Do not condemn and you will not be condemned.
A social psychological research on ways to reduce HIV stigma among Christians
Master Thesis
University of Amsterdam
Faculty of Social and Behavioural Sciences
Social Psychology
25-03-2016
Student: R. Gonschorrek Student number: 10892672
Doncent: Dr. A.H. Westmaas
Abstract
The current research aimed to reduce HIV stigma among Christians. Participants were recruited at a Christian Church community. Fourteen participants joined Focus Group Discussions that offered in-depth findings regarding stigma and related constructs. In a second step, an experiment was conducted among 57 participants to test whether prosoical Bible texts might be used to reduce HIV stigma and increase the prosocial value universalism among Christians. Furthermore, the research tested the association between HIV stigma and BJW-O and BJW-ultimate. The analysis of the data showed no decrease of HIV stigma and now increase of universalism. HIV stigma was already very low and universalims was already high prior to the experimental manipulation. BJW types appeared to be unrealeted to HIV stigma.
Index
Foreword 2 Introduction 2
Focus Group Discussions 9 Methods 9 Results 12 Discussion 18 Experiment 24 Methods 24 Results 30 Discussion 47 General Discussion 53 Conclusion 56 References 58 Appendices 64
Appendix A – Bible Texts 64
Appendix B – Informed Consent Focus Group Discussions 66
Appendix C – Form for the moderator of the Focus Group Discussions 72 Appendix D – Structure of the Focus Group Discussions 73
Appendix E – Informed Consent for printed version of the experiment 75 Appendix F – Informed Consent for the online version of the experiment 80 Appendix G – T0 Questionnaire 84
Appendix H – T1 Questionnaire 104 Appendix I – Debriefing 125
Foreword
The research presented here used the word ‘religious’ to refer to the strong belief in a god or gods (Cambridge Dictionary, 2015). Even though the research was conducted among
Christian participants who showed high importance for God, some of them do not consider
themselves religious. Since the word religious literally means ‘bound’, these participants do not agree to use this word to describe their Christian belief. Instead, they prefer to call
themselves Christians. In order to enable a clear reasoning of theoretical background, the
current research does make use of the word ‘religious’ to describe the strong belief in a god. As the responsible researcher, I want to emphasize that the wording is not meant disrespectful
to the participants of the research. I fully acknowledge that participants who consider
themselves non-religious but Christians are, in fact, not religious.
Ruth Gonschorrek
Introduction
Since its onset in 1981, human immunodeficiency virus (HIV) has cost more than 34
million lives worldwide and is, therefore, a major global health issue (World Health
Organization, 2015). So far, no successful cure for HIV exists and as a consequence, the only
way to reduce the number of deaths caused by HIV is to prevent the further transmission of
the disease. However, a major problem that keeps the transmission of HIV infections going is
the stigma that lies on HIV (Deblonde, et al., 2010; Meiberg, Bos, Onya, & Schaalma, 2008;
UNAIDS, 2016). As conceptualized by Goffman (1963), stigma is the social discretization
and devaluation of people who differ from the social norm. Victims of stigmatization
shameful (Mahajan et al., 2008). Despite these harmful effects, stigmatization is deeply rooted
in society (Aberson, Swan, & Emerson, 1999) and at first sight stigma might even appear to
be functional on the group level. Psychological, social and actual distance is created towards
people who differ from the norm, and by this process, the norms of a group can be maintained
(Devine, Plant & Harrison, 1999). Regarding HIV stigma, it might seem that excluding
people living with HIV (PLWH) from a group will keep the group healthy. However, HIV
stigma is a problem because many PLWH are not aware of them carrying the virus and the
fear of being stigmatized works as a barrier for getting tested (Cunningham, Tschann, Gurvey,
Fortenberry & Ellen, 2002; Deblonde et al., 2010; Meiberg et al., 2008). Worldwide, 17.1
million of the 36.9 million PLWH do not know they are infected and in the Netherlands, it is
about 2.800 of the 20.000 PLWH, (UNAIDS, 2015; Stichting HIV monitoring, 2015). HIV
stigma impedes a promising way to prevent the spreading of HIV, namely to get people at
high risk of infection with HIV tested on a regular basis (UNAIDS, 2015). Furthermore, the
fear of being stigmatized might cause PLWH who are aware of their infection, to keep their
HIV diagnosis quiet. This might, in turn, lead to more infections because no extra caution is
taken when PLWH and healthy individuals have (sexual) contact (Hosseinzadeh & Hossain,
2011). HIV stigma thus has a great impact on the spreading of HIV and therefore the current
research focuses on how HIV stigma can be reduced.
In order to reduce HIV stigma, it is helpful to know what causes the stigma. Herek and
Capitanio (1986) made an important finding related to this question. The researchers
hypothesized that the same stigma can be held for different reasons (as it is the case with
attitudes, see Katz, 1960). Their functional analysis revealed that American participants
stigmatized PLWH for two different reasons. Some stigmatized PLWH because of the
potential health risk that results from interacting with PLWH, whereas others rather
contamination of HIV such as anal sex among men having sex with men (MSM) and drug
use. They associated HIV contamination with immoral behavior. Interestingly, this second
form of stigma was linked to Christian religiosity. Hosseinzadeh and Hossain (2011)
replicated these findings among Muslim participants. It thus appears that (monotheistic)
religions impact HIV stigma in the way that religious individuals tend to form HIV stigmas
because of its symbolic meaning. Building on this it follows that it might be a promising way
to reduce HIV stigma among religious people by an intervention that reduces the impact of
the symbolic meaning attached to HIV. Interestingly, the means to accomplish a reduction of
HIV stigma might also lay within religion because even though religion seems to stimulate
the forming of HIV stigma, it also embodies prosocial values that might contradict the
formation of stigma. For example, within Christian belief, a co-occurrence of stigma
enhancing and stigma-reducing values is reflected in the Bible, the symbol-laden scriptures
that form the basis of Christian belief. The Bible does contain both, messages that imply
stigma (e.g. portraying homosexuality as sin) and messages that promote prosocial values
which might be negatively linked to stigma (e.g. Christians should not judge others). As a
consequence, when high emphasis is put on the prosocial messages promoted within the
Bible, this might compete with and possibly overrule the stigma. Earlier research indicates
how these prosocial Bible messages could be used to reduce HIV stigma. Shariff and
Norenzayan (2007) conducted an experiment that increased the prosocial intentions of
religious participants: priming participants with religious themes of giving led religious
participants to donate more money afterwards, whereas nonreligious participants were
unaffected by the manipulation. Research by Pichon and Saroglou (2009) found a link
between religion and helping; priming participants with the image of a church resulted in
religious participants to indicate more willingness to help a person in need. Prosocial religious
implication for the current research is that exposing religious people to prosocial religious
primes will lead them to show more prosocial and less antisocial tendencies and thus to show
less stigma. In particular, a prosocial message which is overly present in the Christian belief is
desisting from judging others (DFJO). Since stigma means generating negative judgments
based on stereotypes (Corrigan & Penn, 1999), this message also relates to not stigmatizing
others. The Bible contains a body of texts endorsing this prosocial message. Therefore, Bible
texts can be used to prime Christian participants with DFJO. Specifically, it is predicted that:
1. Priming Christians with the Bible message of desisting from judging others (DFJO) will lead to a reduction of their HIV stigma as compared to Christians who were not primed.
