Two studies were conducted to investigate influence of the personality variable Erotophobia and illness transmission mode on social stigma directed toward patients, perceptions of illness, and of those experiencing illness. Using fictitious vignettes in which illness and patient characteristics were held constant and transmission mode was manipulated, the researchers demonstrated that sexual versus nonsexual transmission mode influenced perceptions of illness and of person experiencing illness. In Study 1 erotophobia and illness transmission mode interacted to influence stigmatization of patients. Illness transmission mode was found to influence perception of the illness, illness severity, and perception of the patient. In Study 2, which included a more detailed manipulation of illness transmission, erotophobia and illness transmission mode interacted to influence stigmatization of patient, and perception of the illness and illness severity. Illness transmission mode influenced personality assessments of the fictitious patient. Theoretical and applied implications for education concerning sexually-transmitted infection are discussed.

Stigma has been defined as possessing an attribute or trait that makes a person “deviant, flawed, limited… or generally undesirable” (Jones, Farina, Hastorf, Markus, Miller, & Scott, 1984, p. 6). Illness conditions can be thought of as stigmatizing as they evidence physical limitations and defect (Fife & Wright, 2000). In fact, illness stigmas have been demonstrated as widespread and as having a pervasive negative impact on patient populations. For example, patients with stigmatized illnesses have been found to suffer from negative psychological effects, such as depression, anxiety, and low self-esteem (Crandall & Coleman, 1992; Wright, 1983). When others project onto the stigmatized that they are worthless, inferior, or a threat to society, social rejection and isolation can occur (Fife & Wright, 2000).  The resulting negative social effects include avoidance of social interactions, reduced social support from friends and relatives, social rejection by others, and prejudice and discrimination (Kaplan & Toshima, 1990; Langer, Fiske, Taylor, & Chanowitz, 1976; Crandall & Moriarty, 1995).

Past researchers have suggested that stigmas are similar to stereotypes in that they can be used to enhance or even protect the self image of perceivers, and that stigmatization may increase when an individual feels threatened in some way (for review see, Stangor & Crandall, 2000). Moreover, Pryor et al. (1999) suggested that in the presence of stigma, negative reactions and feelings may automatically become invoked. Similarly, other researchers have suggested that presence of diseased individuals may trigger a series of stigmatized reactions including emotional, cognitive, and behavioral mechanisms, all of which are designed to increase distance from the diseased individual and thereby protecting other individuals and the broader social group (Kurzban & Leary, 2001; Park, Faulkner, & Schaller, 2003).

Physical illness conditions vary greatly in their contagiousness, severity, and visibility; these characteristics also relate to stigmatization. Specifically, researchers have identified several illness characteristics that contribute to the development of stigma, including origin, disruptiveness, aesthetics, peril, course, and concealability (Jones, Farina, Hastorf, Markus, Miller, & Scott, 1984). Moreover, Crandall and Moriarty (1995) demonstrated that the contagious nature and severity of an illness influence stigma, such that contagious and severe illnesses are more stigmatized by others.

Controllable or behaviorally-caused illnesses also lead to greater social rejection, particularly when the illness is perceived as severe (Crandall & Moriarity, 1995). Other studies have also demonstrated that when patients have greater control over the onset of illness, they experience more rejection by others (Meyerowitz, Williams, & Gessner, 1987). It has been suggested that, in fact, we may anticipate this reaction from others when we experience an illness. Senior, Weinman, and Marteau (2002) found participants expected greater negative feelings and responses when they imagined having an illness caused by controllable rather than uncontrollable factors. Weiner (1996) suggested that stigmatization of those experiencing controllable health conditions stem, in part, from anger and irritation on the part of perceivers. Moreover, Dijker and colleagues (Dijker & Raejijmaeker, 1999; Dijker & Koomen, 2003) suggested that anxiety also plays a role in social rejection and avoidance of diseased others.  Based on their findings, anxiety is aroused by both the seriousness and contagion characteristics of a disease.

