Social Context and the Spread of HIV: An Evolutionary Game-Theoretic Investigation on the Impacts of Social Stigma on Epidemic Outcomes

We provide a theoretical foundation for analyzing how social stigma and adopted behavioral traits affect the transmission of HIV across a population. We combine an evolutionary game-theoretic model—based on a relationship signaling stage game—with the SIR (susceptible-infected-recovered) model of disease transmission. Our evolutionary model specifies how two types of social stigma—that which accompanies an HIV⁺ condition and that which follows associating with an HIV⁺ partner—influence behavioral propensities to honestly report one’s condition (or not) and to unconditionally accept relationships (or not). With respect to reporting an HIV⁺ condition, we find that condition stigma impedes the fitness of honest reporting, whereas association stigma impedes the relative fitness of concealing an HIV⁺ condition; and both propensities can coexist in a polymorphic equilibrium. By linking our model to the SIR model, we find that condition stigma unambiguously enhances disease transmission by discouraging both honest reporting and a society’s acceptance of AIDS education, whereas association stigma has an ambiguous impact: on one hand it can impede HIV transmission by discouraging concealing behavior and unconditional relationship acceptance, but it also compromises a society’s acceptance of AIDS education. Our relatively simple evolutionary/SIR model offers a foundation for numerous theoretical extensions—such as applications to social network theory—as well as foundation for many testable empirical hypotheses.