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Introduction Since the appearance of AIDS in the late seventies and early
eighties, the disease has had attached to it a significant social stigma. This
stigma has manifested itself in the form of discrimination, avoidance and fear
of people living with AIDS (PLWAs). As a result, the social implications of the
disease has been extended from those of other life threatening conditions to the
point at which PLWAs are not only faced with a terminal illness but also social
isolation and constant discrimination throughout society. Various explanations
have been suggested as to the underlying causes of this stigmatization.
Many
studies point to the relationship the disease has with deviant behaviour. Others
suggest that fear of contagion is the actual culprit. Examining the existing
literature and putting it into societal context leads one to believe that there
is no one cause. Instead, there would appear to be a collection of associated
factors that influence society’s attitudes towards AIDS and PLWAs. As the number
of people infected with HIV increases, social workers are and will be
increasingly called upon to deal with and serve PWAs. Although not all social
workers chose to work with PLWAs, the escalating incidence of HIV infection is
creating a situation in which seropositive people are and will be showing up
more often in almost all areas of social work practice. This paper aims to
examine AIDS related stigma and the stigmatization process, hopefully providing
insights into countering the effects of stigma and perhaps the possibility of
destigmatization. This is of particular pertinence to the field of social work
due to our growing involvement with the HIV positive population.
Association to
Deviant/Marginal Behavior One of the most clearly and often identified causes of
AIDS related stigma is its association to deviant behaviour. The disease has had
and still does have a strong association for many to homosexuality, IV drug use,
sexual promiscuity and other liberations of sexual practice (O’Hare, et al.,
1996; Canadian Associacion of Social Workers, 1990; Quam, 1990 & Beauger, 1989).
An especially strong association exists between homosexuality and AIDS. This is
largely due to the fact that, in the early years of the disease, it was far more
prevalent within the gay community and almost non-existent outside of it. In
fact, until 1982 the disease was referred to as GRID or Gay Related Immune
Deficiency. Even today, AIDS is often referred to as “the gay plague” (Giblin,
1995). Even though AIDS is now far less prevalent in the homosexual community
and increasingly more outside of it, this link still remains strong for many.
Along with the historical context of AIDS, the media is partly to blame for this
not so accurate association.
The Canadian Association of Social Workers (1990)
reports that, “often the media has not distinguished between ‘gay’ and ‘AIDS’,
so that public understanding of homosexuality and AIDS has become enmeshed”
(p.10). In recent years, the media has started to make more accurate
distinctions between homosexuality and AIDS, but messages are still mixed and
often ambiguous. The situation is quite similar in regard to IV drug use,
prostitution, and other activities commonly associated with AIDS. This focus
that the media has put on marginalized groups incorrectly places emphasis on
high risk groups rather than high risk activities. As a result, the word AIDS
alone conjures, for many, images of those who deviate from what society deems to
be normal behaviour. Already Stigmatized Groups Many of the groups to which AIDS
is associated have long histories of stigmatization before the appearance of
AIDS. Homosexuals, in western culture, have almost always suffered the effects
of being a stigmatized population.
The same is true of prostitutes, IV drug
users, and people of color (O’Hare, et al., 1996; Giblin, 1995 & CASW, 1990). It
is significant to mention colored populations, as the parts of the world that
are most severely effected by AIDS, such as countries in Sub-Saharan Africa,
South East Asia, and Haiti, are mostly populated by races other than Caucasian.
As a result, a strong association has been also been made between AIDS and
people of color (Quam, 1990). The fact that AIDS is associated with already
stigmatized groups has two principal effects. First and most obvious, is that
society’s negative attitudes towards the group in question are transferred to
AIDS and PLWAs. Second, is an amplification of the existing negative feelings
that society holds towards the groups associated with the disease (CASW, 1990).
As a result, homosexuals, prostitutes, colored people and other groups
associated to HIV infection are not only seen as deviant or undesirable, but
also as potential carriers of the virus who are to be feared and avoided.
Religious Condemnation Some religious groups see AIDS as a punishment from God
for sinful behaviour. As children, many people were told that of what could
happen to them if they strayed from what their parents or religious doctrine
considered appropriate behaviour. Quam (1990) writes, “Their parents and other
parental authorities warned them that if they succumbed to pleasures of the
flesh they would suffer dire consequences. Now AIDS would appear to fulfill such
prophecies” (36). Such sentiment still exists publicly today. When asked about
his feelings about the AIDS epidemic, Jerry Falwell, a popular and quite
influential televangelist said publicly, “When you violate moral, health, and
hygiene laws, you reap the whirlwind. You can not shake your fist in God’s face
and get away with it” (Giblin, 1995). Fear of Contagion Another factor
influencing attitudes towards PLWAs is the fear of contagion.
In fact, Bishop,
Alva, Cantu, and Rittiman (1991) argue that this is a greater cause of
stignatization than the association to deviant behaviour. They found that many
people expressed negative attitudes towards PLWAs regardless of how the virus
was contracted or the person’s background. The fact that there is no known cure
for AIDS and as of yet the disease always ends in death validates this fear for
many. As people are becoming more aware of how the virus is transmitted, they
seem to be become less fearful of PLWAs. However, people’s fear and avoidance of
PLWAs is still greatly effected depending on the mode of transmission (Borchert
& Rickabaugh, 1995). Innocent V.S. Deserving Victims In recent years, a
distinction has been made in our society between what we consider to be innocent
and deserving victims of AIDS. Society tends to classify people who contract
AIDS through blood transfusions, their mother’s at birth, or other
uncontrollable circumstances as innocent victims.
On the other hand,
homosexuals, IV drug users, the sexually promiscuous, and other ‘deviants’ are
seen as deserving of the condition they are in when they contract AIDS. The
common attitude held towards the ‘deserving victim’ is that of ‘you play, you
pay’ (Quam, 1990). This mentality leads to feelings of fear and hostility
towards and a great lack of compassion for those who are incorrectly and
irrationally deemed as being deserving of the disease. Borchert and Rickabugh
(1995) found that greater levels of AIDS related stigma were expressed towards
PLWAs who played an active role in the contraction of HIV. They noticed that
people actually expressed quite sympathetic feelings towards people who played
no active role in contraction, the innocent victims. It is only since the
beginning of this decade that we have begun to notice this phenomenon. In the
past, no distinction was made regarding mode of transmission.
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