Religion can thus be linked to prosocial tendencies such as DFJO and also to helping
and altruism (Shariff et al., 2007; Pichon et al., 2009), as well as to antisocial tendencies such
as stereotyping and stigmatizing (Batson, Floyd, Meyer & Winner ,1999; Hunsberger &
Jackson, 2005; Mahajan et al., 2008). Past research found different circumstances which
might facilitate the occurrence of either prosocial or antisocial tendencies. These findings are
of interest for the current research because they might be used to further decrease HIV stigma.
First, the values an individual holds are of great influence. According to Schwartz (1994),
‘values are desirable, trans-situational goals, varying in importance, that serve as guiding principles in people’s lives’. Both genetically determined personality traits as well as the cultural environment influence the specific set of values held by an individual (Saraglou,
2003). Prosocial values are positively linked to religiousness (Batson et al., 1999). But these
prosocial values rather relate to benevolence, the value to act friendly and socially towards
friends and relatives. In contrast universalism, the value to act socially towards the larger
Saroglou, Delpierre & Dernelle, 2004). Religious individuals who ascribe much importance
to benevolence, but not to universalism, even tend to distinct themselves from outgroups who
threaten their values by stigmatizing them (Saroglou et al., 2004). As outlined for hypothesis
1, a direct reduction of the HIV stigma that Christians hold may be accomplished by an
increased emphasis on DFJO. This may be even further facilitated if Christians would
broaden their prosocial values to a universal level. Even though most religious people show
low importance on universalism, this value is present in the three monotheistic religions. For
example, the Bible contains metaphors which encourage prosocial behavior towards strangers
and people of low status. As a consequence, just like priming Christians with DFJO
(hypothesis 1), it might be possible to prime them with the value universalism. This leads to
the second hypothesis:
2. Priming Christians with Bible texts that promote universalism will broaden the extent of their prosocial values to a universal level as compared to Christians who were not primed.
Another aspect which determines whether an individual shows low or high HIV stigma lies in
the Belief in a Just World (BJW) (Lerner, 1960), an individual holds. BJW refers to the
tendency to see the world as just and predictable. Fortunes and misfortunes are linked to
former intentions and behavior. According to a high BJW, bad things happen only to those
who deserve it. Even though such beliefs are illogic seen the world is unpredictable and
unjust, they are helpful in maintaining self-worth and trust in the future (Lerner, 1960). Past
research indicates that BJW is found in different religions (Kaplan, 2012). BJW is also related
to stigma in the way that BJW creates psychological distance towards individuals that
experience misfortunes (such as getting infected with HIV) and as a consequence, these
individuals become excluded from the in-group and stigmatized (Furnham, 2003). Pichon and
Saroglou (2009) found that BJW partially mediates the link between religion and helping
which they hold BJW about themselves (BJW-S) and BJW they hold about others (BJW-O)
(Dalbert, 1999; Sutton & Douglas, 2005). According to Pichon and Saroglou, when religious
people hold high BJW-O, it makes them less likely to help people in need, even if they have
been primed by a religious, prosocial symbol. BJW-S has no influence on helping behavior.
Secondly, individuals may vary in the extent to which they hold an ultimate or immanent
BJW. BJW-immanent is concerned with events that occurred in the past and that take place in
the present. The world is seen as just at any moment. This form of BJW leads to the
conclusion that any individual that experiences misfortune deserves no other. In contrast,
BJW-ultimate is concerned with the justification of the world in the long run. Behavior that is
acted out in the present will lead to either good or bad outcomes in the future (Maes &
Schmitt, 1999; Maes & Kals, 2002). According to Saroglou, when religious people hold
BJW-ultimate, it makes them more likely to help people in need, whereas BJW-immanent is
unrelated to helping behavior. The current research assumes that the relations Saroglou found
between BJW and helping behavior among Christians may be found for HIV stigma in the
opposite way. This leads to the hypotheses that:
3. The extent to which Christians hold BJW-O relates to the extent to which they show HIV stigma. The more BJW-O they hold, the more HIV stigma they show.
4. The extent to which Christians hold BJW-ultimate relates to the extent to which they show HIV stigma. The more BJW-ultimate they hold, the less HIV stigma they show.
The target group of the current study is formed by Christians, who also have a
Sub-Saharan African, Dutch Antillean or Surinamese background. People with Sub-Sub-Saharan
African backgrounds have the second highest rate of HIV, accounting for 14 % of all HIV
cases in the Netherlands (Stichting HIV Monitoring, 2015). Furthermore, people with Dutch
Netherlands (Stichting HIV Monitoring, 2015) and are therefore included in the current
research. The group with the highest rate of HIV infections in the Netherlands is MSM. But
they do not form a suitable target group because their sexual orientation is mostly not
accepted by Christian communities and therefore it is difficult for MSM to attend to Churches
and join Christian communities.
The research thus aimed to test whether Bible texts about DFJO are helpful in
reducing HIV stigma among Christians. The research also aimed to test whether Bible texts
promoting universalism may broaden prosocial values to a universal level among Christians.
Furthermore, since BJW is positively related to both religion and stigma, the current research
also aimed to investigate the relationship between different types of BJW and stigma. This
investigation was undertaken by the means of focus groups that offered useful qualitative data
regarding stigma, HIV stigma, universalism and BJW and by means of a field experiment that
used Bible texts to prime participants with DFJO and with universalism. Stigma, universalism
and different types of BJW were measured using questionnaires.
