Metaphors of AIDS from around Asia
International Journal of Bioethics 11 (2000) 201-16.
Author: Makina Kato and Darryl R J Macer
Institute of Biological Sciences,
University of Tsukuba, Japan
A variety of metaphors were expressed in
response to open comments about attitudes to people with HIV
and AIDS in surveys conducted in Australia, Hong Kong, India,
Israel, Japan, New Zealand, the Philippines, Russia, Singapore
and Thailand. A keyword analysis of the negative comments
revealed some differences in the use of words which may reveal
different societal attitudes. The keywords chosen were:
deserve/serve/ask for, fruit, fault, punish, sin, God, ethic,
moral, responsibility, promiscuous/promiscuity, loose,
prostitution, homosexual/gay, drug/needle, and innocent.
Negative comments were also found among medical students,
despite their intended vocation of healing. A call is made for
attempting to eliminate concepts that there are innocent and
guilty victims because such thinking may have stigmatising
effects on persons with AIDS, and other minority groups in
society, that are inconsistent with the idea of love and
solidarity in society. We need to reinforce the positive
attitudes expressed in the surveys .
Because AIDS is a usually fatal and
usually sexually transmitted disease it has provoked strong
images in people’s minds, which have also been reinforced by
the media. AIDS has been a stimulus for the examination of a
number of bioethical attitudes, for example, the question of
anonymous testing, truth-telling, partner notification,
discrimination, stigmatization, terminal care, and questions
of the privacy of sexual behaviour. How each of these issues
has been dealt with in different cultures is of great interest
for studies of international bioethics.
There are several ways to think of the
term bioethics, one is as descriptive bioethics - the way
people view life and their moral interactions and
responsibilities with living organisms in life. Another is
prescriptive bioethics - to tell others what is good or bad,
what principles are most important; or to say
something/someone has rights and therefore others have duties
to them (1). As we attempt to develop a better understanding
of the most appropriate role for bioethics in helping the
persons infected with HIV, people with AIDS, those persons at
risk of contracting HIV, and the general society, we need to
know the attitudes people have towards those with HIV.
We can gather some information on the
attitudes people have towards the disease AIDS, and people
with it, from the media and numerous publications on the
topic. To directly examine the images ordinary people have
towards AIDS, a question was asked on what people thought of
persons infected with HIV or had AIDS. The question was part
of the International Bioethics Survey, conducted in 1993 (2).
The open comments were placed into categories, and in this
paper some examples of comments for each category will be
presented, and comparisons will be made, discussing what we
can learn from this descriptive bioethics methodology.
International Bioethics Survey
There are several ways to examine the
attitudes people have towards those with AIDS, for example,
face-to-face or telephone, interviews, written surveys,
recording experiences of people with HIV, legal cases of
discrimination, pretending to have HIV and seeing people’s
reactions, to mention just a few. The International Bioethics
Survey was performed in 1993 with the help of collaborators in
different countries, and one of the 32 open questions that was
included was what people thought of persons infected with HIV
or had AIDS (2). There were five other diseases also mentioned
for comparison, namely, hemophilia, muscular dystrophy,
depression, schizophrenia and neurosis (3).
In all samples the most common response
was sympathy and compassion. Other responses included people
are the same so no different to anyone else, that they would
try to show understanding, or saying they would help them. In
general there were more people who said that the diseases were
"their own fault" for mental diseases than genetic
ones, as well as less understanding. The highest level of
rejection was seen for persons with HIV. In 1993 the comments
had been categorized, so our purpose here was to explore more
deeply the negative attitudes towards these persons, by
examining keywords and concepts. The keywords used to explore
negative attitudes were: deserve/serve/ask for, fruit, fault,
punish, sin, God, ethic, moral, responsibility,
promiscuous/promiscuity, loose, prostitution, homosexual/gay,
We would like to discuss some selected
comments to this question by people in both public and student
samples from Australia, Hong Kong, India, Israel, Japan, New
Zealand, the Philippines, Russia, Singapore and Thailand. By
examining keywords and concepts we categorized the combined
comments to this question by public and students from these
countries, Australia (Aus N=296), Hong Kong (HK N=94), India
(I N=700), Israel (Isr N=30), Japan (J N=610), New Zealand (NZ
N=308), the Philippines (P N=131), Singapore (S N=209), and
Thailand (Thai N=819). Because of incomplete translations of
Russian (R) comments their responses could not be reexamined
in this way, so we only refer to the broad categories assigned
by collaborators to the 1993 survey as reported earlier (2).
