Understanding of the Experience of Health - Literature review Example

Stigma and Its Relevant To an Understanding of the Experience of Health Name: Registration number: Course Title: Code: Instructor: Date: 1.0 Introduction One area that discrimination is still rampant as result on individual’s health status is HIV/AIDS. This has persisted in covert and overt manner (Zhang et al., 2008, p. 131). Although actions have been taken in creating awareness through promotion of condom use, reduction of risky behaviours such as needle sharing by drug addicts, there is still a lot to be done to reduce the existing gap (Lyles et al., 2007, p. 133 and 139). One area for improvement is stigmatization of those living with HIV/ AIDS. Stigma can have serious impacts on the social and psychological well being of individuals. According to Karren and Sherman (2012, p.850), stigma is the act of seeing others as defective and having lesser value and thus, not according them the standard treatment. Surgevil and Akyol (2011, p.464) observes that the building block for stigmatization is embedded on prejudice and stereotypes. The resulting outcome associated with this behaviour is discrimination. In this regard the discrimination would be on the basis of HIV/ AIDS status of an individual. The aim of this paper is to explore what stigma is and why it is relevant to an understanding of the experience of health by utilising HIV/ AIDS as a case example. In this regard the health care experience being examined is the “discriminatory and exclusionary treatment” which influences the rights, welfare and acceptance of people living with HIV/ AIDS and health care disparity. 2.0 Stigma and Stigmatization Different works have tried to conceptualise and develop a framework on what stigma is. Mor-Barak (2005 cited in Surgevil and Akyol, 2011, p.464) indicates that diversity management isn’t limited to gender, race or ethnicity, but also to factors like health status. In addition, he notes that this is tied to myriad issues like stereotypes, prejudice, stigmatization and discrimination. Goffman (1963 cited in Karren and Sherman, 2012, p.849) indicates that stigma is “a mark that designates the individual as defective and deserving of less valued treatment than those who are not stigmatised”. In his conceptualisation, he identified three broad categories of stigma. The first is the tribal stigma associated with race and religion among others. The second is the abomination of the body which is associated with physical disabilities and deformities. The third is blemish of the character which is related to factors like mental illness and unemployment. In regard to this conceptualisation, the focus of the paper in relation to HIV/ AIDS will focus of the later two categories since HIV/ AIDS can result into deformities and it is equally related with blemish of character in most events. Wong and Wong (2006, p.97) brings in other parameters like discrediting of individuals by categorising them as less than fully human. However, the striking one in their definition is the view that discrimination is the “invisible sign of disapproval which permits the community, so-called insiders, to draw a line around ‘outsiders’ in order to isolate or exclude any group judged to deviate from accepted norms and morality”. Stigma can be understood from the perspective of diversity management which is about inclusivity of individuals at various levels irrespective of their background, status, colour, religion & gender and health status among others. In addressing diversity, issues such as discrimination and stigmatization comes into limelight. As already noted stigmatization is associated with negative perception, attitude, stereotype and prejudice among others. From the above discussion, stigma in regard to PLHIV can be understood from five perspectives. The first is the macro level which is the negative attitude/ failure of acceptance of those living with HIV/ AIDS at macro level. In this regard, the macro level is either at national level or at local community. This is critical since policies regarding diversity management in relation to health status are outlined at these levels. The second level of stigmatization is at the family level. This is equally critical since they are the care givers and those who are supposed to offer moral support to the patient. The third tier is the immediate friends. The fourth level is the work environment and work mates who if aware of the individual status might decide to discriminate. The last level is the health care workers. This is a critical group that are supposed to offer medical services to the patient. Wong and Wong (2011, p.96) indicates that these are the group of people who are called upon to offer monitoring activity in the interaction between people living with HIV/ AIDS, their family and the larger community. They postulate that their perception, attitude and behaviour towards PLHIVs have a direct bearing on the rights, welfare and acceptance of people living with HIV/ AIDS. Moreover, their attitude towards these people sets the precedence on how other players view these people by adopting non-discriminatory and anti-discriminatory behaviours. Apart from the above, Wong and Wong (2006, p.97) adds an interesting twist of perceived and enacted stigma by noting that “Perceived stigma refers to real or imagined fear of prejudice and potential discrimination arising from a particular undesirable attribute or disease, or association with a particular group. On the other hand, enacted stigma refers to the real experience of discrimination”. 