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lecture notes

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Robb Travers

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Stigma is increasingly emerging as a social determinant of health
One of the challenges is that we don`t really know how to define stigma
Sociological definitions take into account the active way in which stigma keeps its power
to better understand stigma (as a sociological construct)
Considerable body of evidence shows that stigma causes people with HIV to become sick much more
to explore the debilitating impact of stigma on people living with HIV or those at risk
challenges assumptions and expectations about how you thought life would unfold
Diagnosis of any kind of illness jars life from its stable foundation
Prior to 1996, people prepared to die when they had HIV -spending lots of money, going
travelling, maxing their credit cards, taking loans out on their houses
Post 1996, people had to shift from preparing to die to preparing to live -lots of interesting
things happened for people back then
Bury (1982) calls this illness-related process, 'biographical disruption[X
being told that one is HIV-positive
ZZ]Pv}]}(]vP,/s-positive opens a new and difficult journey of restabilizing a life jarred from its
Lots of research of people with physical disabilities -how people look at them, stare at them,
dismiss them when they're speaking -you can't experience stigma in isolation of the social
ZAn attributeZ]oÇ]]]vPÁ]Z]v]µo}]o]v]}v[
His explanation of stigma focuses on the public[s attitude toward a person who possesses an attribute
ZThe person with the attribute is Zreduced in our minds from a whole and usual person to a tainted,
In his landmark book Stigma: Notes on the Management of Spoiled Identity (1963), Goffman described
stigma as:
SLIM disease is a way that acknowledges that there is a stigma attached to it (In Africa)
Abominations of the bodyvvarious physical deformities.
In every society on earth, pointing a finger means the same thing -also crying, smiling, etc.
Blemishes of individual charactervweak will, domineering or unnatural passions, treacherous and rigid
beliefs, or dishonesty. Blemishes of character are inferred from, for example, mental disorder,
imprisonment, addiction, alcoholism, homosexuality, unemployment, suicidal attempts, or radical political
behaviour, bipolar disorder, depression.
i.e. being a Jehovah's witness
Tribal stigma of race, nation, and religionvbeliefs that are transmitted through lineages and equally
contaminate all members of a family
Goffman further explained that stigma falls into three categories:
the person with the disease is seen as responsible for having the illness
Something about diseases that mark the body in some way that stigmatizes people -even cancer
the disease is progressive and incurable
i.e. HIV
the disease is not well understood among the public
the symptoms cannot be concealed.
According to Goffman and other researchers, diseases associated with the highest degree of stigma share
common attributes:
ZStigma exists when elements of labeling, stereotyping, separation, status loss, and discrimination
occur together ]v}Á]µ]}vZoo}ÁZuX[
Link and Phelan (2001) maintain that stigma occurs when there is a convergence of interrelated components (a
social process, not merely sociological):
Jonathan Mann, Founding Director, World Health Organization's Global AIDS Programme distinguished between
three phases of the AIDS epidemic in any community:
Stigma and HIV
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epidemic of HIV infection (would be the first thing in any epidemic)
epidemic of AIDS cases (particularly in a society if there isn't drugs to treat HIV)
Jonathan Mann (1947 t1998)
epidemic of stigma (no society on earth where there hasn't been a massive backlash of stigma)
Herek developed scales to measure AIDS related stigma
AIDS-related stigma tprejudice, discounting, discrediting, and discrimination directed at people perceived to have
HIV/AIDS and the individuals, groups and communities with which they are associated. (Herek, 2002, p.1102).
is universal (always whispering about it, no society is welcome to HIV with open arms)
One exception: in many sub-saharan African countries, it is in heterosexual people but
was blamed on homosexual western men
(e.g., existing prejudices, it always attaches itself to the local epidemiology)
is shaped in each society by unique factors (AIDS stigma here is connected to homophobia in
Thailand -Thailand was viewed as a sex trade state) also, in Russia, there is a huge outbreak of heroin
use -this can be seen in any society which goes from communism to democracy
a consistent pattern tstigma is typically targeted at unpopular groups
fired from jobs
denied housing
evicted from their homes
denied services
People have reported being:
affects already stigmatized groups
acquired in stigmatized ways
is terminal and wasting
In a similar article, Herek said that AIDS is different than any other disease because it:
overlaid with other forms of discrimination
usually includes attributions of blame and responsibility
AIDS related stigma:
2002 t23%
Sometimes power relations based on stigma are very intense
2006 t20%
in a 1992 survey of 1,800 PHAs, 21% reported they had experienced violence in their communities because
of their HIV status
AIDS-related stigma:
Gay students in high schools have the highest rate of suicide/attempted suicide/discrimination
The concept of stigma is comprised of both enacted stigma(or the experience of stigma), such as discrimination
and rejection, and felt stigma, which are the feelings of shame and fear of enacted stigma that are associated
with having HIV/AIDS.
The people who internalize these responses tend to get sick more quickly
Clear health links between enacted stigma and adverse effects on people with HIV
Because of the word prejudiced, the campaign "Are you HIV prejudiced?" was very successful with a high
retention rate
Fife and Wright distinguish between experiences of illness-related rejection on the one hand and internalized
responses to illness stigmaon the other, which appears to be important as the different elements of stigma may
exert different effects.
Practical component to HIV -you can protect yourself from it by stigmatizing other
related to perceived communicability and lethality of HIV
reflects fear and apprehension associated with any transmissible illness
fear of AIDS as an illness and a desire to protect oneself from it
Instrumental stigma
results from the social meanings attached to AIDS
it represents the use of the disease as a vehicle for expressing a variety of attitudes
towards groups
Winston Husbands is a well known AIDS researcher in Toronto from Trinidad
who argues that AIDS gave already prejudiced people a convenient hook to
hang their hanger on -people most likely to stigmatize are also the most
ZHusbands Syndrome[
People who score the highest on tests of stigma of HIV also score the highest on
stigma of gay people, religious groups, etc.
symbolic associations between AIDS and the groups associated with it.
Symbolic stigma
three underlying aspects to AIDS-related stigma (Snyder, 1999, based on Goffman, 1963).
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