Attitudes to persons with HIV or AIDS
From the media it appears that AIDS is
one of the diseases that people dread the most, though from
discussing with different people we can find that the
attitudes to patients with AIDS, as for other diseases, vary
widely. Overall a half of the total respondents expressed
feelings of sadness and compassion, or that people were the
same. However, about one sixth of the 6000 persons who
answered the International Bioethics Survey in the ten
countries said that their feelings towards persons with HIV
depend on how they contracted the disease, and that if it was
acquired through use of drugs, or through sex, it was their
own fault. A further sixth expressed outright feelings of
rejection or fear (2,3).
The results of the re-examination of the
negative comments for keywords are shown in Table 1. We will
give some example comments below, which include a number of
metaphors, which represent some of the ways people view this
disease. These comments illustrate the categories listed in
Table 1. Some comments contain a number of keywords, and each
was scored independently, to give the proportions shown in the
table. There are some interesting differences, for example, in
Singapore 8% of comments included the term “innocent” and
13% included the terms “deserve/serve/ask for”, compared
to 2% and 3%, respectively, in the next highest country. The
term “homosexual/gay” was used by 4-5% of persons in
Australia, Hong Kong and New Zealand, but by only 1% or less
in other countries.
The punishment metaphor was expressed in
several terms. In Australia two people said that it serves
those who got infected through sexual matters right, as in New
Zealand. This corresponds to 0.6 and 0.8% respectively. In
Japan four people used these words, two used for those who got
it through sexual matters as in Australasia. One of the four,
for those who did something to make them feel guilty (J115)
and another for those who got it other than through blood
transfusion (J166). Seventeen Japanese students used these
words, so the total is 3.3%. What is most striking is that
twenty-seven Singapore students used these words. Twenty-five
of them used these words for the patients in some case (only
two didn’t make a distinction of the patients). Fifteen
people used them for those who got it through promiscuous sex
and three mentioned prostitution. Interestingly, twenty-two of
the Singapore students considered their religion to be
important. For example [above each comment is the following
information: number from the questionnaire data; gender; age;
race expressed as Asian, Caucasian, Indian, Japanese, Other;
religion; religiousity expressed as Very, somewhat, not too,
and not at all important]:
S117 Female 19 Asian None Somewhat
Depends on how they are infected. Some
deserve it, some don’t.
A11 Male 52 Caucasian Christian
Depends on how they got it. I have no
sympathy for sexually transmitted deserves suffers.
J166 Male 58 Japanese None Not
important at all
Feel pity if they got infected through
blood transfusion. Others serve them right.
JS24 Male 26 Japanese None Not
important at all
I feel deeply sympathy for those who did
not ask for it.
JS40 Male 24 Japanese None Not
important at all
Serves them right if they got it by sex,
feel pity for whom by blood transfusion and so on.
I51 Female 26 Indian Hindu Somewhat
They deserve it, if it is sexually
In Japan two people used the word
“fruit”, for those who got it in some way other than
through blood transfusion. The word “fault” was more
common. Almost all made a distinction between the people who
got it due to their own fault or not. Even if people felt
sympathy they may feel it is their own fault, however many
blamed the people as a negative group:
I105 Male 23 Indian Hindu Not too
Feel pity and sorry, though it is their
JS433 Male 18 Japanese None Not
important at all
It is own fault of the person like those
who got it.
Punishment and sin were not so common,
however the comments were also strong:
JS326 Male 20 Japanese None Somewhat
They received proper punishment if they
got it while they were playing.
