The Relevance of Stigma in an Understanding of the Experience of Health - Case Study Example

Relevance of stigma in an understanding of the experience of health Student’s Name: Instructor’s Name: Tutor’s Name: Date of Submission: Stigma and why is it relevant to an understanding of the experience of health in relation to HIV/AIDS In modern times, the emergence of sophisticated transmissible diseases has complicated care giving and societal relationships. Information on ways diseases are transmitted has especially been the major driver of these complications. People are either unaware of how certain diseases are transmitted or have superficial “ideas/information” on transmission. Others have the full information but the inner fear distort the information they already have. This situation has led to stigmatization of the people infected with a certain disease, those suspected to be infected or those who take care of the infected persons. HIV/AIDS has been a leading cause of stigma across the world but mainly in the developing economies. In this discussion, stigma, its source and effects are defined through a theoretical overview with the aim of developing a basis for understanding why stigma is relevant to an understanding of the experience of health in modern times so as to create a stigma reducing platform in the society. Stigma is a common human reaction to disease. Throughout history many diseases have carried considerable stigma, such as leprosy, tuberculosis, cancer, mental illness, and many Sexually Transmitted Diseases. HIV/AIDS is the latest disease to be stigmatized (Jennie & John, 2012). HIV/AIDS stigma is a complex concept that refers to prejudice, discounting, discrediting and discrimination directed at persons alleged to have HIV/AIDS, as well as their partners, friends, families and communities while stigmatization is a dynamic process that arises from the perception that there has been an infringement of a set of shared attitudes, beliefs, and values; promiscuity, prostitution, homosexuality, bisexuality, and drug use. These can lead to injurious thoughts, behaviors, and/or actions on the part of governments, communities, employers, health care providers, coworkers, friends, and families (Zierler et al. 2000). HIV/AIDS stigma exists across the globe in a variety of ways, including isolation, denunciation, discrimination and avoidance of HIV infected people, subjection to HIV testing without prior approval, violence against HIV/AIDS infected individuals or those thought to be infected with HIV (Jennie & John, 2012). In most instances, stigma-related violence or the fear of violence puts off many people from seeking HIV testing, or securing treatment. This makes what could be a manageable chronic illness into death and perpetuating the spread of HIV. AIDS stigma is in three categories; instrumental AIDS stigma which is an expression of the fear and anxiety that are likely to be related with any deadly and infectious illness, symbolic AIDS stigma which is the use of HIV/AIDS to articulate attitudes toward the social groups or lifestyles professed to be related with the disease and courtesy AIDS stigma which is stigmatization of people associated to the issue of HIV-positive people. Therefore, sources of stigma may include fear of illness, fear of infection, and fear of death. Fear of illness and fear of infection is a common reaction among health workers, co-workers, and caregivers, as well as the general populace. Stigma is one means of dealing with the fear that contact with a member of an affected group (hugging, seating next to each other, sharing utensils with a PLHA) will result in contracting the disease (Meisenhelder and La Charite 1989). They are various effects of stigma as it will be discussed below. Stigma and discrimination relating to HIV/AIDS has been a leading constraint in public health efforts aimed at combating the epidemic (UNAIDS, 2000). HIV/AIDS stigma negatively affects preventive behaviors such as condom use, HIV test-seeking behavior, care-seeking behavior upon diagnosis, quality of care given to HIV-positive patients, and perception and treatment of People Living with HIV/AIDS (PLHA) by communities, families, and partners. In developed countries, AIDS and homosexuality or bisexuality are associated where this link is correlated with increased levels of sexual prejudice such as anti-homosexual/bisexual attitudes (Jennie & John, 2012). There is has also been increasing connection perceived between AIDS and all male-male sexual behavior. However, evidence shows that the dominant mode of HIV transmission globally for is heterosexual transmission. Surprisingly, AIDS stigma is also widespread in places where the epidemic is widespread and affecting many people, for instance sub-Saharan Africa. Therefore, if there is comprehension of the nature of HIV/AIDS transmission in the society that is by the common people, the affected, the infected and caregivers it would contribute to decreasing AIDS stigma, an essential step in curtailing the epidemic (Malcolm et al. 1998). They are various models that can be used to analyse and discuss stigma and stigmatization. The term stigma is historically physical back in the Greeks traditions who cut or burned marks into the skin of criminals, slaves, and traitors as a way of identification and distinction from the rest of the societal beings and to show that they were tainted or immoral people and should be avoided (Goffman, 1963). However, today stigma has transformed into a characteristic that results in extensive social condemnation or branding that results to