Stigma has ancient roots. It has been described as quality that significantly discredits an individual in the eyes of the others. It also has important consequences for the way in which individuals come to themselves.

Importantly stigmatization is a process. The qualities to which stigma adheres (the color of the skin, the way someone talks, the things they do) can be quite arbitrary. Within a particular culture setting, certain attributes are seized and defined by others as discreditable or unworthy. Stigmatization therefore describes a process of devaluation rather than a thing.

Discrimination occurs when a distinction is made against a person that result in his or her being treated unfairly and unjustly on the basis of their belonging, or being perceived to belong, to a particular group.

There are three phases of HIV/AIDS epidemic. The first phase is characterized by the epidemic of HIV and this creeps in the community silently and unnoticed. The second stage is shown by epidemic of AIDS a life threatening infections. Finally, the third stage is characterized by the epidemic of stigma, discrimination, and denial. The third phase is said to be a global challenge because it perverts concerted action at community, national, and global levels. It makes prevention difficult by forcing the epidemic out of sight and underground. According to UNAIDS, HIV/AIDS related stigma and discrimination are linked to the actions and attitudes of families, communities, and societies. Stigma has been defined in various ways. Some says that stigma is a social process. It has also been defined as discrediting attribute and stigmatized individuals as those who possess an undesirable difference.

Stigma is something that is produced and used to help order society. For example, the most societies achieve is through conformity by contrasting those who are normal with those who are different or deviant. Cultures therefore produce difference in order to achieve social control.

Concepts of symbolic violence and hegemony highlight the role of stigmatization in establishing social order and control, and identify stigmatization as part of the struggle for power. Symbolic violence is a process where words, images and practices promote the interests of dominant groups and hegemony is achieved through the use of political, social and cultural forces to promote dominant meanings and values that legitimize unequal social structures. So all cultural meanings and practices embody interests and are used to enhance social distinctions between individuals, groups, and institutions.

Dominant groups to legitimize and perpetuate inequalities also use stigmatization, and concepts of symbolic violence and hegemony can also help us understand how it is that those who are stigmatized and discriminated against so often accept, even internalize, the stigma to which they are subjected.

This is because the processes of symbolic violence and hegemony convince the dominated to accept existing hierarchies and allow social hierarchies to persist over generations, without generating conscious recognition from those who are dominated. In addition, these processes limit the ability of the oppressed and stigmatized groups and individuals to resist the forces that discriminate against them.

The concept of stigma and discrimination has to be examined within the broader social, cultural, political, and economic framework rather than individual processes. A better understanding of the processes that produce stigma and discrimination, as well as of the processes that produce resistance to stigma and discrimination would enable us to develop more effective responses to HIV/AIDS related stigma and discrimination.

There is complexity and diversity of stigma and discrimination. HIV/AIDS related stigma and discrimination reinforce with pre-existing stigma and discrimination associated with sexuality, gender, race and poverty. HIV/AIDS related stigma and discrimination also interact with pre-existing fears about contagion and disease. Early AIDS similes such as death, as horror, as punishment, as guilt, as shame, as otherness have exacerbated these fears, reinforcing and legitimizing stigmatization and discrimination.

The stigma triggered by many forces, including lack of understanding of the disease, myths about how HIV is transmitted, prejudice, lack of treatment, irresponsible media reporting on the epidemic, the fact that AIDS is incurable, social fears about sexuality, fears relating to illness and death, and fear about illicit drugs and injecting drug use.

The stigma and discrimination associated with HIV/AIDS have many other effects. In particular, they have powerful psychological consequences for how people with HIV/AIDS come to see themselves, leading, in some cases, to depression, lack of self-worth and despair. They also undermine prevention by making people afraid to find out self-worth or not they are infected, for fear of the reactions of others. They cause those at risk of infection and some of those affected to continue practicing unsafe sex in the belief that behaving differently would raise suspicion about their HIV-positive status. And they cause people with HIV/AIDS erroneously to be seen as some kind of problem rather than part of the solution to containing and managing the epidemic.

Class: The HIV/AIDS epidemic has developed during a period of globalization and growing polarization between rich and poor. New forms of social exclusion associated with these global changes have reinforced pre-existing social inequalities and stigmatization of the poor, homeless, landless and jobless. As a result, poverty increased vulnerability to HIV/AIDS, and exacerbates poverty.

Sexuality: HIV/AIDS related stigma and discrimination are closely connected with sexual stigma because HIV is mainly transmitted and in most areas of the world, the epidemic initially affected population whose sexual practices or identities are different from the norm. HIV/AIDS related stigma and discrimination reinforce pre-existing sexual stigma associated with sexually transmitted diseases, homosexuality, promiscuity, prostitution, and sexual deviance.

