"Let's better not choose someone with HIV": Dutch professionals' attitudes and job promotion decisions regarding candidates living with HIV and the mediating role of employability concerns

Despite advancements in HIV health management, workplace stigma against people living with HIV (PLHIV) prevails. However, current literature has focused on labor market access rather than job promotion for PLHIV. This study investigated how professionals living with HIV are perceived compared to those with other chronic health conditions, and explored how employability concerns mediate the association between stigmatizing attitudes and discriminatory practices against PLHIV in job promotions. A nationally representative sample of 640 heterosexual and HIV-negative Dutch professionals completed an online questionnaire designed with input from professionals living with HIV for a cross-sectional study. Data was analyzed using multidimensional unfolding (MDU) to uncover latent dimensions driving participants perceptions of PLHIV and structural equation modeling (SEM) to test the mediating role of employability concerns. The MDU analysis revealed that participants held similar perceptions of and attitudes towards job promotion applicants living with HIV and applicants surviving cancer, compared to those living with other chronic conditions. The SEM showed that prejudice and support for discriminatory policies were significantly associated with discriminatory behavior towards PLHIV, while stereotypes and social distancing attitudes were not. Employability concerns partially and fully mediated, respectively, the relationship between prejudice and support for discriminatory policies, and discriminatory decision-making. Consistent with previous research on discriminatory hiring practices, our findings highlight the crucial role of employability concerns in driving job promotion discrimination against PLHIV and the need to address knowledge gaps about HIV as a manageable condition among Dutch professionals as a means to combat stigma and safeguard careers of PLHIV.