discrediting social distinction that yields a ‘spoiled social identity’ (Goffman, 1963). The societal social concept on the discredit individuals is based on two fundamental issues, that is the recognition of difference and devaluation which mainly occurs in social interactions. Therefore, stigma is considered to dwell in the social context rather than an individual person (Goffman, 1994) thus what is stigmatizing in a given social situation may not be stigmatizing in another context. However, it is also considered that stigma can emerge from an individual through self-categorization as a basis of crisis of confidence in an individual. Therefore, two theories play significant roles in perpetrating stigma and stigmatization; social identity theory and self-categorization theory. These are highly influential theories of group processes and intergroup relations, which redefine how we think about numerous group-mediated phenomena. These two theories are closely related. Social identity theory has a strong focus on how the social context affects intergroup relations while self-categorization theory is the dilemma in which an individual faces as they seek to establish themselves in a group they fit through self evaluations (Malcolm, et al., 1998). Categorization in these key theories forms the basis of stigmatization in HIV/AIDS. Adoption of alienation and demeaning attitude by individuals in the society results in exclusion from the rest of the society. As a result, other societal members confirm that their notions were right even at instances where their suspicions are not correct. Therefore, individuals or their close relations faces humiliation and are often cut off from the rest of the society which eventually leads to stress, depression, health deterioration and ultimately to death of AIDS patients (Goldin, 1994). From social identity and self-categorization theories, it is evident that stigmatization occurs on societal, interpersonal, and individual levels. Pryor and Reeder (2011) expressed a conceptual model that sought to bring greater precision to the current but diverse foundations on stigma. In building on the previous theories (Herek, 2007), the model depicted four vigorously interconnected manifestations of stigma; public, self, stigma by association and structural stigma. In the model, public stigma is at the center of and represents people’s social and emotional reactions to an individual or a group they perceive to have a stigmatized condition. It is comprised of the cognitive, emotional, and behavioral reactions of those who stigmatize (perceivers). Self-stigma in the model reflects the social and emotional impact of possessing a stigma. The self portion includes both the anxiety of being exposed to stigmatization and the probable internalization of the negative beliefs and feelings linked with the stigmatized condition. Stigma by association is more similar to Goffman’s (1963) courtesy stigma and involves social and psychosomatic reactions to people related with a stigmatized person (mostly family and friends) as well as people’s responses to being linked with a stigmatized person. Structural stigma refers to the state of confirming and advancing the stigmatized status by society’s bodies and ideological systems (Pryor and Reeder, 2011). The four manifestations of stigma are interrelated. In HIV/AIDS, stigmatization of individuals or groups of people originates in the cognitive depiction that people, the perceivers, hold concerning those who have the stigmatized condition, the targets, which prompts negative emotional and behavioral reactions. Stigmatization establishment and continuity depends on onset controllability for the stigmatized condition, possibility of stoppage of the perception. The inability to stop the initial perceptions against the HIV/AIDS patients or those thought to be infected could result to anxiety and sympathy on the part of perceivers (Van Alphen et al., 2012). The occurrence of these emotions could result to expressive ambivalence and uncomfortable interactions (Dijker and Koomen, 2003) especially the “death” result perception fatality in HIV/AIDS patients. The fatality perception of HIV/AIDS may result to condemnation and isolation by the public and associated with deviation from the societal beliefs and norms (prostitution, promiscuity and drug abuse) that resulted to the condition. The developed perception by the public against the HIV/AIDS infected or affected persons has damaging effects on the psychological well-being of stigmatized persons. In realization of the public awareness or perception towards an individual, self-stigma can emerge. This eventually leads to self pity, self and public categorization and social devaluation of the individual. This trend leads to enacted stigma through negative treatment of an individual in a stigmatized condition, felt stigma as a result of experience or anticipation of stigmatization on the part of an individual, and through internalized stigma by reducing self-worth and accompanying emotional anguish which people with a stigmatized condition go through (Herek, 2007). Under self stigma in the developmental process in HIV/AIDS infected persons there exists the inner fear of being discovered and thus determined to remain normal and some instances the choice of who to reveal to about the persisting condition. HIV/AIDS stigma does not only affect those who possess a stigmatized condition it also impacts others. Those mostly affected are the family, friends and caregivers who are routinely devalued purely as a result of their relationship with someone