PUBLIC HEALTH DISSERTATION

Public Health Dissertation

Analysis Section

Three social attitudes which appear regularly in the AIDS literature are stigmatization, discrimination (labelling, social distancing), and fear. AIDS has been characterized not only as an epidemic, but as a plague laden with multidimensional social and metaphoric meanings, all of them negative. A great deal of the literature has examined the sociocultural dimensions of the syndrome through the examination of the process of social labelling, the social construction of epidemics and the metaphorical meanings of disease. These studies point out the health policy problems involved in the emergence of the 'third epidemic' of AIDS; i.e. the diffusion of discrimination, ostracism and civil rights (Agrafiotis, 1990), where it represents less of an epidemic in statistical terms than in social ones, hence the reference to AIDS as an 'epidemic of stigma'.

The initial characterization of AIDS as a result of clandestine, immoral and antisocial behaviour, and the labelling of 'high-risk' groups on this basis, laid the groundwork for a 'full-blown' social epidemic of stigma. Scholars examining the phenomenon refer to pre-AIDS observers of human behaviour, finding that the phrases 'spoiled identity' and 'fatally flawed' suit the characterization of the psychosocial position of people with AIDS (Agrafiotis, 1990). Thus, these people are multiply stigmatized; their stigma is layered on pre-existing ones (e.g. homosexuality, promiscuity) along with issues of fear of contagion, physical deterioration, loss of control, and death (social, followed by somatic). Compared to the stigmatization in cases where individuals are not held responsible for their condition, persons with AIDS as judged as responsible for their stigma. Thus, they elicit blame, anger, and the withholding of help and sympathy from others. The 'threat' of AIDS, in both its biomedical and metaphorical sense, is most often managed by rejecting people identified as HIV-positive, who are often not yet 'sick'--they do not have a 'full-blown' case but have been labelled as HIV-positive. From that moment on, they are treated as if sick and experience a social death, often even before clinical signs have begun to appear (Ministry of Health and Welfare and Social Security, 1994). It is no longer only people with HIV who are the target of discourse about AIDS, but also those who are perceived as being 'at risk' due to stereotypic representations of people with HIV (see appendix B). This perception of risk is not an objective reality, but a sociocultural one, reflecting beliefs about values, nature, social institutions, and moral behaviour (Ministry of Health and Welfare and Social Security, 1994).

The ideology of stigmatization inevitably results in actions of discrimination. A stigma is a mark which elicits shame, an attribute which is deeply discrediting: '... including abominations of the body ... blemishes of individual character inferred from a known record of, for example, mental disorder, imprisonment, addiction ... and tribal stigma of race, nation, and religion ...' By its nature, a stigma is a flaw which allows for its bearer to be treated in a dehumanized way. While a stigma cannot be removed (Frankenberg, 1991), behaviour towards marked persons ...