.9%) were students who worked parttime; 63 (12.9%) worked part-time; 13 (2.7%) were fulltime housewives; 68 (13.9%) were supported by AFDC, SSI, or worker’s compensation; and 9 (1.8%) were retired. Procedure Subjects were sampled evenings and weekends for 4 months from 10 randomly selected middle- and working-class census tracts in San Bernardino County, California. Black research assistants (RAs) approached every household in each census tract and if a black adult answered the door, requested that s/he participate in an anonymous survey for $10. Subjects were given a survey and the RAs left, returning one hour later to retrieve it and pay the subject $10 for participating. Materials The main question in the survey read as follows: “HIV/AIDS is a man-made virus that the federal government made to kill and wipe out black people. How much do you agree with the above statement?”, to be answered on a scale that ranged from 1 (I totally disagree) to 5 (I totally agree). The remainder of the survey consisted of the Schedule of Racist Events [11], the African American Acculturation Scale [13,14,29], and demographic questions. The Schedule of Racist Events (SRE) measures the frequency of a variety of types of racial discrimination (e.g., in salaries, by store clerks; see Fig. 1) in blacks’ lives. Types of racial discrimination are conceptualized as culturally specific, stressful events (i.e., racist events) that are analogous to the generic (can happen to anyone) stressful life events (e.g., getting fired, getting married) that are measured by popular stress inventories such as the PERI-LES [26]. The SRE, however, also measures peoples’ appraisals of the stressfulness of the racist events, in a manner similar to the Perceived Stress Scale [27,28]. The logic behind the appraisal (vs the events) approach to measuring stress is that two people may experience the same negative event (getting fired, being called a nigger) with equal frequency, yet one may find it very stressful while the other dismisses it. Theoretically, the event would have a greater negative impact on the individual who appraised it as stressful [27]. Hence some stress researchers take the frequency of events and others the appraisal of events approach to stress measurement. The SRE uses both:
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FIG. 1. Sample items from the Schedule of Racist Events.
It is an 18-item scale measuring the frequency with which blacks have experienced specific racist events and their appraisals of those. Each item is answered on a scale that ranges from 1 (the event never happened to me) to 6 (the event happens almost all of the time). Items are completed once for the frequency of the racist events in the past year, again for frequency of the events in one’s entire lifetime, and again for the appraisal of the stressfulness of each event, as shown by the examples in Fig. 1. These are treated as the subscales Recent Racist Events (range 18–108), Lifetime Racist Events (range 18–108), and Appraised Racist Events (range 17–102). Prior studies [11,14] revealed that SRE scores have
no relationship to blacks’ gender, age, income, or education, in a manner consistent with studies demonstrating that racist discrimination is independent of SES and other status variables [5–7,10,11]. The three SRE subscales have high internal consistency and 1-month, test–retest reliability (Fig. 1), as well as strong construct, group differences, and convergent validity, as detailed elsewhere [11,14]. The African American Acculturation Scale–Revised (AAAS-R) is a new, brief form of the African American Acculturation Scale [13,14]. The original AAAS consisted of 74 items that measured eight aspects (e.g., religious beliefs, health beliefs, values) of African American culture, and had high reliability and validity. The
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AAAS was too long for many subjects, and some African Americans disliked several of the questions. Hence, those items were dropped, and the new, shorter AAASRevised was created by factor analyzing the remaining items. The AAAS-R [29] consists of 47 items that comprise eight, empirically derived subscales (i.e., orthogonal factors) measuring eight dimensions of African American culture, as shown by the examples in Fig. 2. Subjects indicate how much they agree with each item on scales that range from 1 (I totally disagree/not at all true) to 7 (I strongly agree/absolutely true). High
scores (high agreement with the items) indicate a traditional cultural orientation (immersed in black culture) and low scores (disagreement with the items) indicate an acculturated cultural orientation (low or no immersion in black culture). Scores are calculated for each of the eight subscales and a total AAAS-R is calculated as well. The subscales and the entire AAAS-R have high internal consistency reliability (Fig. 2), clear construct, and criterion-related validity and correlate r 5 0.97 with the original version of the scale [29]. Blacks vary considerably in their scores, with some disagreeing with
FIG. 2. Sample items from the African American Acculturation Scale–Revised.