Gender: HIV/AIDS related stigma and discrimination are also linked to gender related stigma. The impact of HIV/AIDS related stigma and discrimination on women reinforces pre-existing economic, educational, cultural, and social disadvantages and unequal access to information and services.

Race and ethnicity: Racial and ethnic stigma and discrimination also interact with HIV/AIDS related stigma and discrimination and the epidemic has been characterized both by racist assumptions about "African sexuality" and by perceptions in the developing world of the West’s immoral behavior". Racial and ethnic stigma and discrimination contribute to the marginalization of minority population groups, increasing their vulnerability to HIV/AIDS, which in turn exacerbates stigmatization and discrimination.

HIV/AIDS related stigma and discrimination take different forms and are manifested at different levels - societal, community and individual and in different contexts.

Legal Context: It is manifested in the form of laws, policies and administrative procedures, which are often, justified as necessary to protect the general population. Examples of stigmatization and discriminatory measures include compulsory screening and testing, compulsory notification of AIDS cases, restrictions of the right to anonymity, prohibition of people living with HIV/AIDS (PLHA) from certain occupations, and medical examination, isolation, detention and compulsory treatment of infected persons.

Education and schools: Children with HIV/AIDS or associated with HIV through infected family members have been stigmatized and discriminated against in educational settings in many countries. Stigma has led to teasing by classmates of HIV-positive school children associated with HIV.

Employment and the work-place: Such discriminatory practices as pre-employment screening, denial of employment to individuals who test positive, termination of employment of PLHA, and stigmatization of PLHA who are open about their sero-status.

Health care system: There have been reports from health care settings of HIV testing without consent, breaches of confidentiality, and denial of treatment and care. Failure to respect confidentiality by clearly identifying patients with HIV/AIDS, revealing serostatus to relatives without prior consent, or releasing information to the media or police appear to be problems in some health services. Factors contributing to these stigmatization and discriminatory responses include lack of knowledge, moral attitudes, and perceptions that caring for PLHA is pointless because HIV/AIDS is incurable.

HIV/AIDS program: HIV/AIDS policies and programs for the general population may also reinforce the perception that it is less important to protect population that practice high-risk behaviors than the innocent and unsuspecting general population. It may result in discrimination against marginalized groups, since those at greatest risk do not receive the resources they need.

Religious institutions: In some contexts, HIV/AIDS related stigma and discrimination has been reinforced by religious leaders and organizations, which have used their power to maintain the status quo rather than to challenge negative attitudes towards marginalized groups and PLHA.

Community contexts: In societies with cultural systems that place greater emphasis on individualism, HIV/AIDS may be perceived as the result of personal irresponsibility, and thus individuals are blamed for contracting the infection. In contrast, in societies where cultural systems place greater emphasis on collectivism, HIV/AIDS may be perceived as bringing shame on the family and community.

Family contexts: In individuals, the way in which HIV/AIDS related stigma and discrimination are manifested depends on family and social support and the degree to which people are able to open about such issues as their sexuality as well as their serostatus. In contexts where HIV/AIDS is highly stigmatized, fear of HIV/AIDS related stigma and discrimination may cause individuals to isolate themselves to the extent that they no longer feel part of civil society and are unable to gain access the services and support they need. This has been called internalized stigma.

Conclusion: We need to acknowledge the way in which HIV related stigma and discrimination interact with and reinforce pre-existing stigma and discrimination associated with sexuality, gender, race and poverty and to locate HIV/AIDS related stigma and discrimination within a broader social, cultural, political and economic framework. It proposes a conceptual framework that defines S&D as social processes which are used to create and maintain social control and to produce and reproduce structural inequalities rather than as individual actions. It describes stigmatization as a process that involves identifying and using difference between groups of people to create and legitimize social hierarchies, and explains how stigma plays a key part in transforming difference into social inequalities.

Priority should be given to developing a legal and policy framework that protects the human rights of PLHA and those affected by the epidemic and that helps to mitigate the impact of HIV/AIDS related stigma and discrimination. There is need to develop advocacy models to address HIV/AIDS related stigma and discrimination, drawing on the experience of community mobilization, empowerment and social transformation. Empower marginalized groups, unleashing the power of resistance, greater involvement of people living with affected HIV/AIDS, to encourage positive perceptions of PLHA, complement ongoing efforts to change individual attitude towards PLHA and those affected by the epidemic through media campaigns promoting tolerance and compassion.

References: UNAIDS & Horizons editions.

*** The writer is the Executive Director, Centre for Peoples’ Concern

Courtesy: The Sangai Express