3.0 Theoretical Models on Stigmatization One of the models that explain stigmatization is social identity theory. The theory posits that stigma is as a result of difference between virtual social identity or the ideal expectation and the actual social identity or what is identity that is perceived by the observer (Karren and Sherman, 2012, p.849). Categorizing and stereotyping forms the core ingredient of stigmatisation. Stereotyping and prejudice is related to negative individuals hold. Kahneman, Lovallo and Sibony (2011, p.51) observe that bias can distort reasoning of individuals. They note that confirmation bias that is as a result of our perception, for instance, leads people to ignore evidence that contradicts their preconceived notion. The two concepts forms the basis in which people simplify complex realities by allowing them to group different social and physical objects into various categories (Karren and Sherman, 2012, p,849 & 850). However, the reality is that belief held against a certain elements of the society might not be valid (p.850). The other model that can be used to explain stigmatization is the labelling theory/ social reaction theory. This construct posits that labelling is a construction based upon what society determines as deviant (Hall, 2007, p.11). In this case people who are HIV positive are deemed to be deviant since they had engaged in what society deemed as deviant for them to contract the diseases (Quah, 1998, p.3). To contextualise this discussion, Zeeleen et al., (2010, p.383) observes that in Sub-Sahara Africa most people are unaware of how the disease is transmitted and thus, those who have contracted it are deemed to have engaged in activities that contravene myths, natural forces and witchcraft. This leads to gossip and rumour and thus, the basis of stigmatization. 4.0 Stigmatization of People Living with HIV (PLHIV/ PLWHIV) Wong and Wong (2006, p.96) observes that the major stigma that is dreaded by the people living with HIV/ AIDS is the negative attitude towards them by other members of the immediate community. They note the following. “People living with HIV/AIDS (PHAs) become more afraid of stigma associated with or caused by the disease than of the disease itself”. The hallmark of this negative perspective is acceptance of those who have been diagnosed as HIV positive. In their definition, they conceptualise this phenomenon (HIV/ AIDS related stigma) as “a process of stigmatization and devaluation of PHAs which results into discriminatory and exclusionary treatment of individuals based on their real or perceived positive status”. Moreover, they note that stigma is multi layered experience since as an individual one might be facing other stigma associated with social deviant behaviours like drug abuse, being a sex worker and being homosexual. In addition, others stigma that an HIV patient might phase even before encountering HIV status are related to racial and religion issues (p.97). Zhang (2008, p. 131) notes that discrimination of those living with HIV is partly associated with the fact that the diseases is acquired through means such as homosexual behaviour, drug use and commercial sex which are disapproved or labelled by most society as deviant. Apart from this it is associated with the fact that it is un-curable diseases that leads to high mortality. Quah (1998, p.3) observes that the stigma directed towards people living with AIDS is based on “the perception of personal responsibility or blame for acquiring the disease”. The argument is that if one is responsible enough, he or she will take responsibility towards not acquiring the diseases, but if one is not responsible enough he or she will not put in the required measures. 5.0 Relevance of Stigma in Understanding Health Experiences The relevance of stigma understands health experience is greatly tied to the results of negative perception/ social rejection which are discriminatory and exclusionary treatment that dictates the rights, welfare and acceptance of people living with HIV/ AIDS (Wong and Wong, 2006) which consequently predetermines the health care disparity. The other relevance that will inform the discourse is that outlined by Zhang et al (2008, p.131). They note that stigmatization of people living with HIV/ AIDS impacts negatively on the quality and timing of testing, treatment and care of infected individuals, the social support the individuals receives, participation of infected individuals in seeking treatment & enrolling in prevention programmes and damages social interactions of PLWHA. In discussing the relevance of stigma in health experiences, the paper takes into consideration perceived stigma and enacted stigma (Wong and Wong, 2006, p.97). As an example, one of the health experiences associated with perceived stigma as result of fear of rejection and discrimination is