While Crandall and Moriarity (1995) suggested that sexism, racism, and ageism do not factor in illness stigmatization in general, their data suggest that preconceived notions of particular types of illnesses may influence stigmatization. In particular, specific illness transmission modes have been shown to influence level of stigmatization. For example, using experimental methodology to manipulate stated mode of transmission, Crandall (1991) demonstrated that sexual and drug-use transmission modes were stigmatized more strongly than blood transfusion or exposure to infected substances. Similarly, Crandall and Moriarity (1995) reported illnesses that were uniquely sexual due to transmission mode or location of symptoms had greater levels of social rejection.

Research involving stigma, sexual health, and the self has focused overwhelmingly on HIV/AIDS.  Given the findings that illness severity and contagiousness are influential in the stigmatization process, it is not surprising that so much attention has focused on the negative impact stigmatization has on persons experiencing HIV/AIDS. In fact, Rozin, Markwith, and McCauley (1994) suggested that personal fear of being connected with or misidentified with HIV/AIDS result in negative reactions toward the stigmatized. And, yet, other sexually transmitted infection (i.e., STI) conditions are more pervasive in terms of numbers of those infected in the United States.

In the United States, it is estimated that 15 million individuals become infected with STIs each year with approximately one quarter of new infections diagnosed in teenagers (Cates, 1999).  These individuals also suffer from the negative impact of stigmatization that seems uniquely linked to STI transmission (Barth, Cook, Downs, Switzer, & Fischhoff, 2002). Many of these individuals delay seeking treatment while many others do not seek preventive screenings. Although many report feeling relatively invulnerable to STI - once infected a common reaction is one of shame and self-disgust (Duncan, Hart, Scoular, & Bigrigg, 2001). One of the most commonly given reasons for delaying treatment and seeking preventive screenings is perceived negative consequences, or how others will think of them. Similarly, Nack (2000) found that a majority of women surveyed with a STI tried “passing” as a healthy individual among family and friends as a way of limiting stigma. Other ways in which women dealt with infection was through stigma deflection, blaming past partners and averting stigma placed on them, or through denial of stereotypical images associated with STI (Nack, 2000; Duncan, et al., 2001). STI-related stigma has also been found to limit the chance of college students being tested for gonorrhea or HIV (Fortenberry, McFarlane, Bleakley, Bull, Fishbein, Grimley, Malotte, & Stoner, 2002). Together these findings demonstrate STI stigmatization has powerful implications not only for mental health outcomes, but also for physical health outcomes of patients and transmission of infection to others.

From the review above, we can conclude that STIs possess a number of specific illness characteristics that make them especially likely to be stigmatized. For example, STIs are frequently linked to controllable behaviors (e.g., sexual activity), they can be serious, and are contagious to others. What has been largely left unanswered in the past literature on the development of health-related stigma is the role of participant characteristics, such as personality in the stigmatization process.

One line of research investigating the role of personality on sexual attitudes and behaviors, has focused on the influence of negative emotional orientations toward sexuality, referred to as sex guilt or erotophobia. Erotophobia has been described as a persistent and general tendency to respond to sexual cues with anxiety and negative emotions (Byrne 1977). Erotophobic individuals are generally more homophobic, likely to adopt traditional gender roles, and view masturbation in a more negative light compared with erotophilic persons (Fisher, Byrne, White, & Kelley, 1988).  Moreover, erotophobia, particularly among women, is associated with avoidance of masturbation, multiple premarital partners, and pornography as well as having conservative attitudes, sex-related guilt and strict parents regarding sex. Erotophobic individuals have a higher tendency to negatively generalize sexual activity than Erotophilic individuals (Fisher et al. 1988).  Research has also demonstrated that sex guilt and erotophobia are associated with a general lack of knowledge about contraception (Fisher, 1980; Gerrard, Kurylo & Reis, 1991; Goldfarb, Gerrard, Gibbons, & Plante, 1988), discomfort with purchasing birth control devices (Fisher, Fisher & Byrne, 1977), and with the use of ineffective methods of birth control (Fisher, Byrne, Edmunds, Miller, Kelly & White, 1979; Geis & Gerrard, 1984; Gerrard, 1987).