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TABLE 1 Blacks’ Agreement with AIDS as Conspiracy Agreement ratings
N (%)
1. Totally disagree
Grouped as
167 (32.7)
2. Disagree somewhat
Disagree group N 5 259 (50.8%)
92 (18)
3. Neither agree nor disagree
116 (22.7)
4. Agree somewhat
62 (12.2)
5. Totally agree
73 (14.3)
Neither Agree nor Disagree group N 5 116 (22.7%) Agree group N 5 135 (26.5%)
every statement (acculturated or assimilated blacks) and others agreeing with every statement (highly culturally traditional blacks). RESULTS
Patterns of agreement with the statement, “HIV/ AIDS is a man-made virus that the federal government made to kill and wipe out black people,” are summarized in Table 1. As shown, 50.8% disagreed, 22.7% neither agreed nor disagreed, and 26.5% agreed with the statement. The Disagree (n 5 259) and Agree (n 5 135) groups were used in all subsequent analyses, and the middle group was omitted. Analyses for the Sample as a Whole To examine the possible sociocultural correlates of agreeing that AIDS is a conspiracy against blacks, a logistic regression predicted AIDS-Conspiracy Agreement group (Agree vs Disagree) from these variables: age, education level (high school drop-out, high school
TABLE 2 Stepwise Logistic Regression Predicting AIDS Agreement Group from AAAS-R, Income, Age, Education, Gender, Recent Racial Discrimination, Lifetime Racial Discrimination, and Appraised Racial Discrimination 95% Confidence interval
Predictor and step entered
Odds ratio
Coefficient/ SE
1. AAAS-R total score 2. Gender (reference: women) Men 3. Lifetime discrimination 4. Education group (reference: college graduates) Less than high school High school graduates Some college
1.02 1.00 3.54 1.02
1.01, 1.03
4.61
2.01, 6.22 1.01, 1.04
4.39 2.83
1.00 1.08 0.41 1.10
0.38, 3.09 0.17, 0.99 0.52, 2.33
0.14 21.99 0.26
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graduate, some college, college graduate), gender, income, level of acculturation (AAAS-R total score), lifetime (SRE lifetime score) and past year (SRE recent score) frequency of racial discrimination, and appraisal of the subjective stressfulness of that discrimination (SRE appraisal score). As shown in Table 2, level of acculturation was selected first; being culturally traditional (less acculturated) significantly increased the odds of being in the Agree group (Agree group AAAS-R score 233.76 versus 213.69 for Disagree group). Gender was selected next, with men 3.5 times more likely than women to be in the Agree group; 28.1% of the women in the sample, but 41.3% of the men, were in the Agree group. Frequency of lifetime racial discrimination was selected third and similarly increased the odds of being in the Agree group (Agree group SRE lifetime score 49.44 versus 40.81 for the Disagree group). Education was selected last, with high school graduates (18.7%) less likely than college graduates (28.1%) to be in the Agree group. Income and age were not related to AIDSConspiracy Agreement group. Thus, this analysis revealed that blacks who agree that AIDS is a genocidal conspiracy against them tend to be culturally traditional, male college graduates who have experienced frequent racial discrimination throughout their lives. Gender Differences The strong gender effect was unexpected and raised questions about the meaning of the other effects. Perhaps the men in this sample were more culturally traditional, experienced more lifetime racial discrimination, and were more educated than the women, such that effects for these three sociocultural variables were simply an artifact of the preponderance of men in the AIDSConspiracy Agreement group. To assess these possibilities, a x 2 compared the education levels of women and men but was not significant (x 2 (df 5 3) 5 3.21, P 5 0.36). Similarly, a MANOVA compared women’s and men’s total AAAS-R and lifetime discrimination scores and was significant (Hotelling’s T 5 0.082, exact F (2,363) 5 14.84, P 5 0.0005). However, women (229.75) scored significantly higher (more culturally traditional) than men (211.18) on the total AAAS-R (MS 5 31335.09, F (1,366) 5 19.92, P 5 0.0005), whereas men (47.10) reported significantly more frequent lifetime racial discrimination than women (42.33; MS 5 2062.56, F (1,366) 5 5.91, P 5 0.02). These analyses indicate that the regression effects for acculturation and discrimination were not simply an artifact of the large percentage of men in the Agree group. Instead, these findings suggest that the predictors of AIDS conspiracy views may differ for black women and men, with low levels of acculturation and high levels of lifetime discrimination predicting agreement for women and for
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men, respectively. To assess this possibility, separate regressions were conducted for women and men. Analyses for Women A stepwise, logistic regression predicted AIDS-Conspiracy Agreement group (Agree vs Disagree) for women only (n 5 164) from these variables: age, education, income, AAAS-R total score, and lifetime, past year, and appraisal of racial discrimination. The AAASR was the sole predictor selected; being culturally traditional increased the odds of black women agreeing that AIDS is a conspiracy against blacks (odds ratio 5 1.03; 95% CI 1.01, 104; coefficient/SE 5 4.46). Education, income, age, and racial discrimination were not predictors for black women. To elucidate precisely which aspects of African American culture are associated with AIDS conspiracy views among black women, a follow-up regression predicted black women’s AIDS-Conspiracy Agreement group from all eight AAAS-R subscales; discrimination, income, age, and education were omitted from this analysis because they were not significant in the prior one. Two cultural dimensions emerged: preferences for things African American (odds ratio 5 1.09;95% CI 1.06, 1.14; coefficient/SE 5 4.82) and traditional family practices (odds ratio 5 1.06;95% CI 1.01,1.12; coefficient/SE 5 2.30). A strong preference for black people and culture, coupled with an early life in a culturally traditional black family (i.e., an extended family that practiced cosleeping during one’s childhood), increased the odds of black women agreeing that AIDS is a government conspiracy against blacks. Analyses for Men A stepwise, logistic regression predicted AIDS-Conspiracy Agreement group (Agree vs Disagree) for men only (n 5 138) from these variables: age, education level, income, AAAS-R total score, and lifetime, past year, and appraisal of racial discrimination. Two racial discrimination variables were selected: lifetime racial discrimination (odds ratio 5 1.08; 95% CI 1.03, 1.13; coefficient/SE 5 3.33), and recent (past year) racial discrimination (odds ratio 5 0.94; 95% CI 0.90, 0.99; coefficient/SE 5 22.49). Frequent experiences with racial discrimination throughout one’s life (particularly early in life), coupled with few experiences of discrimination recently (in the past year), increased the odds of black men agreeing that AIDS is a conspiracy against the black community. Education, income, age, and acculturation were not predictors for black men. DISCUSSION
