The Effects of Stigma on Controlling Hiv and Aids Essay

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The Effects of Stigma on Controlling Hiv and Aids

This essay aims to explain the social ideologies of prejudice and stigmatisation towards individuals infected with HIV/AIDS. It will discuss the issues surrounding the control of the HIV/AIDS disease and examine differential theories to explain the implementations of social discources on those who fear stigmatisation, due to their condition. HIV-related stigma and discrimination refers to prejudice, negative attitudes, abuse, ‘people and objects associated with it’ (Walker, L. 2007:79). Due to the effects of stigmatisation individuals carrying HIV/AIDS can be ostracised by family and the surrounding community. Stigmatisation towards HIV can be perceived to cause individual psychological damage. This can be seen to negatively affect the success of public health education towards the issues of HIV, and the acknowledgement of acceptance of individual sufferers within society. This causes a negative effect on the control and treatment of HIV.

AIDS stigma and discrimination exist worldwide, although they are differently persecuted across countries, communities, religious groups and individuals, ‘the social, cultural, economic and political reaction to AIDS is as central to the global challenges of AIDS itself (Mann 1987 cited in Walker, L. 2007: 80). Community level stigma and discrimination towards people living with HIV/AIDS is found all over the world. A community’s reaction to somebody living with HIV/AIDS can have a profound effect on that person’s life. If the reaction is hostile a person may be ostracised and discriminated against and may even be forced to leave their home, or have to change their daily activities such as work or socialising to prevent degradation. Parker and Aggleton (2003) describe that HIV/AIDS stigma exacerbates pre- existing social divisions by stereotyping and blaming marginalised groups as being responsible for the spread of disease.

An example of this can relate to African, ethnic minorities or gay men. This can be seen as pre-existing societal out groups. Thus meaning, stigmatisation can be identified to fall upon those groups who can be defined to not be the majority or the normal within society. Deacon et al (2005 cited in Walker, L. 2007:84) explains that ‘African immigrants that move to the UK are frequently blamed for the increase’ in the un-controllability of disease transmission, and have been deemed to be the sole cause of HIV/AIDS illness. This was often associated to the view that, ‘in Africa, the most prevalent diseases are those which may be characterized as diseases of poverty’ ( Kibirige, J. 1997: 4). In some societies stigma can be seen as, Parker and Aggleton (2003 cited in Walker, L. 2007: 81) suggests, to ‘always lead to discrimination which has the effect of reproducing relations of social inequality that are advantageous to the dominant class, thus maintaining the status quo’.

This can be related to Gramsci’s (1937) theory of hegemony, by producing, reproducing and maintaining social inequality. In this example those infected with HIV/AIDS, will result in a ‘springboard for activism’ (Deacon et al., 2005:18 cited in Walker, L. 2007:81). It can be seen to be a positive response as minorities will challenge governing bodies to deal with the social discrimination and inequalities attributed to HIV/AIDS, therefore attempting to balance the status quo and bring light on the associated issues surrounding HIV/AIDS stigmatisation in terms of the controllability of the disease. This effect can be described by what Deacon (2005) states a ‘catalyst for change and social justice’. Pierret, J. and Carricaburu, D (1995; 16 ) research found that individuals felt the need to challenge society’s preconceptions of HIV/AIDS and one of their interviewees states “I want to advance an idea.

I believe there are ideas we have to get across to people, messages that are not always easy but that can make things change. I don’t want to accept the idea that being sick means or amounts to something shameful.” The activism of social health control works but is flawed due to many other factors. For the explanation of HIV related stigma in association to individual and social levels of understanding. Joffe (1999 cited in Walker, L. 2007:81), argues that ‘peoples responses to danger in the case of HIV/AIDS, draw on universal defence mechanisms called ‘splitting’ and ‘projection’ – separating good from bad, and rejecting the bad by projecting it onto the other’. This helps individuals in society to deal with ‘outsider’ (Goffman 1963) groups by creating a controlled distance and security from risk. It gives individuals within society, an emotional safeguarding as a defence mechanism by stigmatising those with HIV/AIDS. Joffe (1999 cited in Walker, L. 2007:81), also argues that this emotional response to HIV/AIDS ‘is not even a conscious process’.