One popular explanation for the relation between erotophobia and sexual behaviors is cognitive and perceptual interference. Specifically, Byrne (1983) hypothesized that erotophobia interferes with cognitive processing in sex-related information and decisions (Byrne, 1983). This suggestion has received support from research in several different areas.  For example, Lewis, Gibbons and Gerrard (1986) asked participants to recall information from vignettes about people struggling with, and resolving, moral dilemmas about sex. Results indicated that sexually active women with high sex guilt had more difficulty recalling information from these dilemmas than did sexually active women with low guilt. Lewis et al. (1986) suggested that these women's erotophobia interfered with their ability to process the information. Moreover, Smith, Eggleston, Gerrard, and Gibbons (1996) demonstrated that erotophobic individuals differ from erotophilics in their schematic representations of sexual concepts, and that these differences may disrupt the processing of sexually-related health cognitions.
 
Given the findings demonstrating that erotophobia influences cognitive processing of sexually-relevant information, the suggestion that erotophobia may influence perceptions of sexually-transmitted infection and those experiencing these conditions may not seem surprising. At this time, however, very limited work has focused on the role erotophobia may play in the perceptions of others, and particularly those experiencing sexually-related medical conditions. As mentioned previously, research on personality factors’ influence in the stigmatization process, in general, has been limited as well.

The current studies were designed to address these issues through examination of the influence of erotophobia and illness transmission mode on social stigma, perceptions of illness and of those experiencing illness. Using an experimental design in which illness transmission mode was manipulated, the researchers predicted a main effect for illness transmission mode on the dependent variables. Specifically, when an illness was described as being transmitted through sexual contact (as compared to other means of transmission) we predicted that there would be greater levels of social stigma, and more negative perceptions of the illness and person experiencing the illness. We also theorized that participants with high levels of erotophobia would express greater levels of social stigma and more negative perceptions when evaluating those obtaining illness through sexual contact compared to other transmission modes.

Participants

Participants included 102 college students (32 men and 70 women) from a small liberal-arts southeastern college who completed the Sexual Orientation Scale (SOS; White, Fisher, Byrne, & Kingma, 1977). The SOS has high internal consistency, with an alpha coefficient of .88 for males and .90 for females (Fisher, Byrne, White, & Kelley, 1988). Consistent with past research methodology, from this original sample we identified individuals as erotophobic and erotophilic using gender-specific lower and upper thirds on the SOS distribution (48 erotophobic and 54 erotophilic participants). The lower-third cutoff score was 64 and 44, whereas the upper-third cutoff score was 83 and 58, for male and female participants respectively. All of the participants passed two manipulation checks (one identifying the correct manipulation of illness transmission mode and a second reporting the noncontagious state of the illness at the present time). The median age for participants in the study was 19 years old and modal response on year in school was freshman.

Materials and Procedure

As mentioned above, participants completed the SOS, a survey assessing level of negative orientation toward sexuality through ratings of agreement with 21 statements (e.g., “If I found out that a close friend of mine was a homosexual it would annoy me”; “If people thought that I was interested in oral sex, I would be embarrassed”; “Engaging in group sex is an entertaining idea”). Upon arriving for the study, participants received one of two versions of a fictitious transcription of a physician report describing an interaction with a patient resulting in the diagnosis of a medical illness. The physician described the personal characteristics of the patient briefly, as well as reported initial and secondary symptoms of the illness (i.e., “tenderness and fullness of the abdomen, fatigue, and blistered lesions”; “enlargement of the kidneys and abdominal wall”). Past research has demonstrated that contagion strongly influences illness perceptions. In order to control for the influence of this disease characteristic, both versions of the vignette described the illness as “no longer contagious”. The versions differed in the stated illness transmission mode, with one version suggesting that the illness was contracted through nonsexual contact (i.e., nonsexual version, n = 44) and a second version suggesting the illness was contracted through sexual contact (i.e., sexual version, n = 58).

 After completing an informed consent statement and reading the physician report, participants were instructed to complete a packet of questionnaires including manipulation checks, measures of social stigma, and perceptions of the individuals experiencing the illness and the illness itself. Social stigma measures were adapted from Crandall and Moriarty (1995), and included seven items assessing willingness to interact with the target in a number of social roles and contexts (e.g., as a neighbor, roommate, close friend). These items were summed to create a social stigma index with higher scores indicating higher levels of stigma (M = 23.10, SD = 6.61; Cronbach’s alpha coefficient = .78). Participants rated their perception of individuals experiencing the illness on a nine-point likert-type scale (1 = very positive perception, 9 = very negative perception). Likewise, participant rated their overall perception of the illness from 1 (very positive perception) to 9 (very negative perception) and illness severity from 1 (not at all serious) to 9 (extremely serious).

