The Denial of Choice: HIV/AIDS and Stigma

A “throwback” Op-Ed from college regarding the burden of stigma on HIV/AIDS patients, and its subsequent impact on Public Health.

Consider a scenario in which you are a patient seeking medical care and advice for a disease with a historically poor prognosis. The obvious reaction is to proceed forward with whatever medical care and treatment would be necessary. Now imagine that this dire medical situation is further exacerbated by intense sociocultural stigmatization. How likely are you to proceed forward with seeking help? This scenario may seem trivial to some, but it carries significant weight when considering how deeply intertwined the social and biological aspects of disease have become, often forming the unfortunate byproduct of stigma. The stigma associated with HIV infection and AIDS is often due to socio cultural biases, leading to direct and indirect discrimination of populations via resources, access to medical care/coverage, and inherently discriminatory legislative practices. These factors may adversely contribute to transmission and risk reduction field-work undertaken by public health agencies and nonprofit organizations in the long-term.

In order to accurately discuss the abhorrent nature of HIV/AIDS stigmatization around the world, we must first take an in-depth look at what the term stigma truly implies in this scenario and how it correlates with the social and biological boundaries broken by the HIV/AIDS epidemic. According to Erving Goffman, one of the original pioneers in connecting stigma to disease treatment and control, stigma’s Greek roots refer to a process in which bodily characteristics are engineered in a certain fashion in order to create or expose something unseen and unusual about the moral status of someone else. Kleinman further elaborates by implying that the process of stamping cultural significance onto diseases will transmit those cultural constructs onto the infected party, rendering them culturally abnormal and different, and thus associating that group of individuals with the social and cultural characteristics of being an outcast, reject or pariah. This phenomenon is present in both HIV and AIDS cases, and is often attributed to many issues that public health community faces when attempting to control or limit the spread of HIV/AIDS in at-risk groups, primarily amongst those that are disenfranchised or minority groups.

The fundamental tenants of stigmatization that are present in HIV/AIDS cases can be traced back to the 1980’s outbreak. The 1980’s saw the emergence of the HIV/AIDS epidemic in full force, originally appearing amongst healthy gay men in Los Angeles manifested as the rare lung infection called Pneumocystic carinii pneumonia, with additional cases of Kaposi’s Sarcoma present in New York. According to Avert, a HIV/AIDS advocacy group, June 1982 would mark the point of time in which the HIV/AIDS virus would, unfortunately, be linked to what were deemed to be “lifestyle choices”. Here, officials opted for a blanket definition of the surging disease, choosing the term GRID, or Gay-related immune deficiency. It wasn’t until 1983 that AIDS cases were also being reported amongst female partners of males who had the disease, finally suggesting that HIV transmission and progression into AIDS can be caused via heterosexual interactions, moving away from what was then incorrectly deemed to be a consequence of “lifestyle choices”.

This unfortunate connection between HIV/AIDS and sexual orientation was a coincidence that had long lasting ramifications for the community, irresponsibly making a broad connection between a deadly disease and sexual identity. This connection would manifest itself over time and contribute to HIV/AIDS becoming known as a “gay-disease” early on. Stigmatization of HIV/AIDS, along with the ever present discrimination against the LGBT community contributed to a “double burden of stigmatization”, compounding the stigma associated with HIV/AIDS infection with the heavy stigma dealt towards the LGBT community. This was often magnified through legislative discrimination, exemplified recently in 2016 as North Carolina’s LGBT discriminatory bill (House Bill 2), hiding under the guise of a bill meant to “strengthen” religious freedom.

This connection raises questions regarding the state of mind that individuals find themselves in when diagnosed with HIV. An abhorrent societal tendency to collectively discriminate against both HIV/AIDS and the LGBT community at large exacerbates the concern that individuals who find themselves in risky situations or populations may not expose themselves to the benefits of free-testing centers, social support groups, mentoring and risk reduction activities as a whole. When the tendency to stigmatize the community is so prevalent, the underlying social and cultural implications that are projected onto the problem as a whole begin to supersede the individuals desire to take action.

It becomes disturbingly clear that despite attempts to modernize our viewpoints as a society, current socio-cultural stereotypes and discriminatory practices continue to further select-against populations that are greatly at-risk of being infected with HIV. Stigmatization and our response to the threat it poses will play a key factor in determining the future outcomes of medical and socio-cultural interventions in both HIV/AIDS prevention and treatment.

This is part one in a series of holistic publications that analyzes the various struggles and challenges posed by healthcare and medical care reform.