This can also explain why it is very difficult to educate society away from the preconceptual ideologies of discriminatory feelings towards HIV related illness. In both these instances it can be derived that conscious and unconscious stigmatisation, cause a clear barrier from society and those infected with HIV related illness. This barrier causes many different obstacles for individuals suffering from HIV/AIDS to come to terms with, psychologically with their illness on a personal level but also trying to combat persecution when trying to gain health care for their illness. The discriminatory perception from society doesn’t help with the controllability of the disease as those infected fear discrimination and do not seek medical attention. Deacon et al (2005: 31 cited in Walker, L. 2007) critiques that stigmatisation is bad and explains that stigmatisation can be positive, ‘stigmatisation is an individual reaction to perceived or real danger that draws on shared social representations of deviance to distance people from risk’.

This statement can be related to the perception of illicit activities for example drug use, ‘where there does exist a clear casual relationship in the route of drug administration and HIV infection. The shared use of injection equipment or drug paraphernalia by a HIV positive person can result in micro- injections of serum infected with live virus’ (Hart, G. and Carter, S. 2000 cited in Williams. S. Et al 2000: 238). In this instance it can be seen that society are consciously segregating themselves from deviant communities to control the spread of HIV/AIDS, critiquing Joffe’s (1999) theory of unconscious stigmatisation whereby society are unwittingly segregating themselves away in the effort of disease control. By ostracising these ‘outsider’ (Goffman 1963) groups it can be seen to be creating a clear division that both parties experience. Those who are HIV carriers or are not sure if they do have the illness, but recognise their labelled identity and fear further stigmatisation by going to access health tests and treatment, and as explained before further the risk of transmitting the HIV/AIDS illness.

The use of injecting drugs is ‘not only a significant route of HIV infection in its own right but, as many drug users are also sexually active, this can be an important path by which HIV can be passed to non drug users’(Hart, G. and Carter, S. 2000 cited in Williams. S. Et al 2000: 238). This can be identified by transmission of HIV/AIDS, for example soliciting. Throughout the world, individuals resorting to prostitution can have drug use accredited to their illicit activities. Many varying individuals use prostitution ranging from low class to high class customers. Heterosexual sex can be defined as the main type of prostitution, which can lead to the transmission of HIV related illness. Thus entering the socially accepted communities of higher class boundaries, furthering the uncontrollability of HIV/AIDS. Barnett et al, (2000 cited in Goodwin, R. et al 2003: 4)) explains that ‘business people are a highly mobile group whose lifestyle and relatively high income permits them to engage in particular, higher risk activities’.

Sexual intercourse is stigmatised to be one of the main causes for HIV/AIDS transmission and Kowalewski (1988 cited in Vitellone, N. 2002: 16) has shown that ‘preconceptions of society associate condoms to be HIV/AIDS related’, by the use or non-use of this commodity as a preventative measure in controlling disease spread. Within youth society, transmission of HIV related illness can be problematic. People within society fear stigmatisation and the consequences of rejection by being related to AIDS. The younger males of society are exposing themselves to the transmission of AIDS and other sexually transmitted diseases. This is due to creating their own masculine identity. One step of doing this is by having heterosexual intercourse with women. Gough and Edwards (1998 cited in Vitellone, N. 2002:17) explain ‘the penis may only prove significant as a sign of masculinity if connected to its ‘legitimate’ deployment – heterosexual intercourse. . . .

In this way then, the construction of the penis (as/like masculinity itself) in these extracts is relational, and it is that relation that strengthens the heterosexual aspect of hegemonic masculinity’. Young males are having unprotected sex due to the fear of stigma created by their own social groups, the consequences are seen to be the same as explained for the wider society. This can be seen as rejection of those individuals from the social groups due to being stigmatised if one doesn’t conform to the normative behaviour of the society. Self stigma can also be identified in this instance as young males are putting pressure on themselves to fill their masculine roles within their community, thus creating easy transmission of disease without control. Prejudice and stigma can be placed on those who are underclass due to ‘housing, food, and social services are easily obtained by those with HIV or AIDS’ (Johanna Cranea et al 2002). Cranea, J. et al (2002) further explain that this can transpire into individuals purposely trying ‘to become infected in order to access the benefits that they would be able to receive for being HIV positive’.

The implications of doing so would further ostracise these individuals away from society and force those of low status to intently catch or spread AIDS related illness regardless of the feeling of being stigmatised further enhancing the uncontrollability of HIV/AIDS. These policies of gaining economic advantages due to contracting HIV/AIDS have ‘contributed to the creation of an economy of poverty in which the sick, needy, and addicted must compete against each other for scarce resources’ (Cranea, J. et al 2002:1). These factors all contribute to the expansion of the AIDS epidemic within society. People living within ‘normal’, (Becker 1963) society fear stigmatisation if they carry HIV. ‘The effects of stigma are well known, as are the consequences of isolation and exclusion’ (Walker, L. 2007: 79 cited in Burke, P and Parker, J). People with a positive diagnosis are challenged with, whether or not to tell everybody about their test results. This is a challenge, because a positive diagnosis of AIDS/HIV implies a series of changes, the reorganization of daily life and, redefinitions of identity and relationships with others.