Results

 A series of 2 (Erotophobia, Erotophilia) X 2 (Nonsexual, Sexual Illness Transmission) factorial ANOVAs were conducted on each of the dependent variables above. The analyses for the social stigma index resulted in a significant two-way Erotophobia X Illness Transmission Mode interaction was found (F(1, 97) = 4.08, p < .05). The pattern of means demonstrated that erotophobic participants had lower stigma scores when the patient was described as contracting the illness nonsexually (M = 20.96, SD = 5.95) than sexually (M = 25.86, SD = 7.28). Erotophilic participants did not demonstrate such differences (nonsexual, M = 24.21, SD = 7.38; sexual, M = 23.57, SD = 6.50).

The 2 (Erotophobia, Erotophilia) X 2 (Nonsexual, Sexual Illness Transmission) ANOVA on perception of individuals experiencing the illness, perception of the illness, and illness severity all resulted in significant main effects for illness transmission mode. Specifically, the findings demonstrated that when the illness was described as being contracted sexually perceptions of the fictitious patient were more negative (M = 5.12, SD = 1.49), as compared to when the illness was described as being contracted nonsexually (M = 4.39, SD = 1.54; F(1, 98) = 4.93, p < .03). The overall perception of the illness was also more negative in the sexual transmission condition (M = 6.48, SD = 1.43), as compared to the nonsexual transmission condition (M = 5.45, SD = 1.78; F(1, 98) = 10.63, p < .01). Moreover, the illness was described as being more severe in the sexual transmission condition (M = 5.90, SD = 1.50), than in the nonsexual transmission condition (M = 4.91, SD = 1.54; F(1, 98) = 9.31, p < .01). There was not a significant main effect for erotophobia-erotophilia or an interaction for any of these variables.

The findings of the first study demonstrated that, consistent with expectations, erotophobic and erotophilic participants reacted differently to those described as being diagnosed with sexually versus nonsexually transmitted illness. Erotophobic participants stigmatized the fictitious patient with STIs more so than the erotophilic participants. It is interesting to note that although erotophobia influenced the social rejection (i.e. stigma) directed towards the fictitious patient, it did not influence overall perception of the patient, the illness condition, or perceptions of illness severity. Illness transmission mode influenced each of these variables, although all illness characteristics were held constant in the physician report vignettes, except for the mode of transmission. Moreover, both illness conditions were described as no longer contagious, removing the possible influence of disease contagion on perceptions of the illness. The results of Study 1 were consistent with those of previous literature suggesting that sexual transmission mode may have a unique negative impact on perceptions of illness.

The preliminary findings of Study 1, in conjunction with unanswered questions concerning factors influencing the stigmatization of STI, led us to design another study. The goals of the second study were similar to the first in that we wanted to examine the influence of perceiver personality, erotophobia-erotophilia, and illness transmission mode on stigmatized perceptions of individuals experiencing illness. In the second study, we hoped to clarify the role of transmission further by refining the definition of “nonsexual” transmission mode. Specifically, we replaced the nonsexual transmission mode condition with a condition describing the illness as transmitted through casual contact, In addition, we added a control condition in which transmission mode was not identified. Past research has demonstrated that gender can influence perceptions of sexual and contraceptive behaviors (for review see Hynie & Lydon, 1995), so we also restricted the sample to female participants, in order to remove the underlying influence of gender on reactions to illness.

A key goal of Study 2 was to focus more attention on the stigmatized perceptions of persons experiencing illness, rather than the illness itself. In order to do so, we modified the materials themselves to create a “personal narrative” told through the perspective of the patient, rather than a physician report of the interaction. This allowed participants to view the materials in greater depth of perceptions from the perspective an individual experiencing the illness. We also added more opportunities to evaluate the fictitious person experiencing illness (i.e., the target person), beyond the single item included in the first study.