non disclosure. According to Bingham et al., (2003), there is a higher rate of nondisclosure of one’s sexuality among the African Americans for fear of condemnation by the society especially for those men who have same gender relations. In the report, which included data from 1999 to 2000, 18% of African American men aged between 15 and 29 years were classified as “nondisclosures” while 13% and 8% Hispanic and Caucasian men respectively were classified in the same category. The non-gay identification and bisexual behavior could explain the health disparities in HIV prevalence rate (Cuellar et al., 2004, p.447, 448 and 449). However, for this to be achieved, sexuality of African American and Hispanic men should be understood in relation to non-disclosure behaviour. This kind of fear is driven by need for bodily perfection as outlined by functionalist and instrumentalist towards illness (Vickers, 1997, p.245). One of the major stigmatization issues abetting the spread of HIV/AIDS among the Hispanic and African American males is the condemnation of gay behaviour among this community. This makes the African American and Hispanic men who have sex with same gender relations shun away from disclosing their sexuality and HIV status due to stigmatization and homophobia. This prevents them from seeking medical attention and puts those not infected at risk (Peterson et al., 2004, p. 98, 99 &101). In addition, the frequency of HIV testing among the black MSM is lower as compared to that of Caucasians due to the stigma associated with being HIV positive. This means that most African American males are tested quite some time after being infected. The other issue in relation to disclosure is the religion factor. For instance, it noted that Bangladesh is one of the Asian countries with low prevalence of HIV/AIDS. This can be attributed to the culture and religion of the people in the area. Most of them strictly follow the Islamic culture which strongly advocates against fornication or extra-marital affairs. With such a belief, it is no wonder that the prevalence is low given that most of HIV infections emanate from engaging in sexual activity. The law of the country prohibits drug usage just like the religious beliefs. This helps in reducing infection rates from the use of inject able drugs. Such practices keep the prevalence low (Ruxrungtham, Brown and Phanuphak, 2004, p.3). This kind of doctrine has help in a double edged sword. The first is the reduction in HIV infection rate. On the other hand it has made it difficult for those with the disease to access medical services as they are seen in bad perspective (Ruxrungtham, Brown and Phanuphak, 2004, p.5). References Bingham, T. A. Harawa, N. T. Johnson, D. F et al. (2003). The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men’s Survey, Los Angeles, 1999-2000. Cuellar, I., Bastida, E. & Braccio, M. (2004). Residency in the United States, subjective well being, and depression in an older. Hall, A. (2007). Socio-economic theories of crime. Retrieved on 23 April, 2013 from: http://www.arichall.com/academic/papers/hs8373-paper.pdf. Kahneman, D., Lovallo, D. & Sibony, O. (2011). The Big Idea: ‘Before you make that big decision...’ Harvard Business Review Karren, R. & Sharman, K. (2012). Layoffs and unemployment discrimination: a new stigma. Journal of Managerial Psychology, 27 (8): 848-863. Lyles, C. M., Kay, L. S., Crepaz, N. et al. (2007). Best-evidence interventions: Findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2002- 2004. Am J Public Health. 97(1):133-143. Peterson, J. L., Malebranche, D. J., Fullilove, R. E. & Stackhouse, R. W. (2004). Race and sexual identity: Perceptions about medical culture and healthcare among black men who have sex with men. Journal of the National Medical Association, 96, 97-101. Quah, S. R. (1998). Ethnicity, HIV/AIDS prevention and public health education. International Journal of Sociology and Social Policy, 18 (7/8): 1-25. Ruxrungtham, K., Brown, T. & Phanuphak, P. (2004). HIV/AIDS in Asia. Lancet, Vol. 364, July 3, 2004. [Online]. Available at http://alumni.kit-ipp.org/drupal-6.14/sites/alumni.kit-ipp.org/files/HIV-AIDS%20in%20Asia.pdf [Accessed 23 April 2013]. Surgevil, O. & Akyol, E. M. (2011). Discrimination against people living with HIV/ AIDS in the workplace: Turkey context. Equality Diversity and Inclusion: An International Journal, 30 (6): 463-481. Vickers, M. H. (1997). Life at work with “invisible” chronic illness (ICI): the “unseen”, unspoken, unrecognised dilemma of disclosure. Journal of Work Place Learning, 9 (7): 240-252. Wong, V. & Wong, L. (2006). Management of stigma and disclosure of HIV/ AIDS status in health care setting. Journal of Health Organization and Management, 20 (2): 95-114. Zeeleen, J., Wijbenga, M., Vintges, M. & de Jong (2010). Beyond silence and rumour: story telling as an educational tool to reduce the stigma around HIV/ AIDS in South Africa. Health Education, 110 (5): 382-398. Zhang, L., Li, X., Mao, R., Stanton, B., Zhao, Q., Wang, B. & Mathur, R. (2008). Stigmatising attitudes towards people living with HIV/AIDS among college students in China: implications for HIV/ AIDS education prevention. Health Education, 108 (2): 130-144. Read More