Focus Group Discussions
Methods
Participants
Three multicultural Christian Church communities in the Netherlands were
approached to recruit participants. One of them agreed to take part in the research. In 2015,
this community consisted of 150 adult members. Of them, 120 members were expected to be
Table 1
Inclusion criteria for participation in the research
The group of community members who agreed to take part was divided into three groups for
the Focus Group Discussions (FGDs) of 4-5 participants.
Informed consent & debriefing
During the whole span of the conduction of the research, participants were explicitly
not informed about the aim of the research to investigate their HIV stigma. This was done to
prevent socially desirable answers. Instead, participants were told that the research was about
Christian Belief and its influence on worldviews among different cultural backgrounds.
Before the conduction of the research, participants received and signed an informed consent.
After the conduction of the FGDs and the experiment had been completed, participants got a
debriefing. This procedure was approved by the commission of ethics of the psychology
department of the University of Amsterdam.
Criteria Specification
Christian Belief Identification with Christian Belief
Attendance at Church Regular, attending Church at least twice a month
Age ≥ 18
Cultural Background Surinamese nationality
Sub-Saharan African nationality
Dutch Antillean nationality
and/or
Procedure
The Christian community where the research was conducted was a Free Church
community. Organizational tasks and the creation of content were accomplished by a team of
voluntary leaders. Recruitment for the FGDs was started by one of these leaders. She
approached community members to recruit them. Those who showed interest received more
detailed information about the FGD from the researcher. After the recruitment had been
finished, the three FGDs took place either before or after a church service on a Sunday in a
room of the Church building. The FGDs were guided by a man who also belonged to the
leadership team. His experience as a leader of discussion groups made him a suitable
moderator for the FGDs, and he got a detailed instruction of how to guide the FGDs. Before
the FGDs were started, he signed a form ensuring that he would not share any information
gathered during the FGDs. The FGDs all had the same setup. First, the researcher again
explained what an FGD is. Participants had the possibility to ask questions and were then
asked to sign an informed consent. Participants also reported their age and cultural
background on sheets that were kept anonymous. Following, the moderator started the FGD
with some general questions about how participants experience their Christian belief. In a
next step, he introduced the topic morality; he asked participants what they understand by
morality and what it means to them. He also presented moral dilemmas and asked participants
about their reactions, thoughts, and feelings towards these dilemmas. As the last part, a Bible
text containing the prosocial messages regarding DFJO and universalism was handed out to
the participants, and they were asked about their thoughts, feelings, and reactions towards the
text. Each FGD had a length of 45 minutes and was in agreement with participants recorded.
Material
Moral dilemmas It was not possible to directly ask participants about their (HIV) stigma because this might have caused socially desirable answers. Instead, moral dilemmas were
used to trigger reactions revealing the absence or presence of stigma and also of universalism
and BJW. Most of the dilemmas contained aspects intended to evoke reactions showing (HIV)
stigma. A few other dilemmas did not contain aspects related to stigma. These were added to
distract participants from the aim of the research. A full list of all dilemmas used during the
FGDs can be found in Appendix D.
Bible text For the second, experimental part of the research, it was intended to use Bible texts to prime participants with DFJO and with universalism. A theology student advised several
Bible passages suitable for this purpose of which the Bible text ‘Be merciful just as your
Father is merciful’ (Luke 6:36-42, new international version) was chosen as prime. The complete text can be found in Appendix A. During the FGDs, the text was presented to the
participants to test whether the target group interprets the texts as an appeal to desist from
judging and stigmatizing.
Analysis
The software MAXQDA, version 12, was used to transcribe the records of the FGDs
into written text and to analyze the data. First, the data were manually screened for any
statements that implied the absence or presence of stigma, universalism, and BJW. The
accumulated statements were in a grounded theory approach (Glaser & Strauss, 2009) further
grouped into several categories. The visual tools of MAXQDA were used to compare the
created categories to each other and to look for links among the categories found for stigma
and to look for links between stigma, universalism, and BJW. Additionally, the participant’s
reactions to the Bible text were separately screened and analyzed for stigma and universalism
to investigate the effectiveness of the Bible text as a prime for DFJO and as a prime for
universalism in the experimental part of the research. The data were also screened for topics
other than HIV, which participants tended to stigmatize or held negative attitudes about. The
stigma with questions about other topics prone to stigma so that the aim of the research would
be hidden.
Results
Descriptives
The distribution of age, gender and cultural background of the 14 participants of the
FGDs is depicted in Table 2. As can be seen, the distributions among the FGDs roughly
matched each other.
Table 2
Age, gender and cultural background of participants of the FGDs and the total of all FGDs.
FGD 1 FGD2 FGD 3 Total n 6 4 4 14 Age M 34.67 39.5 39.25 37.36 SD 5.54 13.92 11.64 9.68 Minimum 25 26 30 25 Maximum 42 59 56 59 Gender Female 3 3 2 8 Male 3 1 2 6 Cultural Background Sub-Saharan African 1 2 1 4 Dutch-Antillean 5 2 3 8
Main analysis
General observation Participants talked a lot about what morality means to them and what they think is good and bad. In this context participants often referred to the Bible, which was
mentioned 43 times during the three FGDs. Without exception, participants saw the Bible –
the word of God – as the ultimate reference of what is good and what is bad and as the
guideline for moral decisions. As one participant put it:
‘The word of God is the basis of all morality.’
Stigma At first the FGDs were scanned for any statements which might indicate whether participants tend to stigmatize or not. Of the statements that appeared to be related to stigma,
about one-third implied the absence of stigma. These statements had in common that
participants didn’t make a difference between themselves and others. In contrast, the remaining two-thirds of statements implied the presence of stigma. These statements had in
common that behaviors and characteristics not in line with the Bible were seen as shameful
and undesirable. In a second step, a grounded theory approach was used to discover more
in-depth findings related to stigma.
The first finding was that the statements participants made about morality had in common that
the values of Western society were considered to be inferior to Christian values. In particular,
participants tended to make a clear distinction between Christian morals and the morals of the
Western society. As one participant stated:
‘The kind of moral we see in society and the morality we see as Christians, there is a very big distinction.’
Some participants gave direct examples of what is – according to them - accepted as moral by
Western society but not by Christians (e.g. homosexuality). Next to this clear distinction,
morality and/or that Western society tries to act according to Christian morality but does not
succeed because of poor knowledge about God and the Bible. As one participant stated:
‘When you look at the Christian morals and the worldly morals I see that [Christian morals influence [Western morals]. [...] We can see that the world itself has adapted bits and parts of that from the Ten Commandments. Like yet they do not fulfill it.’