Participants

One-hundred and thirty-two college-age women completed the Sexual Orientation Scale (SOS; White, Fisher, Byrne, & Kingma, 1977). From this original sample, 43 Erotophobic women and 48 Erotophilic women were identified, once again by using the lower and upper thirds on the SOS distribution (lower-third cutoff score = 46; upper-third cutoff score = 63).  As in the first study, all of the participants passed two manipulation checks (i.e., illness transmission mode and noncontagious state of the illness). The median age for participants in the study was 19 years old and modal response on year in school was freshman.

Materials and Procedure

 Upon arriving for the study, participants received one of three versions of the narrative describing the diagnosis of a medical illness. The fictitious target person in the narrative described their symptoms, progression of the illness, and a visit to the physician for diagnosis. All versions of the narrative described a chronic painful condition affecting the stomach, genitals, and kidneys (i.e., “At first I had a fever and was sick at my stomach.”; “I noticed what looked like paper cuts ‘down there’ in my genitals”; “The condition can cause swelling and tenderness in my stomach and kidneys.”). All three versions also stated that the illness was no longer contagious and could not be spread to others. The narrative versions differed in the stated illness transmission mode or Illness transmission mode, with one version suggesting that the illness was contracted through casual contact (i.e., casual version, n = 36) and a second version suggesting the illness was contracted through sexual contact (i.e., sexual version, n = 27). A third version of the narrative described the illness and said to “just develop in some people” without a specific mode of transmission suggested (i.e., control version, n = 28). After reading and signing an informed consent form and receiving the personal narrative, participants were instructed to complete a packet of questionnaires including manipulation checks, measures of social stigma, perceptions of the target person and illness.

Social stigma measures. The social stigma measures assessed willingness to interact with the target in a number of social roles and contexts, and were identical to those used in Study 1 with the exception that two additional items were added to the scale (e.g., interest in meeting the target person after the study and interest in introducing to a friend). These nine items were summed to create a social stigma index with higher scores indicating higher levels of stigma (M = 30.02, SD = 9.16; Cronbach’s alpha coefficient = .84).

Illness perceptions.  Perception of the illness included overall perception of the illness condition rated from 1 (very positive perception) to 9 (very negative perception), and illness severity rated from 1 (not at all serious) to 9 (extremely serious).

Perceptions of the target person. Perceptions of the person experiencing illness (i.e., the target person) included an item assessing overall perception from 1 (very positive perception) to 9 (very negative perception), an item assessing perception of the morality of the target person’s character (1 = moral, 7 = immoral), and three subscales based on personality ratings provided for the target (i.e., Unlikable Personality, Unwise Personality, and Risk-Taking). The three personality subscales were modeled after those developed by Hynie and Lydon’s (1995). Participants completed personality ratings on seven-point bipolar items with higher scores indicating more negative or risk-taking perceptions. The Unlikable Personality subscale consisted of ratings of five traits: likable-unlikable, direct-manipulative, warm-cold, caring-uncaring, and good-bad (M = 18.81, SD = 4.57; Cronbach’s alpha coefficient = .78). The Unwise Personality subscale also consisted of five items: wise-foolish, intelligent-unintelligent, responsible-irresponsible, mature-immature, and experienced-inexperienced (M = 16.29, SD = 4.17; Cronbach’s alpha coefficient =.71). The third personality subscale measured Risk-Taking characteristics on three items: cautious-risk-taking, conservative-liberal, and inhibited-uninhibited (M = 13.54, SD = 2.82; Cronbach’s alpha coefficient = .69).

Results

Social stigma measures. A 2 (Erotophobic, Erotophilic) X 3 (Casual Transmission, Sexual Transmission, Control) factorial ANOVA was performed on a summed scale of 9 items that related to degree of stigmatization of the target. A significant main effect for Illness transmission mode (F(2, 84) = 5.12, p < .01) was found, such that participants had reported highest stigma levels for the sexually transmitted illness (M = 34.07, SD = 8.96) followed by the casually transmitted illness (M = 32.72, SD = 8.47), and the least stigma for the control condition (M = 25.59, SD = 9.70).

In addition to the significant main effect for illness transmission mode, the interaction term approached significance (F(2, 84) = 2.25, p < .10). The pattern of means on the marginal interaction is consistent with expectations that erotophobic individuals would stigmatize those with sexually transmitted illnesses at a slightly higher level than the casual or control conditions (sexual transmission condition, M = 34.80, SD = 8.22; casual transmission, M = 32.11, SD = 6.98; control condition, M = 30.90, SD = 10.98). Erotophilic individuals stigmatized the control condition less than the other two conditions (sexual transmission condition M = 33.17, SD =10.10; casual transmission condition, M = 33.33, SD = 9.92; control condition M = 22.47, SD = 7.57).