All of this alters life as they knew it. Individuals suffering from HIV related illness fear the consequence of stigmatisation and the persecution from co-workers and employers. Walker et al, (2004:88) describes that ‘the impact of law and legal remedies are often limited. Many people face prejudice in spite of the law, which cannot protect them from finger pointing, hostility and social ostracism’. This again relates to the conscious degradation faced by those individuals suffering from the illness, causing anxiety towards gaining help for their problems in fear of the related stigma involved with doing so. Mainly within developed countries, it can be seen to be socially unacceptable to discriminate towards those infected with HIV. Ried and Walker, (2003 cited in Walker, L. 2007:83) define that ‘few people are likely to reveal stigmatising attitudes publicly’.

This shows that health education is beginning to prevail over the prejudice involved with HIV. Unfortunately the attitudes might not be publicly announced but as explained before, unconscious stigma still causes many individual sufferers to conceal their HIV/AIDS identity. The unwillingness to take an HIV/AIDS test means that more people are diagnosed late, when the virus has already progressed to AIDS, making treatment less effective, further transmission and causing early mortality. Within devoloping countries, the education surrounding the AIDS epidemic is far less then that of Western society. The lack of health care is causing the disease to spread uncontrollably. Within many communities HIV/AIDS is so stigmatised and it ‘cannot even be named’, (Jo Stein 2003:95 cited in Walker, L. 2007:82). The prejudice of those within these developing countries are similar to those of western society.

Discrimination and high levels of conscious stigma can be seen within both types of societies. Posel (2004 cited in Walker, L. 2007:82) revealed that ‘HIV/AIDS leads families to banish children who are infected with AIDS; husbands chase away wives who have become sick’. The extremity of this situation is of the ut most importance. Those who have been ostracised due to stigmatisation will fail to gain access to health care as within these developing countries, families are seen to be the majority carers for their members. The rejection due to shame will promote those banished to conceal their identities like that of western individuals, further resulting the un-controllability of the disease ending in early death. ‘Death from AIDS is accompanied by shame,a death from AIDS is full of disappointment’. (Posel 2004:9 cited in Walker, L. 2007:80). The reason for banishing individuals infected with AIDS can be attributed to what.

Goffaman (1963 cited in Walker, L.2007:83 ) describes, secondary or ‘courtesy stigma as a condition which is experienced by a person to whom they are related.’ This can be seen in Burke’s (2004) notion of disability by association. He uses this to describe how family members can become isolated because of the associated disability. This notion of ‘courtesy stigma’ can be seen in social persecutions of individuals within family groups carrying the AIDS virus. Communities recognise that families caring for those individuals may become infected. Due to the lack of education these families are ridiculed for their involvement with the care of those infected. The example of this family rejection is not of the same consequence within western societies where health care is far more advanced and able to deal with individual cases of those seeking HIV/AIDS treatment.

There is a relation between family stigmatisation and that of community- based care support. The community-based care people are volunteers, who assist with the health care of those infected with HIV/AIDS. These volunteers are linked to formal health and welfare sectors but ‘their commitment is often difficult to sustain’ (Walker, L. 2007: 87). One key barrier to the implementation of community- based care is that of stigma (Stadler, 2001). The barriers caused by stigmatisation are encouraging those who volunteer with the heath care of the infected to stop due to the persecutions of society. ‘Doctors in healthcare setting, in resource-poor areas with limited or no drugs have reported a frustration with the lack of options for treating people with HIV/AIDS, who were seen as ‘doomed’ to die’.

Due to this frustration, the HIV infected may not receive treatment as they are not the priority so are discriminated against and run the risk of further transmission to other individuals. (Dodds, C. et al 2004). Society’s stigma is not only causing the families shame and degradation but is also causing those who have some medical training to stop aiding the infected. Thus helping HIV/AIDS to be further uncontrolled, claiming more lives and helping the spread of disease, due to lack of education. In global society the media has a large involvement in society discourses towards negative aspects of culture, thus creating ‘moral panic’ (Cohen 1972).

This is where the media exacerbate issues of public worry. Lear (1995 cited in Goodwin, R. et al 2003:3 ), shows that ‘by examining representations of risk and risk groups we can gain a greater understanding of the ‘moral panic’ often associated with the epidemic, a panic which may allow individuals to psychologically distance themselves from particular groups’. The media’s interpretation of the AIDS/HIV disease relates to Joffe’s (1999) notion where it has helped with both the, intentional and unintentional stigma and persecutions towards individuals carrying the virus.