I254 Female 32 Indian Christian Very
I will be kind to them though I feel it
as a punishment from God.
I429 Male • Indian Christian Very
If it is through blood transfusion I will
I861 Female 18 Asian Christian Very
As I feel these disease are due to their
sins, they should correct the sin. They must repent.
Few people used the word God. In India
four people used this word and three of them were Christian.
Three of them said that the disease is punishment from God (or
nature). One person said that those who have sin should come
to God (I48). In Singapore two people said that the disease is
the punishment from God. In other countries God was perhaps
only indirectly associated with this attitude.
I48 Female 54 Indian Christian Very
I believe the main reason for AIDS is
undisciplined life. It is a penance for their sins. Such
persons should come to God.
S12 Female 21 Asian Christian Very
Nothing. I will avoid them. God did not
give them a second chance.
In New Zealand the person who used the
word “ethical” made a distinction between the people
infected through blood transfusion and others, as did some
using theterm moral. An Indian comment that was more just is
also given, and a Japanese comment usingthe term moral but
with a positive motive:
N274 Female 20 Caucasian Christian
2 ways: sympathetic -if got through blood
transfusion, unsympathetic -if got from sleeping around or
injecting drugs -consider both to be unethical.
I354 Male 35 Indian Hindu Very
Responsibilities of such a person should
be shared by society. (Cause is important.) It is difficult to
feel truly. One can be only ethically compassionate or help to
find ways out.
JS386• • • • •
I doubt their morality but want to help
for their recovery.
I168 Male 30 Indian Moslem Somewhat
Those who get it by accident -we pity
them. Those through immoral practice -they deserve it.
I259 Male 30 Indian Hindu Not
important at all
Victims of a life without any morality
principles and human values.
The term promiscuous was used more in Thailand than in any
other country. Usually it was part of a conditional
expression, comparing the persons who got HIV from promiscuity
to those who got it from their family or occupation. For
T25 Female 34 Thai Buddhist Not too
Sympathy for doctors and nurses who were
infected but dislike for one who was promiscuous or use
T27 Male - Thai Buddhist Somewhat
Sympathy for transfusion or those
infected by spouse but dislike for one who had bad behaviour.
T106 Male 18 Thai Buddhist Very
Sympathy for one who got it by genes and
blood, but dislike for one who got from prostitution.
T574 Male 20 Thai Buddhist Somewhat
No feeling for one who was promiscuous,
bisexual and using needles and I feel sympathy for one got it
Among the other countries, in the
Philippines it was used more by those who were very religious,
but not only religious persons:
JS434 Female 19 Japanese None Not
important at all
Among the many people who spend the
promiscuous lives, I think others are very pitiful because
they are regarded as like them.
I332 Male 29 Indian Hindu Very
Sad about people who contracted it
through promiscuous sex. Pity people who contracted it through
S105 Female 19 Other Moslem Very
If they are promiscuous, serves them
Prostitution was mentioned by 3% of
people in Singapore, but by none in India which probably
reflects ignorance of the infection route which was reported
to be high at that time. Comments:
A147 Female 60 Other Christian Very
Feel sorry for them, but if they get
through prostitution or "running around", they
should not do that and it is a lesson for them.
J190 Male 33 Japanese Other Somewhat
Except blood products, the infection by
abnormal sex and prostitution is unforgivable and helpless.
J348 Female 53 Japanese Buddhist
It depends on the channel of the
infection but I feel pity for the patients infected through
blood transfusion. Think the patients infected through
prostitution are dirty. I wish they won't infect it to their
S140 Female 18 Asian Moslem Very
If they got it through sex in
prostitutes....they deserve it!
The terms “Homosexual or Gay” were
more common in Australia and Hong Kong, and New Zealand (Table
1), countries which at that time had almost no reported cases
of heterosexual transmission beyond an initial infected
partner (4). However, still less commonly quoted than one
would expect from transmission incidence, or social phobia.