A second finding was that - using the Bible as the basis for judgments – most
participants tended to judge within a few seconds about what is good and what is bad. An
example of this is the following interaction between the moderator and a participant:
Moderator: ‘[A man] steals jewelry from a shop. […] what are your thoughts about this action?’
Participant: ‘Looking back at the Ten Commandments, he stole something!’
Moderator: ‘And this man stole because otherwise he would not have the money to pay the medicine for his sick wife. Is he still a robber?’
Participant: ‘Yeah, [God's] word doesn´t justify that.’
However, other participants were not as eager to judge. Just as the participants who did judge
more easily, they based their statements on the Bible. They outlined that they were not able to
judge about right and wrong because their God is the only one to judge. For example, one
participant reacted as follows to the moderator's question about the robber stealing jewelry:
‘As a Christian, I think […] instead of judging fast, [you think] like ‘wow, what animated this person, what is he going through?’’
Furthermore, it appeared that more than one-third of the statements showing fast judgments
correlated with statements implying stigma. The statements of participants who did not judge
A third finding was a contrast between participant’s opinions and participant’s behavioral intentions. When participants talked about their opinion concerning moral
dilemmas, they made rather stigmatizing comments towards behaviors and characteristics
which are not in line with the Bible. However, when participants talked about the intentional
behavior they would perform in a situation concerning a moral dilemma, most often they talked about performing prosocial behaviors towards people who showed behaviors or
characteristics not in line with the Bible: of the 27 statements about behavioral intentions, 24
are rather prosocial. Furthermore, one-third of statements which imply prosocial behavior also
imply stigma, and this extends to two-thirds when looking not only at the initial statements of
participants but also the immediate reactions of other participants. For example, when
participants were asked whether a pastor should listen to someone who is homosexual, all
participants reacted like this example:
‘Jesus would never say something like: ‘you are not welcome because you are homosexual.’ It’s not like Jesus accepts homosexuality or that he sees [homosexuality] as something good, but the word of God says: ‘come as you are.’’
The fourth and last finding concerning stigma was that sin was often mentioned within
stigmatizing statements. Participants considered behaviors and characteristics not in line with
the Bible as a sin. Furthermore, sin was mentioned within fast judgments and only to a much
smaller extent within the deliberate judgments.
HIV stigma When looking at the participant’s reactions to moral questions about HIV, it appeared that participants did have practical knowledge about HIV. For example, when
talking about sharing a plate with a girl who has HIV, participants lined out that they would
share a plate because of the practical fact that HIV cannot be transmitted by sharing a plate.
that it is safe to share a plate with PLWH. But other participants kept their confidence that it
is safe to do so. No participant made a stigmatizing comment when talking about HIV.
Instead, the reactions to the example of the HIV-infected girl emphasized that it is important
to treat her well and not to exclude her from the group. For example, when one participant
said ‘Don’t let them feel like they don’t belong,' the rest of the FGD nodded their heads in
agreement.
Universalism Thirteen statements with a link to universalism were found. Although participants did make a difference between themselves and people who are seen as bad by
Western and/or Christian society (e.g. ‘murderers’ and ‘homosexuals’), participants
demonstrated universal values in the way that they said to value these people despite their
imperfections. In most of these statements, participants related universalism to Christianity;
they stated that being a Christian empowered them to act according to universal values. As
one participant stated:
‘When you love and put God first, you love with all your heart and everything that is within you; it empowers you to love your fellow man.’
Furthermore, half of all statements containing universal aspects correlated with the statements
coded as not stigmatizing. One example is this statement, which was coded as universal and
as not stigmatizing:
‘If I see somebody who needs help, I don´t care what you´ve done or where you’re coming from, if, at that moment, I can help I do it directly, I don´t ask him. No matter where you come from, what´s your color or nationality.’
BJW The three FGDs contained only a few statements that showed BJW. These statements have in common that God is seen as a protector who keeps the pure believer from harm and
judges the sinners. As one participant stated:
‘There are really good Christians and the bad ones, but the Bible says: ‘by their fate we shall know them.’’
BJW statements were not correlated with other statements. All forms of BJW (S,
BJW-O, BJW-ultimate, and BJW-immanent) were found.
Implications for the experiment
The participants reactions towards the Bible text ‘be merciful’ were examined to investigate whether the text would evoke the intended reactions about DFJO and universalism. Of the
reactions participants gave on the text, one third was related to both universalism and DFJO.
Universalism and DFJO thus appeared to be highly correlated with the reactions of the
participants. The remaining two-third of the reactions emphasized the love towards God and
love towards oneself. Furthermore, the FGDs were screened for topics which could be used in
the questionnaire of the experimental part of the research in order to distract participants from
the topic of interest; HIV stigma. Table 3 shows all topics where participants showed negative
attitudes about. However, some topics might have been mentioned more often because they
were given as examples during the FGDs. Another topic which was given as an example of a
negative attitude was poverty, but participants emphasized that they did not hold a negative
Table 3
Topics that were negatively evaluated during the three FGDs. Topic X times mentioned Given as example
Homosexuality 8 x yes Murder 3 x no Robbery 3 x yes Lie/Falsehood 2 x yes Rape 2 x no Pornography 1 x no Euthanasia 1 x no
Nakedness (on television) 1 x no
Adultery 1 x no
Cursing 1 x no
Drug dealing 1 x no
Marriage with animals 1 x no
Divorce 1 x yes
Discussion
The primary aim of the FGDs was to investigate (HIV) stigma, universalism, and BJW
among a Christian community. Drawing on the results of this analysis, a second aim was to
generate practical implications for the experimental part of the research.
In general, participants made both stigmatizing comments and comments implying the
absence of stigma. In-depth findings were (1) that participants saw the Bible as the ultimate
guideline for appropriate thoughts, decisions and behaviors, (2) that participants tended to
moral judgements, (4) that participants tended to refer to the concept of sin when expressing
stigma, and (5) that the participant’s opinions about immoral behaviors differed from their behavioral intentions to react to these immoral behaviors. A specific analysis of HIV stigma
indicated no HIV stigma. Furthermore, participants did make statements implying universal
values and statements implying BJW. The Bible text ‘be merciful’ did, as expected, evoke reactions implying universal values, and the absence of stigma and the accumulation of topics
participants might evaluate negatively resulted in a list of several topics.