Illness perceptions. A 2 (Erotophobic, Erotophilic) X 3 (Casual Transmission, Sexual Transmission, Control) factorial ANOVA was computed on each of three variables relating to perception of the illness condition. Analyses on illness perception demonstrated that there were no main effects for erotophobia or illness transmission mode on illness perception, however, there was a significant two-way interaction (F(2, 85) = 3.04, p < .05). Erotophobic and erotophilic participants differed in their perceptions of the negativity of the illness depending on the transmission mode, such that erotophobic participants rated the STI as more negative than illness contracted through casual contact or the control condition (sexual transmission, M = 7.13, SD = 1.06; casual transmission, M = 6.50, SD = 1.20; control M = 6.90, SD = .99). Erotophilic participants, however, rated the casually transmitted illness more negatively than the STI or the control conditions (casual transmission, M = 7.06, SD = 1.16; sexual transmission, M = 6.75, SD = 1.22; control M = 6.00, SD = 1.33).

Analyses on illness severity resulted in a significant main effect for erotophobia-erotophilia such that erotophobic participants (M = 5.92, SD = 1.17) rated the illness conditions as more severe overall than the erotophilic participants (M = 4.90, SD = 1.67; F(1, 85) = 11.28,  p < .01). The two-way interaction also reached significance (F(2, 85) = 3.94, p < .02). Erotophobic and erotophilic participants were similar in their ratings of severity for the casually transmitted illness (M = 5.56, SD = 1.38; M = 5.67, SD = 1.68, respectively). However, for both the STI condition and control condition the erotophobic participants had higher ratings of severity (sexual transmission, M = 6.00, SD = 1.00; control condition, M = 6.20, SD = .93), as compared to the erotophilic participants (sexual condition, M = 4.58, SD = 1.56; control condition, M = 4.44, SD = 1.54).

Perception of the target person. A series of 2 (Erotophobic, Erotophilic) X 3 (Casual Transmission, Sexual Transmission, Control) factorial ANOVAs were conducted on five variables relating to perception of the target person described in the narrative. These variables included overall perception of the target person, characteristic morality, and three subscales based on personality ratings provided for the target (Unlikable, Unwise, and Risk-taking subscales).

For the overall perception of the target person, a main effect for illness transmission mode was found (F(2, 85) = 6.89, p < .01), such that when the illness was described as being contracted sexually ratings of the target person were more negative (M = 6.00, SD = 1.54) than when the illness was described as being controlled casually or no cause was given (M = 4.81, SD = 1.51; M = 4.29, SD = 1.76, respectively).  Similarly, the target person was more likely to be described as immoral when experiencing a sexually transmitted illness, as compared to an illness transmitted casually or when no cause was stated (sexual transmission, M = 4.44, SD = 1.19; casual transmission M = 3.44, SD = 1.13; control M = 3.44, SD = 1.31; F(2, 84) = 5.71, p < .01).  A marginally significant two-way Erotophobia-Erotophilia X Illness Transmission Mode interaction was also found on rating of immorality (F(2, 84) = 2.64, p = .08). Although this interaction did not reach significance, the pattern of means was consistent with expectations that the highest ratings of immorality would be found for erotophobic participants reading the sexually transmitted illness condition (Erotophobic participants sexual transmission, M = 4.67, SD = 1.29; casual transmission, M = 3.28, SD = 1.36; control, M = 4.10, SD = .88). Erotophilic participants also rated the sexual transmission condition highest followed by the casual transmission condition (sexual transmission, M = 4.17, SD = 1.03; casual transmission, M = 3.61, SD = .85; control, M = 3.06, SD = 1.39).