Age may be important as seen in Australasian comments, as they
may be less tolerant towards alternative sexual choices. In
New Zealand eleven people used these words and eight of them
considered their religion to be important, and seven were over
60 years old. In Australia thirteen people used these words
and eight of them were over 61 years old. For example:
N71 Female 65 Caucasian Christian
I am plain scared of them. Through blood
transfusions I am really sorry . All blood must be
meticulously tested. As for Homosexuals its their own fault
-their misbehavior has brought to AIDS which will be the
plague of the earth.
N73 Male 70 Caucasian Christian
No pity for homosexuals (active). Sorry
for those contaminated, with blood transfusion.
N304 Male 70 Caucasian None No too
Depends on how they contracted it. If
sexual indulgence, either homo or hetero, serves them right.
If blood transfusions complete sympathy.
A51 Male 67 Other Christian Somewhat
Very sad if caught other than
A125 Female 76 • Christian Somewhat
Sorry for the ones who get it from blood.
Not so sorry from the gay people.
Another key word one would expect to be
associated with AIDS because of earlier infection routes is
drugs or needles. In Australia for example, seven people
mentioned about the people infected through drugs and all of
them made a distinction between people based on the channel of
infection. Four people expressed pity only for the people who
got it by accident like through blood transfusion. Five people
showed that they don’t have good feelings towards the people
infected through drugs. Comments:
N82 Female 52 Caucasian Christian Not
Depends how it was acquired. Sadness for
blood recipients. Disgust for sexual deviants and drugtakers.
N321 Male 42 Asian None Somewhat
Depend on how they contact the disease.
No sympathy for those who use drug.
A36 Male 21 Caucasian Christian Very
Sorry for those who got it through blood
transfusions etc. through no fault of their own. The others
and druggies, gays, those who sleep around, BAD LUCK.
S119 Female 19 Asian Moslem Very
I don't feel sorry for those who had it
through unhealthy sex, drug abuse.
The distinction with so-called
“Innocent” persons was most common in Singapore. This type
of comment was seen everywhere except notably in Japan and
Philippines. For example:
I12 Male 29 Indian Christian Very
My feeling depends on the way how they
got infected. If they are innocent I will show sympathetic
I131 Female 23 Indian Hindu Not too
Some innocent people also infected by
this through blood transmission.
I729 Female • Indian Hindu Somewhat
Sympathy for innocently affected.
S1 Female 21 Asian Christian Very
For innocent people or children who got
it from their mothers or through blood transfusion etc., I
think it is really unfair to them. For those who get it
through casual sex etc., I think it serves them right!
S71 Female • Asian Christian Very
Some are innocent. Some got it because of
themselves. e.g. flirt around.
S90 Female 19 Asian Other Somewhat
Scared and sometimes sympathize with them
if they are innocent people who got it from blood transfusion
or from their mother.
S163 • 18 Asian Moslem Very
Feel sorry for innocent victims.
HK38 Female 19 Asian Christian
Some are innocent e.g. babies, patients
infected by blood transfusion. Some should bear the
At the bottom of the table, the keywords
“blood transfusion or hemophilia” are given, as they were
quite frequent, usually in a comment making a comparison or
distinction between two groups of patients:
The people who got infected because of
hemophilia or blood transfusion are pitiful. Sorry for the
people who got it through dishonest sexual matters...
One of the bioethical issues closely
related to AIDS, is privacy. Confidentiality is a consequence
of respecting autonomy. People were asked the question
"If someone has HIV (the AIDS virus), who else besides
that person deserves to know that information?" (2).
People in all countries are similarly positive about sharing
information with a spouse, with 85-98% saying that a spouse
deserved to know if someone was the carrier of a defective
gene or had a genetic disease, with 88-98% saying the same for
HIV (Table 2). Less people were willing to share with family,
and about half the people thought that the information should
be shared with the insurer or employer, except in Japan were
only one quarter did. If so many people would be willing to
share the information with others, then the attitudes that
people have towards the disease are even more important than
in the case when people do not want to share that information.