The realization of the FGDs was not without limitations. Firstly, the cultural
background of participants is somewhat diffuse. Participants varied in whether they were
themselves born in a Sub-Saharan African or Dutch-Antillean country or whether they were
more loosely connected to one of these cultures through the nationality of their parents. Since
most participants felt connected to their parent’s and the Dutch culture, it is unclear which cultural background underlies the participant’s specific contributions to the FGDs. A related
limitation might be the researcher’s presence during the FGD’s. Even though she did not engage in the discussion, her presence as the only white person in a group of black
participants might have caused an increased consciousness for cultural background among the
participants, and this in turn might have led to answers not valid in real-world settings.
Despite these limitations, the results of the FGDs allow for useful conclusions. Even though
the cultural backgrounds varied, participants appeared to be alike in the sense that they
identified themselves with the Christian belief. Additionally, the design and the recording of
the FGDs was set up in a way to promote confidentiality and questions prone to socially
desirable answers were not stated directly, bringing socially desirable answers to the lowest
possible level.
The analysis of the FGDs showed that stigma was prevalent during the FGDs but
resulting in the mixed impression that all participants made both stigmatizing and
stigmatizing contributions and that the topics of the FGDs evoked stigmatizing and
not-stigmatizing reactions. In general, behaviors and characteristics not in line with the Bible
triggered negative attitudes and stigmatizing reactions. Concerning the definition of stigma as
the social discretization and devaluation of people who differ from the social norm (Goffman,
1963) several conclusions can be drawn from the analysis of the FGDs. First of all,
participants considered Western morality to be either inferior to Christian morality or to be an
only Western construct opposed to Christian values. In this way participants discretized,
devalued and thus stigmatized Western society for its inferior values. In a more indirect way,
stigma might also be reflected in the eagerness of participants to judge on moral dilemmas.
While a few participants refrained from making fast judgments, most participants judged
moral dilemmas immediately. When making fast judgments, participants used the Bible as the
ultimate and only reference. These two findings, that participants judged fast and considered
only one reference, indicates that participants did not engage in reflective thinking when
making a moral judgment. Reflective thinking is a slow thinking style that takes several
possibilities into account, resulting in deliberate judgments. By contrast, automatic thinking is
based on biased thinking and results in fast judgments (Evans & Curtis-Holmes, 2005; Evans,
2008), and it is present within stigma (Santuzzi & Ruscher, 2002). Therefore, it is possible
that the fast moral judgments reflect stigma. However, an important side note is that
automatic thinking is a common mental process (Tversky & Kahneman, 1974). The pure
engagement in this thinking style can therefore not account as evidence for stigma. But the
assumption that the fast judgments indirectly imply stigma is further accredited by the fact
that fast thinking indicates a lack of open-mindedness (Campitelli & Labollita, 2010). An
additional accrediting fact is that the fast judgments made during the FGDs had mostly
participants explicitly devalued anything the Bible described as sin. The most prominent
example is homosexuality, which was mentioned several times as an example of sin. Stigma
and sin thus appear to be related, which was also found by several other researchers (e.g.
Arboleda-Flórez & Stuart, 2012; Espínola-Nadurille, Crail-Melendez & Sánchez-Guzmán,
2014). According to Corrigan, Watson, Byrne and Davis (2005) the relation between sin and
stigma is that sin is perceived as willingly performed evil behavior that evokes feelings of
anger and fear. These combined feelings in turn lead to avoidance behaviors and stigma. This
reasoning leads to the conclusion that people who believe in sin, also tend to stigmatize.
Another noteworthy finding was that participants held opinions very different from their
behavioral intentions. Almost all opinions they expressed towards people performing
behaviors or possessing characteristics not in line with the Bible were negative, stigmatizing
opinions. But nevertheless, the participant’s behavioral intentions to act towards these people
were prosocial intentions. As the formation of stigma is a mental process, it appears that the
emergence of negative opinions towards other’s characteristics or behaviors - a mental act - is closer related to stigma than the intention to perform a certain behavior is related to stigma.
Hence, the finding that participants hold negative, stigmatizing opinions should be interpreted
as an evidence of the presence of stigma. By contrast, the willingness to perform prosocial
behaviors should not be interpreted as evidence for the absence of stigma. But although the
prosocial intentions are not decisive in demonstrating an absence of stigma, they do reflect a
prevalence of universal values because universalism is defined in terms of behavior, in
particular, prosocial behavior towards the in - and outgroup (Schwarz, 1994). Almost all
behavioral intentions to act towards members of outgroups were prosocial. Participants thus
appear to hold at the same time stigma and universal values. In conclusion, participants do
stigmatize, but their universal values motivate them not to act according to their stigma. An
very weak (Webb & Sheeran, 2006; Rhodes & Dickau, 2012). Besides the stigmatizing
comments, participants also made fewer comments indicating the absence of stigma. These
comments were deliberate judgments or not judging at all, or they emphasized equality. In
contrast to the stigmatizing comments, these comments were positively related to universal
values in the way that prosocial, not-stigmatizing opinions were further complemented by
prosocial behavioral intentions.
The specific analysis of statements related to HIV indicated no HIV stigma.
Participants made only comments implying the absence but not the presence of stigma. Two
explanations are possible. Firstly, to trigger reactions about HIV, a moral dilemma dealing
with the topic HIV was presented to the participants. The central character was an HIV
infected girl. Even though no further information about the girl was given, participants
considered her to be very young, Christian and innocent. For this reasons it appears possible
that participants did not show stigma because they assumed the girl to be a victim of the
misbehavior of others. Maybe participants would have shown stigma towards an adult
infected individual. This assumption appears likely considered that participants did show
stigma towards homosexuality, which is often associated with HIV. Another explanation is
that participants truly do not stigmatize HIV. This appears likely because participants had
sufficient practical knowledge about HIV and its transmission. Practical knowledge generally
reduces HIV stigma (Balfour et al., 2010). The findings regarding HIV stigma are not definite
enough for an explicit conclusion.
The FGDs were also specifically analyzed for the presence of BJW. A few statements
were found that indicated the different forms of BJW (BJW-S, BJW-O, BJW-immanent,
BJW-ultimate). These statements were not related to stigma even though a relation was
In conclusion, participants made stigmatizing statements and to a smaller extent, they
made statements that indicated the absence of stigma. Their stigma was reflected in the
devaluation of Western society and the devaluation of any characteristic or behavior not in
line with the Bible; especially anything the Bible considers as sin was stigmatized. Fast
judgments on moral dilemmas indirectly implied stigma. In contrast to the rather stigmatizing
opinions of participants, their behavioral intentions were influenced by universal, prosocial
values.
