HIV and AIDS-related stigma and discrimination:
a conceptual framework and implications for action
Jonathan Man disgusted between 3 phases of the Aids epidemic in any community.
1. epidemic of HIV- an epidemic that typically enters every community silently and unnoticed, and often
develops over many years without being widely perceived or understood.
2.epidemic of AIDS itself- the syndrome of infectious diseases that can occur because of HIV infection,
but typically only after a delay of number of years
3. describe to be most explosive- the epidemic of social, cultural, economic and political responses to
AIDS. --> high levels of stigma, discrimination and at times collective denial that to Man words " are as
central to the global AIDS challenge as the disease itself
Peter Piot describes as the continuing challenge.
top of his list of the five most pressing items of this agenda for the world community was the need for a
renewed effort to combat stigma
he went on to emphasize this calls for an all out effort by leaders and by each of us personally.
stigma removes what still stands as a roadblock to concerted action weather at local community, national
or global level
our collective inability to more adequately confront stigmatization, discrimination and denial in relation to
HIV and AIDS is linked to the relatively limited theoretical and methodological tools avaible to us
-important to critically evaluate the aviable literature on the study of stigma and discrimination, both
independent of HIV/AIDS and more specifically in relation to it in order to develop a more adequate
conceptual framework for thinking about the nature of these processes for analyzing the ways in which
they work in relation to HIV and AIDS and for pointing to possible interventions that might minimize
their impact and their prejudicial effects in relation to the epidemic
Stigmatization and discrimination as social process
while it is important to recognize that stigma and discrimination are characterized by cross-cultural
diversity and complexity, one of the major factors limiting our understanding of the phenomena may well
be less their inherent complexity than the relative simplicity of existing conceptual frameworks
-Goffman said Stigma - an attribute that is significantly discrediting which the eye of society serves to
reduce the person who possesses it.
Goffman argued that the stigmatized individual is thus seen to be a person who [possesses " an undesirable
difference". He argued that stigma is conceptualized by society on the basis of what constitutes difference
or deviance and that it is applied by society through rules and sanctions resulting in what he described as
a kind of spoiled identity for the person concerned
-emphasis placed by Goffman on stigma as a discrediting attribute has led to focus on stigma as though it
were a kind of thing- a relatively static chacterestic or feature, albeit one that is at some level culturally
-the emphasis Goffmans work gave to possessing an underdesirble difference which leads to a spoiled
identity in turn has encourage highly individualized analyses unmediated fashion
stigma understood as a negative attribute, is mapped onto people who in turn by virtue of their difference
are understood to be negatively valued in society
one of Goffmans work might suggest that as a formal concept, stimgmiazation devalues relationships
rather than being a fixed attributed social process has seriously limited the ways in which stigmaztion and discrimination have been
approached in relation to HIV and AIDS
the literate of stigma has grown rapidly
the concept of stigma has been applied to an exceptionally wide range of different circumstances
largest % of this radily expanding literature has come form social psychologist who have used social
cognitive approaches in ordr to examine the ways in which individuals construct categories and
incorporate these categories in stereotypical beliefs
the definition of stigma has been vague and highly variable
when definitions are offered they have been relatively limited
as in the broader literature on stigma much work on HIV and AIDs related stigmatization has tended to
understand stigma in highly emotional terms
other research has focused on stigmatizing attitudes and the extent to which such attitudes are correlated
with misunderstandings and misinformation concerning the modes of HIC transmission or the rish of
infection through everyday social contact or negative attitudes toward the groups that are believed to be
disproportionately affected by the epidemic such as gay and bisexual men, injecting drug users or sex
correct as opposed to incorrect beliefs thus become the defining cause of stigmatization in relation to
people living with HIV and AIDS as well as those perceived to be associated with the epidemic in a
variety of different ways
This basic approach to conceptualizing and investi- gating stigma in relation to HIV and AIDS has had
important consequences, in turn, for the primary forms of intervening in response to stigma and
The vast majority of the interventions that have been developed and evaluated in the research literature in
order to respond to stigma related to HIV and AIDS have been aimed at increasing ‘tolerance’ of people
with AIDS on the part of different segments of the ‘general population’.