In 1994 Macer et al. (5) conducted a
survey of members of the Japan Association of Bioethics, which
included the same question on attitudes to persons with AIDS.
Strikingly, 24% of the 175 respondents said that they knew
someone with HIV. This is high in a country with a low
prevalence of HIV, but not so different to the general public
in the USA, where even in 1991 17% of people reported that
they knew someone with HIV (6). The types of comments
expressed were similar to the public in general, suggesting
the educated people in bioethics were equally likely to
distinguish between someone being a so-called “innocent”
and “guilty” victim. Personal knowledge of someone with
the disease may not make people more sympathetic to any of the
diseases examined in the survey (2). However, this group of
persons were less willing to share information with others
about HIV status, with the equivalent values for Table 2,
being 14% responding that the employer deserved to know (and
74% stating they did not), 10% for insurer (75% no), 89% for
spouse (5% no) and 76% for other immediate family (11% no). We
could suggest that the people in the Bioethics Association
were more concerned about privacy than the general public or
Another method that could be used to
examine the attitudes towards people with AIDS is to interview
people who carry HIV directly about their experiences. One of
the problems with this method is that in some countries
included in this comparison, for example Japan, people with
HIV do not openly disclose their infection because of fears of
rejection or ridicule. Even in countries like Australia or New
Zealand which have a more open social image of AIDS, there may
be some people who are afraid to announce that they have HIV,
and certainly there are some circles in any society where one
would not say “I have AIDS”. In addition if such a method
is used responsibly, it needs considerably more investment in
terms of counseling and followup.
There have been some studies published on
the results of interviews with people with HIV infection. One
group of studies has focused on the discrimination that people
report in practice. Danziger (7), and Andre et al. (8)
examined cases of discrimination by health care workers in
Poland and Italy, respectively. This practice was also been
reported widely in Japan in the early 1990s. Dentists are one
of the groups most frequently reported for discrimination, and
often the persons were denied health care services or forced
to seek other care. One of the reasons for this fear is that
the hospital or clinic does not want to be labeled as a place
where one may catch HIV. In the comments in this survey the
most common medical term mentioned was blood transfusion (see
Table 1). Only one person in this survey however, referred to
Sorry. Especially sorry if contracted
from infected blood or dentist but a serve-you-right attitude
if from free sex. NZ315
This suggests that most people did not
especially associate dentists with AIDS. The student surveys
conducted in Australia, Hong Kong, Japan, New Zealand and the
Philippines were among potential health care workers of the
future. There were a few comments about professional
responsibility among more than 700 comments from these groups.
The professional role did not seem to affect the attitudes,
with 10% in Hong Kong rejecting persons with HIV, although in
the future they would be health care workers and this attitude
would be unprofessional. Examples include:
I guess a feel a little worried by them
but as a doctor I will take all precautions to protect myself
and do my best to help them. AS49
In the sense of having had sex with
unspecified persons, it serves them right. But I won't
discriminate them because they are AIDS patients. JS18
If it is caused from the person's
everyday behavior, it is proper punishment. As for other
cases, I think there are less cases if doctors are careful on
the time of blood transfusion. JS291
I don't tell (not to the patients
Fine -other than to take special care
when dealing with them as patients. AS24
I want to know how they get the disease
and then I can show my feeling. If I don't know that, I will
see them as a patient only. HK80
There were only a few comments that
mentioned a specific gender, despite the common distinction in
the literature between men and women. At the time of the
survey there was a trend for half the new infections to be
women. These comments were most common in Thailand, and in
other countries only one clearly blamed men.
Men-no sympathy. Women-sympathy if they
are decent, got from husband. S34
Have had no direct contact with any
person -my feeling are complicated. Those who have contracted
from blood transfusions and women from bi-sexual /drug users
-then it is tragic. A32
Sympathetic. Particularly medically
acquired HIV. Promiscuous homosexuals and women with recent
infection sexually acquired were warned. Sympathetic with
their suffering but not their carelessness. A173
In all countries people made distinctions
between so-called “innocent” and “guilty” persons.