The analysis of the FGDs offered several practical implications for the second part of
the research. Firstly, the finding that the Bible was very important to participants supports the
operationalization of the second part; namely to use Bible texts to prime participants with
DFJO and universalism. The analysis of participant’s reactions to the Bible text ‘be merciful’ showed that the text did evoke statements implying universalism and statements implying the
absence of stigma. But the unexpected finding that participants show prosocial values almost
exclusively in their behavioral intentions raises the importance of a Bible text that also refers
to behaviors. The Bible text ‘the Good Samaritan’ (Appendix A) is such a Bible text, and it was therefore included as a second text to prime participants with universalism. Another
practical implication was derived from the accumulation of topics participants had negative
attitudes about (see Table 3). Some of these topics could be used to complement the questions
about HIV stigma. Altogether, these practical implications are considered to increase the
validity of the second part of the research because they strengthen the link between the
Experiment
Methods
Participants
The participants for the experiment were recruited from the same Christian
Community as participants of the FGDs and the same inclusion criteria for participation were
applicable (see Table 1). In total, 80 community members had agreed to take part in the
experiment and of them, 55 participants (67.9 % of the whole sample) completed their
participation. By taking part in the research, participants had the chance to win one of 10
vouchers worth 10 euros. After the recruitment, participants were randomly divided into the
experimental condition and the control condition.
Design
A repeated measures design between groups was used: the dependent variables
universalism, HIV stigma, BJW-O, and BJW-ultimate were measured prior to the
experimental manipulation (T0) and then again two weeks later, directly after the
experimental manipulation (T1). Initially, a third measurement of the independent variables
was planned two weeks after T1, but the majority of participants did not fill in this last
questionnaire and therefore only the questionnaires of T0 and T1 were taken into account in
the current research.
Informed consent & debriefing
As it was the case with the FGDs, participants of the experiment were not informed
about the aim of the research to investigate their HIV stigma. Instead, participants were told
that the research was about Christian Belief and its influence on worldviews among different
conduction of the research, participants received and signed an informed consent. After the
conduction of the research had been completed, participants got a debriefing. This procedure
was approved by the commission of ethics of psychology department of the University of
Amsterdam.
Procedure
After the focus groups had been conducted and analyzed, the recruitment for the
experiment was started. The recruitment phase was time-consuming. First, both the researcher
and the pastor talked to the community after a service, to ask community members to
participate. After this, the community members had to be personally approached to ask them
to participate. This was only possible after the services on Sundays. Community members
who were willing to participate could do so either online or at the church. Participants who
chose to participate online were informed about the research at the church and then filled in
the online questionnaires at home. The informed consent was integrated into the
questionnaires as the very first part of the online questionnaire. Participants were asked to fill
in the questionnaires on the same Sunday as they had received the email but not all
participants did so. Up to three emails were sent to remind participants of the questionnaires.
Participants who chose to fill in the questionnaire at the church received a printed version,
which they could fill in at a table in the church. The T0 questionnaire formed the baseline
measurement of the dependent variables HIV stigma, universalism, O, and
BJW-ultimate. Additionally, the first questionnaire contained descriptive questions about
religiousness and cultural background. Each participant received the second questionnaire
exactly two weeks after the first one had been filled in. Again, participants could choose
between an online and a paper version. Participants who did not fill in the second
questionnaire were reminded to do so by the researcher speaking to the entire community at
did not fill the questionnaire. The T1 questionnaire started with the manipulation and then
again measured the dependent variables. The use of participant numbers made it possible to
combine the answers of each participant for the first and the second questionnaire without
violating the anonymity of participants.
Experimental manipulation
The experimental manipulation at the beginning of the T1 questionnaire consisted of a
writing task. The aim of the task was to prime participants of the experimental group with the
tendency to desist from judging and stigmatizing and with universalism. The experimental
condition received two Bible texts that contained these primes, and the control condition
received a Bible text that was unrelated to stigma and universalism. All participants were
instructed to write a short letter to an imagined friend in order to convince him or her of the
meaning of the Bible text(s). To further ensure that participants in the experimental condition
correctly comprehend their texts, they were instructed to use the words mercy and judging in
the letter about not-judging and not-stigmatizing and the words neighbor and love in the letter
about universalism. An important complementary instruction was an emphasis on the letters
to be very convincing. According to cognitive dissonance theory, participants who didn’t endorse the message of the story in the first place did in this way convince themselves, that
they do endorse the message (Lieberman, Ochsner, Gilbert & Schacter, 2001). As an
enforcement to write a convincing letter, participants had the chance to win a VVV voucher
worth 20 euro’s by writing the most convincing letter. At the end of the T1 questionnaire, the experimental condition got the instruction to try to behave like the role models of the Bible
texts within the next two weeks and report any success weekly. By this, the symbolic meaning
of the stories was expected to be salient for a longer period. But since the third questionnaire
(T2) was not filled in by most participants, the long-term effect of the primes could not be
Material
Religiousness In order to measure religiousness, the three-item religiosity index, as developed by Pichon and Saroglou (2009) was used. The three items of the index are
presented in a 5-point Likert-scale and research by Pichon and Saroglou. (2009) revealed a
reliability of α = .87. This high reliability was not replicated in the current research. Instead, there was a very low reliability, α = .42. The item ‘importance of religion’ drastically lowered the reliability of the scale. This relates to the complication mentioned in the foreword of this
research, namely that some participants prefer not to use the word ‘religious’ when talking
about their Christian belief. As a consequence, the item was taken out of the scale. The other
two items of the scale, importance of God and frequency of prayer, were not correlated, as a
Spearman’s rank-order correlation revealed, rho = .18, n = 57, p = .18. Since both items are still informative in themselves, they were kept in the analysis as individual variables.
Values The dependent variable universalism was measured using the short version of Schwartz’ Value Survey (SSVS). Lindeman and Verkasalo (2005) tested the reliability and validity of the SSVS in four different studies and found good reliabilities ranging from α = .69
to α = .99. For each of the ten values, participants could indicate the importance they ascribe
to the value using a 7-point Likert scale ranging from 1, against my principles, to 7, of
supreme importance. Next to the value universalism, other values measured by the SSVS were of interest for the current research. These are the values related to religiousness.