Health education within western society is increasing in relation to HIV related illness. Researchers and care providers are identifying the various risk groups associated with the disease. By identifying these risk groups there becomes a fundamental flaw. By doing so health carers are able to show support to these groups by offering health treatment but the meaning can be seen in such a way to help reinforce perceptions of people living with HIV as an out-group. This notion reflects Joffe’s (1999) theory of ‘unconscious’ stigmatisation, as a result of this, it sets out boundaries between the ‘us’ and ‘them’. Making it hard to overcome the obstacle of reducing AIDS related stigma by forging a barrier between ‘them’ resulting in the uncontrollability of HIV/AIDS.


The battle of confronting stigmatisation by society, towards those who carry HIV/AIDS is not a simple task to overcome. Society fear the preconceptual ideas of the disease and need to be educated towards the factors surrounding the issues of coping with HIV related illness. Health education towards HIV not only needs to be implemented by the onlookers but also by those carrying the disease. They need to be taught their rights within society, to be able to combat the discrimination, stigma and persictions faced within their communities. As stated before by Joffe’s (1999) notion of stigma being ‘not even a conscious process’ and also Deacon et al’s (2005) explanation that ‘stigmatisation is an individual reaction to perceived or real danger that draws on shared social representations of deviance to distance people from risk’. Educating society away from discriminating against diseased individuals is a hard task. It is the uneducated societies that are at risk of most stigmatisation, causing the needless suffering and pain attributed by stigma.

Holloway (2005 cited in Walker, L. 2007:93) suggests that ‘it is at the heart of social work to challenge the oppression and injustice, to seek to alleviate suffering and hardship; in short to promote the social change and social justice’. AIDS within society needs to be addressed not only on community based levels but on an international scale confronting the social differences and inequalities reproduced by stigmatisation. The media have a huge role to play in the combat against AIDS. It should denounce any stigmatisation or discrimination towards HIV or AIDS only promoting the equality of those within society. It could use known individuals who have contracted the disease to publicly explain the difficulties faced and how they gain health care and treatment.

By creating HIV and AIDS as a normal factor within society, it will help those concealing their diseased identity to come out and gain life saving treatment. Deacon et al (2005 cited in Walker, L. 2007:95) suggests that ‘using historical examples of people with other diseases that are no longer a threat to the community, such as leprosy, can be a useful way of demonstrating the social nature of stigmatisation ’. ‘Stigma and discrimination can act as important structural barriers to HIV prevention’ (Parker et al. 2000 cited in Walker, L. 2007:86). The barriers that HIV and AIDS stigmatisation have created, can help in the battle against other prejudice activities such as drug taking or prostitution. This can be seen to be the only positive discourse that stigmatisation creates.

Society has a role to play when it comes to the controllability of the HIV/AIDS disease. There are different factors facing the varying cultures where HIV/AIDS is stigmatised, but all these need to implement education as the sole factor of controlling this disease.

Burk, P. (2003) ‘Disadvantage and Stigma: A Theoretical framework for Associated Conditions’ in in Burke, P and Parker, J. (eds) Social work and Disadvantage; Addressing the Roots of Stigma Through Association. Philadelphi; Liz Walker Publications, pp 11-27 Hart, G. and Carter, S. (2000) ‘Drugs and risk: developing a sociology of HIV risk behaviour’ in, Williams. S. Et al. (eds) ‘Health, Medicine and Society; Key Theories, Future Agendas’. London: Routledge. pp 109- 123

Sontag, S. (1999). ‘Illness as Metaphor’ and ‘AIDS and Its Metaphors’ in C. Samson Health Studies: A Critical and Cross-Cultural Reader Oxford: Blackwell Walker, L. (2007) ‘HIV/AIDS; Challenging Stigma by Association’ in Burke, P and Parker, J. (eds) Social work and Disadvantage; Addressing the Roots of Stigma Through Association. Philadelphi; Liz Walker Publications, pp 79 – 97 Internet

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Kibirige, J. (1997).’Population growth, poverty and health,’ Social Science & Medicine 45 (2): 247-259[Online] Available at; Accessed 40/03/2010

Pecheny, M et al. (2007) ‘The Experiences of Stigma; People Living With HIV/AIDS and Hepatitis C in Argentina’. [Online] available at; Accesses 05/03/2010

Vitellone, N. (2002). ‘Condoms and the Making of Sexual Differences in AIDS Hetrosexual Culture’, [Online]. Available at; Accessed March 4 2010

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