AIDS Attitude Scale

Abstract

The AIDS Attitude Scale (AAS) is a 54-item instrument designed to quantify attitudes toward AIDS (Acquired Immunodeficiency Syndrome) and individuals living with HIV infection or AIDS. Developed initially to measure college students’ attitudes, the scale employs a 5-point Likert scale format, ranging from Strongly Agree to Strongly Disagree. The primary utility of the AAS is to distinguish between individuals exhibiting high levels of empathy and tolerance toward people with HIV/AIDS and those demonstrating less tolerant attitudes. The development process involved an initial pool of 94 items, expert review, and rigorous item analysis resulting in the final 54 statements. Subject areas covered include fears concerning contagion and casual contact, moral judgments, and positions on legal and social welfare issues related to the disease.

Keywords

AIDS Attitude Scale, AIDS, HIV infection, attitudes, stigma, tolerance, empathy, psychological assessment, social welfare, contagion concerns, Likert scale.

Authors

Jacque Shrum, Norma Turner, Katherine Bruce.

Purpose

The fundamental purpose of the AIDS Attitude Scale (AAS) is the standardized measurement of an individual’s affective and cognitive responses regarding AIDS and the associated populations. It serves as a diagnostic tool to assess the spectrum of attitudes, ranging from highly tolerant and empathetic to intolerant and judgmental.

By quantifying these attitudes, the scale provides essential data for evaluating the effectiveness of educational interventions, public health campaigns, and counseling programs aimed at reducing stigma and promoting tolerance. The scope of the scale encompasses several key domains that influence public perception of HIV/AIDS.

Construct

The AAS is designed to measure the psychological construct of Attitude Toward Persons with HIV/AIDS, which is multidimensional. The scale specifically targets three primary, consistent factors identified through factor analysis: contagion concerns, moral issues, and legal/social welfare issues.

These domains reflect the core anxieties and societal judgments surrounding the disease. Contagion Concerns address fears related to casual contact and transmission risk. Moral Issues capture judgments concerning the perceived deservingness of individuals with HIV. Finally, Legal and Social Welfare Issues measure opinions on policy matters such as employment rights, confidentiality of test results, and criminal liability.

Validity

Rigorous validation procedures were employed during the development and subsequent studies of the AAS. Content and Face Validity were established by a panel of four expert judges—including professionals in social work, health education, and experimental psychology—who assessed the relevance and appropriateness of each item and the scale’s overall content (Shrum et al., 1989).

Evidence for Construct Validity was supported by factor analysis, which consistently revealed the hypothesized three-factor structure (contagion, moral, and legal/social welfare issues), accounting for over 40% of the total variance (Bruce et al., 1990; Shrum et al., 1989). Further studies documented evidence for known-groups validity, as the scale successfully differentiated attitudes between college students and clients at sexually transmitted disease clinics. Concurrent, convergent, and discriminant validity have also been formally documented (Bruce & Reid, 1998; Bruce & Walker, 2001). Additionally, AAS scores successfully predicted AIDS-related information-seeking behaviors following high-profile celebrity announcements.

Reliability

The AIDS Attitude Scale demonstrates high levels of internal consistency, indicating strong reliability across different samples. Initial testing on 135 undergraduate students established excellent internal consistency, measured by Cronbach’s alpha at .96 (Shrum, Turner, & Bruce, 1989). This high reliability suggests that the items within the scale measure a consistent underlying construct.

Subsequent independent studies confirmed this reliability, with another student sample yielding a similarly high Cronbach’s alpha of .94 (Bruce & Reid, 1998), affirming the consistency and stability of the measurement across time and different populations within the college setting.

Factor Analysis

The exploratory factor analysis conducted during the scale’s development identified a robust structure comprising three principal factors underlying attitudes toward AIDS/HIV: Contagion Concerns, Moral Issues, and Legal/Social Welfare Issues. These three factors collectively explained more than 40% of the variance observed in the AAS scores, lending strong support to the scale’s construct validity.

This tripartite structure confirms that attitudes are not monolithic but are segmented across different dimensions of fear (contagion), judgment (morality), and public policy (legal/social welfare). The structure has remained consistent across multiple validation studies, solidifying the scale’s theoretical foundation (Bruce et al., 1990; Shrum et al., 1989).

Instrument

Test Type: Attitude Measurement Scale (Psychometric)

Format: 54-item self-report scale utilizing a 5-point Likert scale response format.

Language Available: English (Original development language).

Population Group: General population, specifically aimed at measuring attitudes toward people with HIV/AIDS.

Age Group: Adolescents and Adults (Initially validated on college students).

Population Details: Originally standardized on undergraduate students in health education courses (N=164 for item analysis, N=135 for reliability). Subsequent studies have applied the scale to various populations, including clients at sexually transmitted disease clinics.

Test Methodology: Respondents circle or blacken one response option for each item on a separate answer sheet. Completion time is typically less than 15 minutes. Scoring involves direct scoring for 25 tolerant items (Strongly Agree = 5) and reverse scoring for 29 intolerant items. Scores are standardized to range from 0 to 100 using the formula: AAS score = (X − N)(100)/(N)(4), where X is the total of the scored responses and N is the number of items properly completed. Higher scores reflect greater empathy and tolerance.

Keywords

Psychological instrument, attitude assessment, HIV stigma, tolerance, empathy, public health, social psychology, Cronbach’s alpha, standardization formula.