Religious participants were expected to score high on the values benevolence, tradition,
conformity and security and to score low on the values hedonism, stimulation, and
self-directionality. The values power, achievement, and security, were expected to be unrelated to
religion (Pichon & Saroglou, 2009). The SSVS could therefore be used as an additional
BJW-O Lipkus, Dalbert, and Siegler (1996) developed scales to measure BJW-O and BJW-S. The scale measuring BJW-O consists of 8 items (e.g. I feel that I get what I deserve) Lipkus et
al. found a reliability of α = .82. In the current research, the scale had a reliability of α = .81.
The scale measuring BJW-S consists of 8 questions (e.g. I feel that people get what they
deserve) items and had a reliability of α = .76 in the research of Lipkus et al. In the current
research it had a reliability of α = .87. Both scales were measured using a 6-point Likert scale
ranging from 1, strongly disagree, to 6, strongly agree.
BJW-ultimate Maes (1992, 1999) developed two scales to measure BJW-immanent and BJW-ultimate. The scale measuring BJW-immanent consists of four questions (e.g. a bad
lifestyle is often quickly followed by misfortune). Maes (1999) found a reliability of α = .72.
In the current research, the reliability is only α = .52. The scale BJW-ultimate consists of five
questions (e.g. often, even great misfortunes will be compensated in the end). Maes (1999)
found a reliability of α = .90. In the current research, the reliability was only α = .5. As a
consequence, results have to be interpreted with caution. Both scales were measured using a
6-point Likert scale ranging from 1, strongly agree, to 6, strongly disagree.
HIV Stigma The ‘personal stigma for community members’ scale, developed by Visser, Kershaw, Makin and Forsyth (2008) was used to measure HIV stigma. This scale contains 17
items, which are formulated as statements (e.g. I would not like someone with HIV to be
living next door) and it has the two answer categories agree and disagree. According to
Visser et al., the scale had adequate internal consistency (ranging from 0.70 to 0.87). After
one item was revised and two items were deleted, the current research revealed a reliability
of α = .73. For the current research, another 17 items were added to the scale. These items
were phrased exactly like the statements about HIV. However, the content of these items were
other often stigmatized or not stigmatized topics (e.g. I would not like a homosexual to be
were explicitly disapproved during the FGDs and poverty because it was explicitly not
disapproved. The purpose of these 17 added items was to distract participants from the aim of
the study, to measure HIV stigma. Since a total of 34 items was quite long, the added items
were randomly merged with the real HIV items and then the scale was divided into two parts
to improve the readability of the scale.
Bible texts Two Bible texts from the new international version of the Bible were used to prime participants with DFJO and universalism. A theology student had recommended both
texts for this purpose. The Bible texts ‘Be Merciful’ (Luke 6:36-42) was presented to the
participants of the FGDs and did evoke reactions that implied the absence of stigma and the
presence of universalism. The text ‘the Good Samaritan’ (Luke 10:25-37) was added because the FGDs revealed that participants expressed universalism through prosocial behavioral
intentions, and the story of the Good Samaritan emphasizes prosocial behaviors. The Bible
text ‘Jesus Calms the Storm’ (Mark 4:35-41) was chosen as a text for the control group because its content is not related to DFJO or universalism. The complete Bible texts can be
found in Appendix A.
Qualtrics the questionnaires were offered both in a printed version and in an online version. The online version was created with the software Qualtrics.
Analysis
The statistical program SPSS version 22 was used to analyze the data of the
experiment. Before the main analysis, the missingness within the dataset was analyzed in
much detail. This was done because more than half of all participants had not or had not
properly filled in parts of the T1 questionnaire. Firstly, an overall summary of the missing
values and an overview of the pattern of the missingness was derived for all variables via the
function multiple imputation – analyze patterns. In a second step, the frequencies and case
missingness. In a final step, the scores on T0 were compared between the participants who
had filled in the second questionnaire in bad quality and the participants who had filled in the
questionnaire in good quality. For the main analysis, a Mann-Whitney U test was conducted
to compare the experimental and the control condition on their HIV stigma, and an
independent-samples t-test was conducted to compare both conditions on their scores on
universalism. Finally, two Pearson product-moment correlation coefficients were used to test
whether there is a positive relationship between HIV stigma and BJW-O and a negative
relationship between HIV stigma and BJW-ultimate.
Results Drop out
Eighty participants agreed to fill in the questionnaires. Of them, 13 participants did not
fill in the questionnaire that was sent to them. Of the remaining 67 participants, seven
participants took back their agreement when they saw the questions and did not fill in the
questionnaires. Five participants only filled in the first questionnaire; three of these
participants were left out of the analysis because the T0 questionnaire was incomplete. For the
remaining two participants, it was tested whether their scores on T0 significantly differed
from the other participants on the depending variables: Mann-Whitney U Tests were
Table 4
Baseline comparisons between the drop-out and the remaining participants. All variables were compared using Mann-Whitney U Tests.
Participants Drop-out U z Md n Md n HIV stigma 24 -1.31 1.2 55 1.33 2 Universalism 49 -.1 5 51 5 2 BJW-O 29.5 -9.5 3.4 49 3 2 BJW-ultimate 25.5 -1.2 4.25 52 3.75 2 * significant at p = .05. (two-tailed)
No significant differences were found on any of the depended variables. This indicates
random drop out. The data of the participants could therefore be removed from the dataset
without causing data distortion.
Descriptives
Fifty-five participants had filled in T0 and T1. This is a response percentage of 68.8
%. Of them, three were outlying cases on the depended variables BJW-ultimate or HIV
stigma (T1). These three cases varied more than three standard deviations from the mean and
as a consequence, they were removed from the dataset. The data of the remaining 52
participants were further analyzed. The distribution of their age, gender, cultural background
Table 5
Age, gender, cultural background and the use of the printed vs. the online version of the questionnaires of participants from the total sample and the experimental and control condition.
Experimental Control Total
N 25 27 52 Age M 36 41 38.6 SD 9.21 10.34 10.36 Minimum 19 21 19 Maximum 56 60 60 Gender Female 15 16 31 Male 10 11 21 Cultural Background Sub-Saharan African 10 11 21 Surinamese 0 3 3 Dutch-Antillean 14 12 26 Not specified 1 1 2 Online vs. printed Online 16 14 30 Printed 6 6 12 Combination 3 7 10
Note: Participants who chose for a combination of the printed and the online version of the questionnaires filled in T0 either online or on paper and T1 in the other version.
