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.