This study has three important findings. First, nearly 27% of black adults in this sample endorsed the view
that HIV is an artificially created virus designed by the federal government to exterminate the black population. Although this is far less than the 54% found in the Southern Christian Leadership Conference surveys [17], 27% is nonetheless an appreciable percentage and so is a significant finding. Hence, studies with large, random samples are needed to finally assess, rather than continue to speculate about, the prevalence of such views in the black community. The second important finding was that endorsing AIDS-conspiracy beliefs was not related to blacks’ incomes. Likewise, blacks who endorsed AIDS-conspiracy beliefs were more likely to be college graduates than high school graduates, with higher levels of education increasing the chances of agreeing with such views. These findings for social status are significant because they indicate that AIDS-conspiracy beliefs are not limited to poor and/or uneducated blacks as one might expect. In addition, the finding that those who endorsed AIDS-conspiracy views tended to be college graduates who no doubt understand how AIDS is transmitted suggests that some blacks may reject biomedical information in favor of conspiracy theories that are consistent with their experiences in a racist world [12]. This is precisely what many have speculated and feared [16–21,23]. The third important finding was that different sociocultural variables predicted AIDS-conspiracy beliefs for black women vs men, and men were more likely to hold such views. For women, being culturally traditional was the predictor, whereas for men, a history of frequent racial discrimination was the predictor, with education, age, and income not associated with the beliefs of either gender. Together, these three findings suggest that AIDSconspiracy beliefs among blacks must be acknowledged and addressed in culturally tailored AIDS prevention and education programs. This is particularly the case for college-educated blacks who are not only more likely to endorse conspiracy beliefs, but also may be inclined to reject biomedical information inconsistent with those views. In addition, there may be a need to increase AIDS education and prevention programs for black men given that they were 3.5 times more likely than black women to endorse AIDS-conspiracy beliefs. Such programs also may need to be gender-specific, with those for black men acknowledging the racism they experience as a powerful variable in their suspicions about AIDS and those for women acknowledging their strong cultural and family ties as a similar variable. It is important to note that blacks who endorsed versus rejected AIDS-conspiracy views did not differ in their degree of residential racial segregation, religiosity, or distrust of whites in general (AAAS-R subscales), and
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so these issues may be less important in culturally tailoring programs than blacks’ cultural ties and experiences with racism. However, because precisely how to improve AIDS prevention and education programs for blacks in light of AIDS-conspiracy beliefs cannot be discerned without further investigation of the social and cultural correlates of those beliefs, the comments above are speculative. Our purpose in this paper was not to investigate the AIDS-prevention implications of blacks’ AIDS-conspiracy views. Rather, it was to begin the process of empirically assessing the extent to which such views exist at all. By presenting the first empirical evidence indicating that some blacks do indeed hold AIDS-conspiracy beliefs, we mean to highlight the need for researchers to (finally) examine those. One concern about this study is that the manner in which we asked the AIDS-conspiracy question may have led blacks to endorse it. Given that 50% of subjects rejected the AIDS-conspiracy view, however, and that the result that 27% endorsed it is far lower than found in prior surveys [17], we doubt that our methodology determined our findings. Because our purpose here, however, is to encourage the long-overdue, empirical studies of this topic, we advocate research not only with samples more representative than ours, but using different methodologies for assessing AIDS-conspiracy views as well. Such studies might also assess the extent to which AIDS-conspiracy views among blacks are associated with knowledge of the Tuskegee study of untreated syphilis among black men. Many have speculated that knowledge of that study is related to suspicion of AIDS prevention programs [12,16,17,20,21,23]; perhaps such knowledge explains why college-educated blacks and black men were those likely to endorse AIDS-conspiracy beliefs here. Empirical analysis of blacks’ knowledge of that study and of its role in their beliefs about AIDS prevention also is long overdue. REFERENCES 1. Bell D. Faces at the bottom of the well: the permanence of racism. New York: Basic Books, 1992. 2. Dovidio JF, Gaertner S. Prejudice, discrimination, and racism. Orlando: Academic Press, 1986. 3. Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Social Sci Med 1990;30:1273–81. 4. Idson TL, Price HF. Analysis of wage differentials by gender and ethnicity in the public sector. Rev Black Polit Econ 1992;20: 75–97. 5. Feagin JR. The continuing significance of race: antiblack discrimination in public places. Am Sociol Rev 1991;56:101–16. 6. Feagin JR., Feagin CB. Discrimination American style: institutional racism and sexism. Englewood Cliffs (NJ): Prentice Hall, 1978.
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