Only one comment actually mentioned the term guilty, “If the
patients got it because they did something to have a guilty
conscience, it serves them right. The other patients are
pitiful all the more for because there're this kinds of
patients.” (J115) How do we assign people to a guilty
category in our mind? Some people used religious criteria,
others used sexuality, others use of illegal drugs. These
groups may all be associated with behaviour that is against
someone’s morality, and many of the people who gave negative
comments were judgmental of other’s lifestyle. This type of
reasoning may also attach much stigma to the people with AIDS.
When people realize that they have HIV, they have to confront
an altered identity, and have a long latent period before they
start to show signs of AIDS, and have further intensive
therapy as demanded by modern treatment strategies. There is a
long time in which the psychology has to develop to being
prepared for the disease, and beyond the normal regret of the
actions which contributed to the disease, people who are
called “guilty” may have considerable stigma about their
behaviour (9). The degree of stigma may vary over the course
of the infection, and depend upon changing social attitudes
and reactions to the people with HIV.
One of the goals of bioethics is to help
people make decisions, so they can make better choices. It
should also make us more tolerant of other’s decisions.
There is some education of AIDS in schools, and in the 1993
International Bioethics Education Survey it was found that 94%
of Australian and New Zealand biology teachers had taught
about AIDS and 84% of Japanese biology teachers (10). Less
social studies teachers had discussed AIDS in Japan, 60%,
compared to 78% in Australia and 90% in New Zealand. However,
this did not examine the ethical content of those classes.
It is reassuring that most people
expressed sympathy or compassion towards those with HIV.
However, the hate expressed in some of the negative comments
is not one we would like to have in a bioethically mature
society. It can be found in comments of major public figures,
e.g. “We've got to have some common sense about a disease
transmitted by people deliberately engaging in unnatural
acts.” (Sen. Jesse Helms, New York Times, 5 July
1995). We can also see this hate expressed in three countries
included in this survey, though the events were after the
survey was conducted so did not themselves alter the results.
In 1996 Israel had a scandal over semi-official ban on the use
of Ethiopian blood in donations, which was estimated to be
actually protecting a risk of one infection every ten years
(11). In 1997 the Indian state of Maharashtan forced
compulsory HIV testing, segregation and branding for girls of
12 years and over who lived in homes for the destitute, and to
brand HIV positive prostitutes with indelible ink (12), which
was not allowed by the Supreme Court of India. Russia
introduced a law in 1995 that demanded certificates of freedom
from HIV for non-Russian citizens living there (13). In the
surveys there were a significant number of comments expressing
fear which are the reasons for such strong measures, but they
were not limited to those countries. Pressure upon people with
HIV may be just as great in the absence of clearly
discriminatory laws merely by the combined attitudes of some
groups in society which blame the person for having a disease.
This paper summarizes some of the
metaphors that were used about persons with HIV. It provides a
complement to other works in the literature which deal with
the popular metaphors expressed (14). Over time social
attitudes change, and we can see that people in the United
States displayed more tolerance towards people with AIDS after
time, however, they still did not express compassion to those
who contracted the disease through sexual or drug use
practices (5). However, still people supported the presence of
anti-discrimination laws passed in 1990 in the USA. Despite
the opinions expressed to protect persons privacy in Table 2,
there are cases still reported where employers test persons
with HIV and illegally dismiss them (12). Such testing is
actually even not economic, but based on public fear (15). One
should also note that despite the anti-discrimination laws in
the USA to protect persons with AIDS internally they had a
policy to exclude HIV-infected foreigners from entering the
One of the factors that might have been
thought to influence attitudes was the frequency of AIDS
cases, and the main routes of infection. In Table 1 the
prevalence of HIV and number of reported AIDS cases for 1993,
the time of the survey, are shown. There had been cases
reported in all countries. For India there is doubt over the
real number of AIDS cases at that time, but each country was
at a different stage in infection route, and there was a trend
over time in HIV infections from accidental transfusion and
homosexually acquired HIV towards heterosexual routes.
