The closing ceremony of the 2011 Caribbean HIV Conference was predictably themed “looking to the future”. But in his plenary presentation, Futures Group senior vice president Farley Cleghorn paused to examine the nature and reach of the age-old duo of stigma and discrimination. He explained that it was a key cause for the level of new infections notwithstanding strides in prevention, treatment, care and support.
“Stigma and the resulting discrimination discount the investments being made in all these areas,” Cleghorn stressed.
In teacher mode, he started at the start. What is stigma? It is a social construct that separates people, creating divisions and notions of superiority and inferiority.
“The stigma that we are talking about is the disqualification of certain parts of the population from full social acceptance and therefore the full expectation that they can participate in the benefits of a society: the advancements of medicine, policy and practice that everyone should feel equally a part of,” he explained. Discrimination is the result of stigma—unfair actions directed toward an individual or group based on the way they are perceived.
Stigma can manifest in several insidious ways. For example there is anticipated stigma which is the fear of being stigmatised. It is a potent force that often determines whether people access services related to HIV/AIDS. Internalised or self stigma is when people’s notions of themselves are impacted by the society’s negative attitudes to some part of their identity. This too could have deep impacts, leading to fatalism and risk-taking. Cleghorn submitted that the region’s criminalisation of sexual minorities and lack of protection for people living with HIV feed stigma and therefore erode the HIV response.
“Conferences like this give us the opportunity to examine ourselves and see that our environments provide a structural impediment to the removal of stigma and discrimination. These kinds of structural and legal impediments promote the epidemic. Homophobia promotes HIV transmission,” he stressed. “It does so by social exclusion and diminishing the impact of programs that lead to the reduction of HIV. HIV is directly linked to the inability of people to take their place fully in society. This is something we have to work on if we want to say we have an effective HIV response.”
Cleghorn’s sentiments echo those of the 2011 UNAIDS World AIDS Day Report which calls for reducing stigma, respect for human rights and creating a protective legal environment. The report calls these actions “critical enablers” and says they are crucial to overcoming the barriers to successful programme outcomes.
To find out more about successful strategies for combatting stigma go to www.stigmaactionnetwork.com