A significant main effect for erotophobia-erotophilia was found for the Unlikable personality subscale (F(1, 84) = 5.50, p < .05), such that erotophobic participants rated the target person more negatively than Erotophilic participants (M= 17.42, SD = 3.33; M = 15.25, SD = 4.61, respectively). There was no significant main effect for illness transmission mode and no significant interaction. Analyses for the Unwise personality subscale, however, did result in an significant main effect for illness transmission mode (F(2, 83) = 8.28, p < .01), such that when the illness was described as being sexually transmitted the target person received significantly higher ratings than when their illness was contracted in casual manner or when no cause was stated (sexual transmission, M = 21.59, SD = 4.46; casual transmission, M = 18.31, SD = 3.54; control, M = 16.61, SD = 4.66). This analysis also revealed a marginal effect for erotophobia-erotophilia (F(1, 83) = 3.41, p = .07), such that erotophobic participants rated the target person more unwise than erotophilic participants (M = 19.95, SD = 4.43; M =17.79, SD = 4.50, respectively). Likewise, a significant main effect for illness transmission mode (F(2, 84) = 15.12, p < .01) was reported for the Risk-Taking personality subscale. The highest ratings were found in the sexual transmission (M = 15.52, SD =2.59), followed by the casual contact condition (M = 13.33, SD = 2.65), and then the control condition (M = 11.86, SD = 1.97).

General Review and Interpretation of the Findings

How does illness transmission mode and erotophobia influence social stigma measures? Participants’ reactions to the fictitious target person were influenced by illness transmission mode and erotophobia. In Study 1, these variables had a combined influence on social stigma measures, such that erotophobic participants stigmatized patients with the STI condition at greater levels than those with the nonsexually transmitted illness, and more so than erotophilic participants. In fact, erotophilic participants reacted in a similar way to those with sexually transmitted or nonsexually transmitted illness conditions. This finding suggests that erotophobia, or discomfort with sexual matters, impacts not only self-perceptions and cognitions relating to sexuality but the perceptions of others.

In Study 2, illness transmission mode influenced social stigma in that the sexual and casual transmission modes were stigmatized at a similar level, whereas the control condition was less stigmatized. Although the interaction did not reach significance, erotophobic and erotophobic participants seemed to differ in their reactions to the illness based on transmission mode - primarily in their reaction to the control condition. Why would the erotophobic and erotophilic participants differ in this way? This pattern of means on the social stigma measure is interesting when we reflect on how the personal narratives were written, particularly in light of the illness symptomology described across all three conditions. Specifically, symptoms included cuts in the genital area regardless of stated transmission mode. The control condition may have represented a STI to erotophobic participants given the location of symptoms and in light of there being no stated transmission mode. This conclusion is not based on a clear manipulation of symptom locale and transmission mode and is at this time speculation; however, the findings for illness severity support this interpretation.

How does illness transmission mode and erotophobia influence perceptions of the illness condition? Our findings demonstrated that, consistent with past research, illness transmission mode greatly impacts on impressions of illness severity and general perceptions of the illness, such that sexual illness conditions, as compared to nonsexual conditions, were viewed as more severe and negative. These results were demonstrated using an experimental manipulation in which every aspect of the illness held constant except for the specific transmission mode.

When we further refined the stated illness transmission in Study 2, we found significant two way interactions (Erotophobia X Illness Transmission Mode) on variables examining perceived severity of the illness and overall perceptions of the illness. The pattern of means for illness severity was similar to those of social stigma measures. In particular, erotophobic participants rated the illness described as sexually transmitted and that in the control condition with higher levels of severity, as compared to the erotophilic participants. Moreover, erotophobic participants did not distinguish between the STI and the control condition in terms of severity, suggesting that these conditions were perceived in a similar manner. As suggested above, in the case where transmission mode is not identified (i.e., control condition) symptoms occurring in a sexually-linked area of the body such as the genitalia may be sufficient to lead to a negative reaction in erotophobic individuals.

A two-way interaction was also found on the measure of overall illness perception. These findings further demonstrated the range of reactions erotophobic and erotophilic individuals have to the different illness transmission modes. In particular, the erotophilic participants had a more negative reaction to the casually transmitted illness, followed by the STI, and then the control condition. Erotophobic participants, on the other hand, perceived the STI in the most negative light, followed by the casually transmitted and control conditions.