with a stigmatized condition (Jennie & John, 2012). The development of stigma by association perception in HIV/AIDS has been found to be linked to lower self-esteem and psychosomatic distress in those related with stigmatized individuals. The likely impact on non-stigmatized people often influences them to try to hide their association with a stigmatized family member or at some instances encourage that member to hide his or her condition. Similar stigmatization may affect non-family members like friends, work mates or social group members. This may eventually lead to breaking up of those relations by the stigmatized individual or the non-stigmatized individuals in a quest to save themselves from ridicule or for protection of their associates (Mak and Kwok, 2010). In conclusion, the emergence of “ultimate death” perceived transmissible diseases has accelerated health related stigma and has eventually complicated care giving and societal relationships. The relevance of stigma in understanding health experiences is seen through the societal relationships that emerge from perceived HIV/AIDS condition against an individual or a group which affect their self esteem and welfare in the society. HIV/AIDS stigma negatively affects counter measures of HIV/AIDS spread behaviors such as HIV test-seeking behavior, care-seeking behavior upon diagnosis, quality of care given to HIV-positive patients, condom use, and perception and treatment of People Living with HIV/AIDS (PLHA) by communities, families, and partners. In most instances, AIDS stigma results in violence or the fear of violence which puts off many people from seeking HIV testing, or securing treatment. This makes what could be a manageable chronic illness into death and perpetuating the spread of HIV. HIV/AIDS stigma against the infected person’s influences development of anger against other societal beings resulting to “revenge” attitude against the society through HIV spread by the infected individuals. Ilic et al. (2013) focuses on the experience of stigma and illustrate the development of the Multifaceted Stigma Experiences Scale (MSES). They explain that the experience of both slight and blatant forms of stigma hampers recovery in people with a mental illness stigma. On the other hand, Herek (2007) assess the impact of felt stigma and self-stigma on emotional well-being of people infected with HIV. In this case Herek (2007) emphasize the significance of identifying the potentially negative effects of self-stigma and felt stigma when providing mental health care to people with HIV. Pinel and Bosson (2013) hypothesize that felt stigma presumes a sense of stigma perception, which is a state of self-consciousness in which people with a stigmatized condition sense slight or overt negative treatment by others; persons with high stigma perception perceive more discrimination than those low in stigma perception. Therefore, understanding of both shared and unique stigma mechanisms stigma in health experiences is crucial in developing mitigating advances in reducing HIV/AIDS stigma. A effective reduction plan can only be arrived at by understanding how stigma develop and generate psychological and physical health disparities, and investigate when and to what degree conceal ability restrains stigma effects. 6.0 References Dijker, A.J., and Koomen, W. (2003). Extending Weiner’s attribution-emotion model of stigmatization of ill persons. Basic and Applied Social Psychology, vol.25, p.51–68. Goffman, E. (1963). Stigma. Notes on the Management of Spoiled Identity. New York: Simon and Shuster, Inc. Goldin, C.S. (1994). “Stigmatization and AIDS: Critical issues in public health,” Social Science and Medicine vol.39, no.9, p.1359-1366. Herek, G. M. (2007). Confronting Sexual Stigma and Prejudice: Theory and Practice. Journal of Social Issues, vol.63, p.905-925. Ilic, M., Reinecke, J., Bohner, G., Rottgers, H., Beblo, T., Driessen, M., Frommberger, U., and Corrigan, P.W. (2013). Belittled, avoided, ignored, denied: Assessing forms and consequences of stigma experiences of people with mental illness. Basic and Applied Social Psychology. Jennie, M. & John, G. (2012). Second Opinion: An introduction to Health Sociology. Oxford: Oxford University Press. Malcolm, A. et al. (1998). HIV-related stigmatization and discrimination: Its forms and contexts, Critical Public Health vol. 8, no. 4, p.347-370. Meisenhelder, J.B. and La Charite, C.L. (1989). “Fear and contagion: A stress response to AIDS,”Advanced Nursing Science, vol. 11, no. 2, p. 29-38. Pinel, E. C., and Bosson, J. K. (2013). Turning our attention to stigma: An objective self-awareness analysis of stigma and its consequences. Basic and Applied Social Psychology. Pryor, J. B., and Reeder, G. D. (2011). HIV-related stigma. In J.C. Hall, B.J. Hall & C.J. Cockerell (Eds.), HIV/AIDS in the Post-HAART Era: manifestations, treatment, and Epidemiology (pp. 790-806). Shelton, CT: PMPH-USA, Ltd. UNAIDS. (2000). HIV and AIDS-related stigmatization, discrimination and denial: forms, contexts and determinants. UNAIDS Best Practice Collection. UNAIDS/00.16E. Van Alphen, L.M., Dijker, A.J.M., Bos, A.E.R., Van den Borne, B. and Curfs, L. (2012). The influence of group size and stigma severity on social acceptance: The case of people with intellectual disability moving into neighborhoods. Journal of Community & Applied Social Psychology, vol. 22, p. 38-50. Zierler, S. et al. (2000). “Violence victimization after HIV infection in a US probability sample of adultpatients in primary care,” American Journal of Public Health vol.90, no.2: p.208-215. Read More

