AIDS and Stigma: Cultural Discontents and Social Manifestations

Stigma and discrimination have, since the end of the 90s, been identified as major obstacles to effective responses to the AIDS epidemics. But little substantive work has been undertaken in terms of identifying causes, characteristics, and consequences or in terms or providing a means of measuring HIV-related stigma. Based on the results of two years of investigation of HIV-related stigma in Mexico and Ecuador, this talk will discuss the construction of HIV-related stigma and discrimination and some of the key results especially in terms of internal stigma of persons living with HIV and persons from key populations to the dynamics of epidemics in Latin America. 

Methodology includes both qualitative and quantitative tools: focus groups and in-depth interviews with key populations (persons living with HIV, gay and other men who have sex with men MSM, sex workers SW), behavioral surveys with MSM and SW, a health survey with health professionals and a media scan. Results highlighted a cycle of inter-related and mutually-reinforcing elements: stigma causes discrimination which leads to the internalization of stigma which, in turn, reinforces the original stigma. 

Stigma, divided into pre-existing, HIV-specific and enacted stigma, can provide important insights into both fear-based and moral-based stigma. Enacted stigma shows clear patterns of identification, distancing and exclusion. Internal stigma, the result of the acceptance and internalization of stigma and discrimination, analyzed as both process and product shows that disdain and social pressures can lead to a sense of loss of control and auto-perceptions related to shame, guilt and discomfort with self. Subterfuge, isolation and avoidance are key results which are crucial constituents to increased vulnerability. 

The work shows clearly that pre-existing stigma related to gender and sexuality are predominant aspects of stigma in Latin America. Implications for this work include outlining a means of analyzing stigma and discrimination as well as providing clear avenues for stigma reduction. It illustrates the cultural implications of a machistic society in terms of feeding a concentrated epidemic and providing a base for the generalization of the epidemic.