This week, HBO is releasing the critically acclaimed series It’s a Sin,” one of the most-watched new series in the United Kingdom. The show follows young gay men in 1980s London as the HIV/AIDS epidemic unfolds. Today, 40 million people around the world and more than 1 million in the United States live with HIV, disproportionately sexual minorities and people of color. In 2018, gay and bisexual men comprised almost 70 percent of all new infections, and Black and Latinx individuals accounted for 69 percent. Trans folks also face a “silent epidemic”: 1 in 7 trans women, and almost 1 in 2 Black trans women, currently live with HIV.

Over the past 30 years, the medical and advocate communities have worked together to slow HIV’s spread and improve treatment and management. But where medicine and knowledge are scarce, the epidemic continues, with 0.7 percent of the global population now living with HIV. While some of those have become more visible, comparatively few hold political office worldwide.

Our research sought to understand why. We found that many voters don’t support political candidates with HIV because of prejudice, moral judgment and concerns that they could not win elections. That lack of political voice further marginalizes communities that have long faced discrimination.

A significant proportion of voters are biased against politicians with HIV

To explore how voters react to politicians with HIV, we administered online surveys to nationally representative samples of likely voters in the United States, Britain and New Zealand, using the digital survey company Cint to contact more than 4,300 respondents. In each survey, we conducted an experiment that presented participants with pairs of hypothetical candidates and asked them which they’d vote for. We randomized several candidate characteristics, including HIV status, as well as whether they were born with HIV or contracted the virus later in life.

This approach, called “conjoint analysis,” allows us to estimate how a characteristic like being HIV positive affects respondents’ decisions, while controlling for a set of other attributes, such as being White, gay, or male.

Our study finds that, in these three countries, a candidate who is HIV positive loses between 11 and 13 percentage points of support. Politicians with HIV are penalized more severely if the candidate contracted HIV later in life, presumably through sexual behavior or other forms of transmission. When respondents knew a candidate was born with HIV — and therefore could not be considered responsible for getting it — that candidate lost only six to eight percentage points in support. For comparison, gay male candidates lost by three percentage points in New Zealand, 4.5 points in the U.K., and almost seven points in the United States.

We also looked at discrimination across subgroups of voters, including liberals and conservatives, younger and older people, men and women, religious and nonreligious voters. Even young, highly educated, and self-identified progressive voters strongly penalize candidates with HIV.

Voters were also concerned about whether HIV-positive candidates could win enough support to get elected. We asked respondents which candidates they believed would be less likely to win elections. Respondents were more likely to pick candidates if they were HIV positive by nine percentage points in the United States, six in the U.K. and 13 in New Zealand.

HIV/AIDS, media visibility, and representation

HIV/AIDS stigma builds upon the stigma widely held toward the already marginalized communities disproportionately hit by the virus: gay men, trans women, sex workers and drug users. Having few positive public models reinforces prejudice. For years, people with HIV have been largely absent from the media or depicted in a dehumanizing and stereotypical way in movies and popular culture. Notable exceptions included “We Were Here,” “How To Survive a Plague,” “Angels in America,” “The Normal Heart,” “The Inheritance,” and “BPM.” Over time, celebrities living with HIV — such as Magic Johnson, Charlie Sheen and Jonathan Van Ness — have also let their status be known and changed perceptions of life with the virus.

That hasn’t happened in politics. Very few politicians openly living with HIV have won elected positions anywhere in the world. Three currently hold national office. Ryuhei Kawada has been a member of Japan’s House of Councilors since 2007. Lloyd Russell-Moyle won a seat in the British House of Commons in 2017 and spoke publicly about his HIV status on World AIDS Day in 2018. Aldo Dávila was elected to parliament in Guatemala in 2020.

In the United States, Roger Montoya became a member of the New Mexico House of Representatives last year. The most prominent U.S. politician openly living with HIV is perhaps Corey Johnson, the New York City Council speaker who was one of the early favorites for that mayoral election before deciding not to run. Johnson’s political rise suggests that HIV-positive status may not remain an insurmountable barrier to prominent political office.

Meanwhile, misconceptions and stigma thrive. A 2017 survey found that 51 percent of Americans, ages 18 to 30, would be uncomfortable having a roommate with HIV, despite the fact that the virus cannot be transmitted through casual contact. In 2019, 28 percent of American millennials said they avoided hugging, talking to or being friends with someone living with HIV. Invisibility also compounds ignorance: A majority of Americans remain unaware that a prescription medication, PrEP, dramatically lowers the risk of getting HIV when taken as a preventive measure.

When members of other marginalized communities — like gender and sexual minorities — step into political office or become more visible in the media, bias decreases. The scarcity of politicians with HIV in office makes it harder for people to see them as legitimate leaders or as people who deserve policies that would improve their lives.

Gabriele Magni (@gabmagni) is an assistant professor of political science at Loyola Marymount University.

Andrew Reynolds (@AndyReynoldsPU) is a senior research scholar in the School of Public and International Affairs at Princeton University.