Furthermore, participants scored high on the variables importance of God and
frequency of prayer. The mean score on the importance of God was M = 6.85, SD = .77 and
96.2 % of the sample scored 7, which is the highest score on this item. The participant’s mean score on the frequency of prayer was M = 6.6, SD = 1.14 and 82.7 % of the sample had the
highest score 7, indicating that they pray every day. Besides, several participants scored low
on either one of these items positively related to religiousness, frequency of prayer, or
importance of God, but there was no single participant who scored low on more than one of
these items. These findings indicate that participants were religious. This notion is further
Figure 1. Bar graph of the mean scores of all participants (experimental and control condition) on T0 on the ten values of the SSVS (Lindemann et al., 2010). Note: In general, religious people tend to score high on the values benevolence, tradition, and conformity and low on the values hedonism, stimulation, and self-direction (Pichon & Saroglou., 2009). (n = 52, error bars: +/- 2 SD).
Participants scored higher on the values which are positively linked to religiousness than on
the values which are negatively linked to religiousness except the value tradition. However,
participants strongly varied on their values as can be seen on the large error bars.
Missing data
An exploration of each case revealed that several participants had left out whole
variables, meaning that they did not fill in any of the items making up one particular variable,
whereas only 11 participants left out a single item. Other participants had filled in variables in
the way that they gave each item of a particular variable the same value. According to these
findings, participants could be grouped in four different categories, which are depicted in
Table 6.
Table 6
Categorization of the quality of participant’s answers to the questionnaires and the percentages (%) of each category within the whole sample.
Category Quality %
1. Participants that correctly filled in all variables good 38.5%
2. Participants that filled in the same value for all items of one or more
variables.
bad 25 %
3. Participants that left out all items of one or more variables bad 15.4 %
4. Participants who both left out some variables and filled in the same values
for other variables
The finding that participants had filled in the same values for all items of a variable led to the
assumption that these variables were not correctly and honestly filled. As a consequence,
variables with only the same value for each item were considered missing variables.
Therefore, participants falling into the quality categories 2 to 4 (table 6) were considered
participants with missing variables. Since this large percentage of missing variables might
impact the further interpretation of the data, an explorative analysis on the missingness was
conducted. A first finding was that the missingness occurred almost exclusively among
variables on T1. For T0, only 3.8 % of participants had a missing variable compared 61 % of
participants who had one or more missing variables on T1. For an overview of the
missingness, missing values patterns were derived. The patterns evoked the impression that
the missingness of variables depends on where the variable was placed in the questionnaire. It
seems that variables placed at the beginning of the questionnaire were filled in correctly more
Table 7
The chronological order of the variables of the T1 questionnaire, the missingness ( %) per variable and specification of the reason of missingness.
Reason missingness
Chronological
order
Variable %
missing
Same values for all
items
All items left
out 1 10 values 9.6 % 5 0 2 BJW-S 26.9 % 13 1 3 BJW-O 32.7 % 15 2 4 BJW-ultimate 19.2% 9 1 4 BJW-immanent 19.2% 9 1
5 Stigma first part 23.1 % 11 1
6
Stigma second
part
61.5 % 9 23
Note: items of the variables BJW-ultimate and BJW-immanent were placed together in one scale.
Except for the variables BJW-S and BJW O, variables showed an increase in missingness as
they are placed more towards the end of the questionnaire. The scale that measured HIV
stigma contained not only items about HIV stigma but also items related to other often
stigmatized topics. This was done to distract participants from the aim of the research, to
investigate HIV stigma. Due to the length of the scale, it was divided into two parts. Even
though both parts contain similar items, the second part shows a dramatic increase of
missingness as can be seen in Table 7.
To get more information about possible associations between the content of variables
and the quality of questionnaires, participants with questionnaires of good quality were
with a complete set of variables are referred to as participants with good quality
questionnaires and participants who did not fill in all variables or filled in the same values for
some, are referred to as participants with bad quality questionnaires. As mentioned above, the
T1 questionnaire had a much higher rate of participants with bad quality data (61 %) than the
T0 questionnaire had (3.8 %). Therefore, the first test was whether there was an association
between the version (online or paper) of the T1 questionnaire and quality of the data. A
Chi-square test of independence (with Yates Continuity Correction) indicated no significant
association between version and quality, χ² (1, n = 52) = 1.38, p = .24, phi = .02. Furthermore,
participants with bad and good quality data were compared to each other on their baseline
(T0) scores on all descriptive, independent and dependent variables. Depending on the level
of measurement and on whether variables were normally distributed or not, different
statistical measurements were applicable. For the descriptive variables gender and cultural
background, Chi-square tests of independence were conducted to investigate associations
between gender and quality and between cultural background and quality. The tests revealed
no significant association between gender and quality (with Yates Continuity Correction), χ² (1, n = 52) = .06, p = .81, phi = -.07 and no significant association between cultural
background and quality, p = .22 (Fisher’s Exact Test). Another Chi-square test of
independence (with Yates Continuity Correction) was conducted to investigate the association
between the condition (experimental or control) and quality of the questionnaire. No
significant association was found between condition and quality, χ² (1, n = 52) = .0, p = 1, phi
= .03. The bad quality of data could thus not be linked to the version (paper vs. online) of the
T1 questionnaire, gender, cultural background or whether participants belonged to the
experimental or control condition.
For the two descriptive variables Importance God and Frequency Prayer and the
whether participants with questionnaires of good or bad quality differed on these variables.
The results are depicted in Table 8.
Table 8
Results of Mann-Whitney U Tests comparing participants with good quality data and participants with bad quality data on the variables Frequency Prayer, Importance God and HIV Stigma on T0.
Good Quality Bad Quality
Variable U z Md n Md n r
Importance God 288 -1.81 7 20 7 32 0.25
Frequency Prayer 307 -.37 7 20 7 32 .05
HIV Stigma 177.5* -2.73 1.13 20 1.27 32 .38
Note: significance is indicated with * = p ≤ .01 (2-tailed)
As can be seen in Table 8, there was a significant difference between good and bad quality on
HIV stigma. This means that participants who filled in the questionnaires in bad quality
showed higher HIV stigma as compared to participants who filled in the questionnaire in good
quality.
Participants with good and bad quality questionnaires were also compared on the
descriptive variable age, on the dependent variable universalism and for the dependent
variables BJW-O and BJW-ultimate and the related variables BJW-S and BJW-immanent. For
the comparisons, independent-samples t-tests were conducted. The results are depicted in
