HIV and AIDS.docx notes for week 3.docx

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John Oesch

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 constructed  -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 workers  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 stigmatization.  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 useful.  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 stigmatized.  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 inequalities.  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
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