Strategies have been developed to ‘increase empathy and altruism’ and to ‘reduce anxiety and fear’
primarily by providing what is perceived to be correct information and by developing psychological skills
thought to be essential to more effective manage- ment of the emotional responses that are thought to be
unleashed by HIV and AIDS as encountered by these different population groups
Interestingly, while references to stigma and stigma- tization in work on HIV and AIDS typically
acknowl- edge Goffman and his work as intellectual precursors, discussions of discrimination are rarely
framed in relation to any theoretical tradition whatsoever (even when discussed,as is often the case,in
tandem with the discussion of stigma)
Discrimination-- As the Oxford Dictionary of Sociology stipulates, however, ‘[t]his concept—which in
common usage means simply ‘‘treating unfairly’’—occurs most commonly in sociology in the context of
theories of ethnic and race relations.
rarely sociologists viewed discrimination as an expression of ethnocentrism—in other words a cultural
phenomenon of ‘‘dislike of the unlike’’’
This sociological emphasis on the structural dimen- sions of discrimination is particularly useful in
helping us think more sensibly about HIV and AIDS-related stigmatization and discrimination To move beyond the limitations of current thinking in this area, we need to reframe our understandings of
stigmatization and discrimination to conceptualize them as social processes that can only be understood in
relation to broader notions of power and domination.
stigma plays a key role in producing and reproducing relations of power and control. It causes some
groups to be devalued and others to feel that they are superior in some way.
stigma is linked to the workings of social inequality and to properly understand issues of stigmatization
and discrimination, whether in relation to HIV and AIDS or any other issue, requires us to think more
broadly about how some individuals and groups come to be socially excluded, and about the forces that
create and reinforce exclusion in different settings.
stigma arises and stigmatization takes shape in specific contexts of culture and power.
Culture, power and difference
this regime, physical violence or coercion increasingly gave way to what he described as
‘subjectification’, or social control exercised not through physical force, but through the production of
conform- ing subjects and docile bodies. Michel Foucault highlighted how the social production of
difference (what Goffman and the US sociological tradition more typically defined as deviance) is linked
to established regimes of knowledge and power. The so-called unnatural is necessary for the definition of
the natural, the abnormal is necessary for the definition of normality, and so on.
Foucault’s work more clearly emphasizes the cultural production of difference in the service of power.
While Goffman’s work on stigma hardly even mentions the notion of power, and Foucault’s work on
power seems altogether unconcerned with stigma in and of itself, when read together their two bodies of
work offer a compelling case for the role of culturally constituted stigmatization (i.e., the production of
negatively valued difference) as central to the establishment and maintenance of the social order.
Within such a framework, the construction of stigma (or, more simply, stigmatization) involves the
marking of significant differences between categories of people, and through such marking, their insertion
in systems or structures of power
stigma and stigmatization function, quite literally, at the point of intersection between culture,
power and difference—and it is only by exploring the relationships between these different
categories that it becomes possible to understand stigma and stigmati- zation not merely as an
isolated phenomenon, or expressions of individual attitudes or of cultural values, but as central to
the constitution of the social order.
The strategic deployment of stigma
symbolic violence (asso- ciated, in particular, with the sociological work of Pierre Bourdieu) and
hegemony (initially elaborated in Antonio Gramsci’s political theory, but more recently employed
usefully in cultural analysis by writers such as Raymond Williams, Stuart Hall and others) are particularly
They highlight not only the functions of stigmatization in relation to the establishment of social order and
control, but also the disabling effects of stigmatization on the minds and bodies of those who are
It aimed to examine how social systems of hierarchy and domination persist and reproduce them- selves
over time, without generating strong resistance from those who are subject to domination and,indeed,
often without conscious recognition by their members. For Bourdieu, all cultural meanings and practices embody interests and function to enhance social
distinctions among individuals, groups and institutions.
Power therefore stands at the heart of social life and is used to legitimize inequalities of status within the
social structure. Cultural socialization thereby places indivi- duals as well as groups in positions of
competition for status and valued resources, and helps to explain how social actors struggle and pursue
strategies aimed at achieving their specific interests.
‘Symbolic violence’ describes the process whereby symbolic systems (words, images and practices)
promote the interests of dominant groups as well as distinctions and hierarchies of ranking between them,
while legit- imating that ranking by convincing the dominated to accept existing hierarchies through
processes of hege- mony.
While ‘rule’ is based on direct coercion, ‘hegemony’ is achieved via a complex interlocking of political,
social and cultural forces which organize dominant meanings and values across the social field in order to
legitimize the structures of social inequality, even to those who are the objects of domination
With respect to stigmatization and discrimination, such insights are important for several reasons.
First, if as Bourdieu argues, all cultural meanings and practices embody interests and signal social
distinctions among individuals, groups and institutions, then few meanings and practices do so as clearly
and as profoundly as stigma, stigmatization and discrimina- tion. Stigma and discrimination therefore
operate not merely in relation to difference , but even more clearly in relation to social and structural
stigmatization does not simply happen in some abstract manner. On the contrary, it is part of complex
struggles for power that lie at the heart of social life. Put even more concretely, stigma is deployed by
concrete and identifiable social actors seeking to legitimize their own dominant status within existing
structures of social inequality.
To untie the threads of s