Although stigma and its
relationship to health and disease is not a new phenomenon, it has not been a
major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the
epidemic placed stigma on the public agenda and drew attention to its
complexity as a phenomenon and concept worthy of further investigation. Despite
the consensus that stigma is one of the major contributors to the rapid spread
of HIV and
the frequent use of the term in the media and among people in the street, the
exact meaning of 'stigma' remains ambiguous. The aim of this paper is to
briefly re-visit some of the scholarly deliberations and further interrogate
their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a
model is presented. Its usefulness - or explanatory potential - is that it
attempts to provide a comprehensive framework that offers insights into the individual
as well as the social/structural components of HIV-related stigma in a particular context. As such, it has the
potential to provide more nuanced understandings as well as to alert us to
knowledge-gaps in the process.
...Given the negative effects of the ‘third epidemic’,
scientists and activists have put a vast amount of effort into reducing its
impact and educating the public that ‘stigma’ and discrimination are socially
objectionable (Sengupta, Banks, Jonas, Miles & Smith 2011;
Steinberg 2008).
Anti-discriminatory legislation was put in place to protect the rights of PLWHA
and ‘anti-stigma’ educational campaigns mounted – putting ‘stigma’ as a concept
on the public agenda. The educational initiatives introduced ‘stigma’ into the
public's discourse and emphasised its offensiveness and undesirability. The end
result today is that most people are aware of the negative attributes of the
concept and its social unacceptability, and therefore – I would venture to
suggest – there has been a reported decrease in ‘stigma’, particularly as
evidenced by results from nationwide surveys (Shisana, Rehle, Simbayi, Zuma,
Jooste, Pillay-van-Wyk, et al. 2009).
However, as pointed out in this article, the reality on the ground is that
despite the introduction of ART, stigma continues unabated, and is often
disguised in different, more elusive forms (Abrahams & Jewkes 2012;
Naidoo, Uys, Greeff, Holzemer, Makoae, Dlamini, et al. 2007).
Further evidence to substantiate the on-going existence of stigma is provided
in the latest Gap Report (UNAIDS 2014).
There is no dispute that growing awareness that it is
unacceptable to discriminate against people with HIV is an important step
forward, but it is not quite the same thing as a real reduction in stigmatising
attitudes and behaviours. For these reasons, 12 years later I concur with Stein
(2003),
who argued that HIV stigma has not in fact diminished but has, rather, become
another ‘dirty secret’. This further problematises its ‘measurement’ and raises
the question about ‘how to measure a hidden truth?’...
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By:
- 1 PhD, is Emeritus Professor of Health Sociology at the Department of Sociology , University of the Witwatersrand , Johannesburg , South Africa.
- SAHARA J. 2016 Dec;13(1):8-16. doi: 10.1080/17290376.2015.1130644.
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