Henna Toppenberg and Rob Ruiter Henna Toppenberg and Rob Ruiter Harry Heuts

Learning about HIV-related stigma in virtual reality

In Mind
Written by  Jolien Linssen Wednesday, 10 June 2015 15:02

In 1987 Diana, Princess of Wales, shakes hands with a man with HIV. Click, goes the camera, and the picture is seen all over the world. At the height of the AIDS frenzy, this gesture was a huge statement. How different things are today, with HIV now a chronic rather than a deadly disease in many parts of the world. Nonetheless, people living with HIV continue to be confronted with stigma – a prejudice all of us may be guilty of.


“It’s not as extreme as it was in the eighties, when people were afraid to even touch someone with HIV”, says PhD candidate Henna Toppenberg. “In the West today stigma takes more subtle forms. But it’s still there, in a wide range of situations. People living with HIV are less likely to be employed, for example, and once they have a job they have a harder time getting promoted.”

“The tricky thing about stigmatising behaviour is that it’s often unconscious”, explains Rob Ruiter, UM professor of Applied Psychology and Toppenberg’s supervisor. “People tend not to realise that they treat HIV patients differently.” But the consequences are real, and so research into this behaviour is needed. This is the challenge for Toppenberg and her supervisor, for how can we measure behaviour that is largely the result of unconscious processes? Their answer: in virtual reality.

Virtual reality
“We have a fantastic laboratory here that enables us to study social interactions in a highly controlled environment”, says Toppenberg. Enter the Virtual Reality Lab at the Faculty of Psychology and Neurosciences and the first thing you see is an ordinary room of about fifty square metres. Put on the head-mounted display, however, and you find yourself in a completely different world.

“Although you know that what you’re seeing is not really there, your brain tricks you into believing the opposite”, says Ruiter. “I remember testing the head-mounted display at a conference a couple of years ago. Suddenly, I was on a shaky bridge over an abyss. I found it hard to move, even though in reality I was just standing on normal ground. The great thing about virtual reality is that it enables us to measure behaviour as people actually engage in it in a context resembling real life, instead of having to ask them afterwards: ‘So what did you do?’”

To study stigmatising behaviour towards people with HIV, Toppenberg had her research participants enter a virtual hospital room, where they were confronted with a virtual patient diagnosed with HIV, cancer or a broken leg. “When they enter the room, the participants know nothing about the patient. Their task is to find out his name and diagnosis, which is written on his wristband and on a board at the foot of the bed. The name of his partner is also recorded on the board, so his sexual orientation is clear.”

None of the participants were aware of what was actually being measured: the way they behaved towards the virtual patients. “One sign of stigmatisation is keeping an increased personal distance during social interactions, so that’s what we were interested in”, Toppenberg explains. “We found that the participants kept the greatest distance between themselves and virtual HIV patients. The distances were largest when the HIV patient was homosexual.” Strikingly, the participants – healthy, heterosexual students – were convinced that they had approached all patients in the same manner.

Gay people living with HIV experience a double stigma, due to not only their disease but also their sexual orientation. Related to this, but not exclusive to homosexuals, are assumptions about personal responsibility: if you contracted HIV through promiscuous behaviour, isn’t that your own fault?

Toppenberg: “In another study, we created a virtual office where participants came face to face with virtual HIV-positive job applicants. We were interested in whether it made a difference if the applicants were open about their medical condition, which was the result of either unprotected sex or a blood transfusion. We expected that acknowledging their disease openly would lead to more understanding and less stigma on the part of the participants, especially if the applicant could not be held responsible for contracting HIV. To our surprise, we haven’t yet been able to confirm this hypothesis.”

Trial and error, of course, is all part of the academic game. “We have to acknowledge that virtual reality is a relatively new technology”, Ruiter says. “So we’re still in the process of figuring out the most valid way to do this type of research.”

It’s also too early to speculate about the practical applications of Toppenberg’s findings. “Our initial goal was not only to show that stigmatising behaviour occurs, but also to come up with ways to reduce it”, she says. “At the moment we’re investigating whether empathy could affect the way people with HIV are approached. If so, it could be used as a tool to reduce stigma.”

Another challenge for the future will be to translate the findings obtained in virtual reality into real life. As Ruiter puts it, “To bring about change, we first need to fully understand how stigmatising behaviour works.”  

Rob Ruiter (1969) studied Health Sciences at Maastricht University, where he obtained his PhD in psychology in 2000. His research focuses on the effectiveness of persuasive messages. He has been professor of Applied Psychology and head of the Department of Work and Social Psychology since 2012. He is also involved in PhD projects in Southern and Eastern Africa. 

Henna Toppenberg (1977) studied social psychology in Leiden and cognitive neuroscience in Amsterdam. She previously worked as a policy adviser at the Ministry of Economic and Labour Affairs in Curaçao. She has been working on her PhD research at the Faculty of Psychology and Neuroscience since 2009.

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