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: [email protected] (Correspondence for Katherine Bruce)

Correspondence Address: Katherine Bruce, Department of Psychology, UNC Wilmington, Wilmington, NC 28403.

Permissions & Fee and Test Year

The AIDS Attitude Scale (AAS) was originally developed and published in 1989 (Shrum, Turner, & Bruce, 1989). The scale is published in its entirety in the founding article, suggesting it is generally available for academic and research use, though specific usage permissions should be requested from the corresponding author, Katherine Bruce.

Initial Publication Year: 1989.

Reference’s

• Bruce, K., & Moineau, S. (1991). A comparison of sexually transmitted disease clinic patients and undergraduates: Implications for AIDS prevention and education. Health Values, 15, 5–12.

• Bruce, K., Pilgrim, C., and Spivey, R. (1994). Assessing the impact of Magic Johnson’s HIV positive announcement on a university campus. Journal of Sex Education and Therapy, 20, 264–276.

• Bruce, K., Shrum, J., Trefethen, C., & Slovik, L. (1990). Students’ attitudes about AIDS, homosexuality, and condoms. AIDS Behavior and Prevention, 2, 220–234.

• Bruce, K. E., & Reid, B. C. (1998). Assessing the construct validity of the AIDS Attitude Scale. AIDS Education and Prevention, 10, 75–89.

• Bruce, K. E., & Walker, L. J. (2001). College students’ attitudes about AIDS: 1986 to 2000. AIDS Education and Prevention, 13, 428–437.

• Shrum, J., Turner, N., & Bruce, K. (1989). Development of an instrument to measure attitudes towards AIDS. AIDS Education and Prevention, 1, 222–230.

Items of the AIDS Attitude Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

For each of the following statements, please note whether you agree or disagree with the statement. There are no correct answers, only your opinions. Use the following scale:

• SA: Strongly Agree With the Statement

• A: Agree With the Statement

• N: Neither Agree nor Disagree With the Statement

• D: Disagree With the Statement

• SD: Strongly Disagree With the Statement

1. Limiting the spread of AIDS is more important than trying to protect the rights of people with AIDS.

2. Support groups for people with HIV (Human Immunodeficiency Virus) infection would be very helpful to them.

3. I would consider marrying someone with HIV infection.

4. I would quit my job before I would work with someone who has AIDS.

5. People should not be afraid of catching HIV from casual contact, like hugging or shaking hands.

6. I would like to feel at ease around people with AIDS.

7. People who receive positive results from the HIV blood tests should not be allowed to get married.

8. I would prefer not to be around homosexuals for fear of catching AIDS.

9. Being around someone with AIDS would not put my health in danger.

10. Only disgusting people get HIV infection.

11. I think that people with HIV infection got what they deserved.

12. People with AIDS should not avoid being around other people.

13. People should avoid going to the dentist because they might catch HIV from dental instruments.

14. The thought of being around someone with AIDS does not bother me.

15. People with HIV infection should not be prohibited from working in public places.

16. I would not want to be in the same room with someone who I knew had AIDS.

17. The “gay plague” is an appropriate way to describe AIDS.

18. People who give HIV to others should face criminal charges.

19. People should not be afraid to donate blood because of AIDS.

20. A list of people who have HIV infection should be available to anyone.

21. I would date a person with AIDS.

22. People should not blame the homosexual community for the spread of HIV infection in the United States.

23. No one deserves to have a disease like HIV infection.

24. It would not bother me to attend class with someone who has AIDS.

25. An employer should have the right to fire an employee with HIV infection regardless of the type of work s/he does.

26. I would allow my children to play with children of someone known to have AIDS.

27. People get AIDS by performing unnatural sex acts.

28. People with HIV should not be looked down upon by others.

29. I could tell by looking at someone if s/he had AIDS.

30. It is embarrassing to have so many people with HIV infection in our society.

31. Health care workers should not refuse to care for people with HIV infection regardless of their personal feelings about the dis- ease.

32. Children who have AIDS should not be prohibited from going to schools or day care centers.

33. Children who have AIDS probably have a homosexual parent.

34. HIV blood test results should be confidential to avoid discrimination against people with positive results.

35. HIV infection is a punishment for immoral behavior.

36. I would not be afraid to take care of a family member with AIDS.

37. If I discovered that my roommate had AIDS, I would move out.

38. I would contribute money to an HIV infection research project if I were making a charitable contribution.

39. The best way to get rid of HIV infection is to get rid of homosexuality.

40. Churches should take a strong stand against drug abuse and homosexuality to prevent the spread of AIDS.

41. Insurance companies should not be allowed to cancel insurance policies for AIDS-related reasons.

42. Money being spent on HIV infection research should be spent instead on diseases that affect innocent people.

43. A person who gives HIV to someone else should be legally liable for any medical expenses.‌

44. The spread of AIDS in the United States is proof that homosexual behavior should be illegal.

45. A list of people who have HIV infection should be kept by the government.

46. I could comfortably discuss AIDS with others.

47. People with AIDS are not worth getting to know.

48. I have no sympathy for homosexuals who get HIV infection.

49. Parents who transmit HIV to their children should be prosecuted as child abusers.

50. People with AIDS should be sent to sanitariums to protect others from AIDS.

51. People would not be so afraid of AIDS if they knew more about the disease.

52. Hospitals and nursing homes should not refuse to admit patients with HIV infection.

53. I would not avoid a friend if s/he had AIDS.

54. The spread of HIV in our society illustrates how immoral the United States has become.