One possible explanation for these differences in perceptions of the illness considers the relative weight that personal perceptions of vulnerability may play in the reaction to illness. Illness transmission mode could influence perceived vulnerability; such that participants in the casually transmitted illness conditions could view themselves to be at greater risk, as compared to the STI condition. If that was the case, then all participants would have a more negative reaction to the casual illness condition, as past research has suggested that risk and contagion play a significant role in illness perceptions. The pattern of means for erotophilic participants follows this pattern; however, erotophobic participants rated the STI condition more negatively than the casual. This finding supports the assertion that erotophobic participants react to the STI in a more biased manner and that this bias may not be based solely feelings of vulnerability. To fully answer this question, however, perceived vulnerability and actual risk behaviors associated with illness conditions must be examined in conjunction with illness perceptions.

How does illness transmission mode and erotophobia influence perceptions of the person experiencing illness? The current studies documented that, consistent with past research, illness transmission mode influenced perceptions of the patient. In both studies, patients/target persons described as experiencing the STI were rated more negatively as compared to the other illness conditions. In addition, in Study 2 findings demonstrated that the target person was viewed as more immoral when experiencing a STI as compared with the other conditions. The highest ratings of immorality were given by erotophobic participants rating those with STI condition, however, this effect did not reach significance. Erotophobic participants, in general, were found to rate the target person as less likable than erotophilic participants, regardless of illness condition.

The other two personality subscales were not influenced by erotophobia but rather by illness transmission mode. Specifically, the personality of the target person was described as unwise and risk-taking when the illness experienced was sexually transmitted compared to the casual and control conditions. These findings are consistent with past research demonstrating that when person’s experience controllable illness, or illness onset is related to behaviors, the social rejection is increased (Crandall & Moriarity, 1995; Meyerowitz, Williams, & Gessner, 1987). Participants may have attributed more “control” and thus blame in the STI condition as compared to the other illness conditions (i.e., casual, nonsexual, control) because of the part patients played in obtaining the illness – through their own sexual behaviors.

Implications of the Study

Examining means across the two studies, stigma measures and perceptions of the patient and illness were comparable or slightly more negative in Study 2, as compared to Study 1. Study 2 included the manipulation through personal narrative rather than the physician report. This change in manipulation was designed to give students a more detailed view of the person experiencing the illness condition, which in turn may have led to greater willingness on participants’ parts to provide negative evaluations. We can not remove the possible influence of site of symptoms across the two studies. Specifically, in Study 1 symptoms included “blistered lesions” but not an identified site of outbreak; whereas materials in Study 2 clearly identified skin irritations affecting the genitalia. This enhanced focus on the sexual nature of the symptomology may have contributed to a more negative reaction towards the patient and illness itself as all the illness conditions became “sexualized” by the site of symptoms.

The current study demonstrated that illness transmission mode and personality influenced the stigmatization process, such that those with STI conditions (and/or those with illnesses affecting sexualized areas of the body) were perceived more negatively and with greater social stigma. This was especially true when the perceiver had higher levels of erotophobia. The overall level of negative perception of the patient and stigmatization directed at the patient, however, was not very high given the full range of possible scores.

Although the level of stigmatization and negative perceptions were not at the highest end of their respective scales, any difference in these variables is notable due to the controlled experimental manipulation of the illness characteristics and patient descriptions. Also, social desirability may have adversely affected our ability to demonstrate strong levels of rejection and negative perceptions. In these studies we asked participants to admit to a variety of undesirable attitudes and behaviors directed at those experiencing illness. For example, on the social stigma measures participants were rating the likelihood that they would actively avoid contact with the fictitious patient and deny knowing them personally. Admission of negative attitudes and behaviors on these scales therefore was likely to be conservative.
Given the findings of the current study we propose greater educational interventions regarding illness characteristics and social rejection. Moreover, educational endeavors should focus not just on patients and their families, but on those interacting with patients. The social rejection experienced by those victimized by ongoing illness is similar in some ways to those victimized by a sexual assault. In both cases there may be a tendency to “blame the victim” for the negative experience, and the victims themselves may feel a strong sense of shame and isolation. Social education discussing rape mythology and “blaming the victim” have been found to impact on social attitudes towards sexual assault (Foubert, 2000). In a similar fashion, discussion of illness characteristics and the tendency to blame those experiencing illness may reduce the level of stigmatization, particularly for those experiencing sexually transmitted illness.
 

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