We can say that the metaphors that people
have, can continue to maintain discriminatory attitudes
towards persons with HIV. The results of this study suggest
that the public education campaigns to reduce HIV spread, may
have actually against increased discrimination persons with
HIV and AIDS, if the metaphors expressed in this survey
represent the behaviour of persons. We should be more careful
in combating AIDS, so that only the disease and not the people
with it, are targets of the negative campaign to eradicate the
tragic disease. The social attitudes towards persons with HIV
will also affect the risk behaviour and prevention measures
that are taken, though it is difficult to predict in which way
(16). The discriminatory attitudes may represent broader
racial or sexual discrimination in society, and there have
even been cases of persons led to seek deliberate HIV exposure
as a sign of hopelessness (17).
In Hong Kong, Japan and Singapore there
had been media discussion of foreign persons as sources of
HIV, for example foreign prostitutes, but there were no
comments specifically mentioning foreigners in any country.
There were also surprisingly few comments about homosexuals,
given the prejudice that is shown against them (18). It
appears that either people just inferred these groups in their
comments, or they did not label persons and instead used terms
like it serves them right - in general to anyone. It would
have been interesting to conduct the survey at the end of the
1980s when such prejudice may have been more common. For
example, in homosexual bathhouses in Japan, foreigners were
excluded for fear that they would carry HIV (18). In Japan
there are actually no open public associations of persons with
AIDS, or homosexuals, while in countries like Australia there
is still homophobia and AIDS-phobia but there are public
associations for both homosexuals and for people with AIDS
(19). A survey of 620 companies in Japan in 1993 found only 7%
had an AIDS policy, but 85% were working on AIDS education
(20). However, it is unlikely that those companies that
actually discriminated would reveal they did so.
Overall there tended to be less critical
comments seen from females when compared to males, but there
were more differences in the attitudes between some samples
than between gender or age within the samples. Several studies
have found that females tend to have more favourable attitudes
towards persons with AIDS than males, including one conducted
on studnts at Shimane University (21), and a survey in
Scottish public (22).
In conclusion, we can say that exploring
the comments people make in response to the questionnaire can
provide useful insights on their attitudes and background. We
think we should reject the terms like “innocent victims”
and “sinful or deserving of the disease”, because we have
no right to be a judge of others. All sufferers are victims,
and the social pressure can aggravate the stigma associated
with the disease. The fear of discrimination is an important
type of stigma, and a Scottish study found that people with
AIDS probably felt disproportionately more negative attitudes
towards themselves than the people had (22). Some social
images differ between countries, and cultural specific
pressures may alter the actual type of stigma that is put on
persons, as seen in a study of USA and Africa (23).
"Bioethics" means the study of
ethical issues arising from human involvement with life, and
we can call it simply the "love of life" (1). Love
is a broad term, but includes the concepts of balancing
benefits and risks. Love is the desire to do good and the need
to avoid doing harm. It includes love of others as oneself,
the respecting of autonomy. It also includes the idea of
justice, loving others and sharing what we have - distributive
justice. There should not be any distinction between “us”
and “them” (24). Bioethics includes love for oneself and
one’s family, love for other people, love for the
environment around us, and love for God. Under the concept of
love of others and loving good, there can be no discrimination
of the sick, and we would argue that rejection of those with
HIV is against bioethics.
We are indebted to all those who helped
conduct the International Bioethics Survey (see Macer, 1994),
and to Mrs Chalobon Kachonpadungkitti who translated the Thai
comments into English.
1. DRJ. Macer. Bioethics is Love of
Life. Christchurch: Eubios Ethics Institute, 1998.
2. DRJ. Macer. Bioethics for the People by the People.
Christchurch: Eubios Ethics Institute, 1994.
3. DRJ. Macer (1995) "Medical aspects of the repression
of deviating behaviour", Int. J. Bioethics 6:
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Table 1: Keywords in comments about
people infected with HIV or having AIDS in different
countries, with seroprevalence of HIV
deserve, serve, ask for