Therefore, sources of stigma may include fear of illness, fear of infection, and fear of death. Fear of illness and fear of infection is a common reaction among health workers, co-workers, and caregivers, as well as the general populace. Stigma is one means of dealing with the fear that contact with a member of an affected group (hugging, seating next to each other, sharing utensils with a PLHA) will result in contracting the disease (Meisenhelder and La Charite 1989). They are various effects of stigma as it will be discussed below.

Stigma and discrimination relating to HIV/AIDS has been a leading constraint in public health efforts aimed at combating the epidemic (UNAIDS, 2000). HIV/AIDS stigma negatively affects preventive behaviors such as condom use, HIV test-seeking behavior, care-seeking behavior upon diagnosis, quality of care given to HIV-positive patients, and perception and treatment of People Living with HIV/AIDS (PLHA) by communities, families, and partners. In developed countries, AIDS and homosexuality or bisexuality are associated where this link is correlated with increased levels of sexual prejudice such as anti-homosexual/bisexual attitudes (Jennie & John, 2012).

There is has also been increasing connection perceived between AIDS and all male-male sexual behavior. However, evidence shows that the dominant mode of HIV transmission globally for is heterosexual transmission. Surprisingly, AIDS stigma is also widespread in places where the epidemic is widespread and affecting many people, for instance sub-Saharan Africa. Therefore, if there is comprehension of the nature of HIV/AIDS transmission in the society that is by the common people, the affected, the infected and caregivers it would contribute to decreasing AIDS stigma, an essential step in curtailing the epidemic (Malcolm et al. 1998). They are various models that can be used to analyse and discuss stigma and stigmatization.

The term stigma is historically physical back in the Greeks traditions who cut or burned marks into the skin of criminals, slaves, and traitors as a way of identification and distinction from the rest of the societal beings and to show that they were tainted or immoral people and should be avoided (Goffman, 1963). However, today stigma has transformed into a characteristic that results in extensive social condemnation or branding that results to discrediting social distinction that yields a ‘spoiled social identity’ (Goffman, 1963).

The societal social concept on the discredit individuals is based on two fundamental issues, that is the recognition of difference and devaluation which mainly occurs in social interactions. Therefore, stigma is considered to dwell in the social context rather than an individual person (Goffman, 1994) thus what is stigmatizing in a given social situation may not be stigmatizing in another context. However, it is also considered that stigma can emerge from an individual through self-categorization as a basis of crisis of confidence in an individual.

Therefore, two theories play significant roles in perpetrating stigma and stigmatization; social identity theory and self-categorization theory. These are highly influential theories of group processes and intergroup relations, which redefine how we think about numerous group-mediated phenomena. These two theories are closely related. Social identity theory has a strong focus on how the social context affects intergroup relations while self-categorization theory is the dilemma in which an individual faces as they seek to establish themselves in a group they fit through self evaluations (Malcolm, et al., 1998). Categorization in these key theories forms the basis of stigmatization in HIV/AIDS.

Adoption of alienation and demeaning attitude by individuals in the society results in exclusion from the rest of the society. As a result, other societal members confirm that their notions were right even at instances where their suspicions are not correct. Therefore, individuals or their close relations faces humiliation and are often cut off from the rest of the society which eventually leads to stress, depression, health deterioration and ultimately to death of AIDS patients (Goldin, 1994).

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