Stigma – Why and When it’s Upsetting
posted: 12/11/2009
Some types of HIV-related stigma cause much more harm and upset to people living with HIV, than other types of stigma. The types of stigma that cause most upset seem to be
- problems with health care workers,
- secrecy and lack of openness within the family, and
- exaggerated kindness from members of your family.
“Our findings suggest that certain setting-specific manifestations of stigma are indeed more psychologically damaging than others”, comment the Dutch investigators in the article in the journal AIDS.
There is a lot of research showing that HIV-related stigma causes psychological distress. No-one before has looked at the impact of different types of stigma, in different situations.
In 2007, Dutch investigators did a “snap-shot” study of 669 people living with HIV. The people had a mean age of 47 years and were well educated, with almost 50% having a degree. Most (80%) were gay men, 68% were in employment and 48% had a partner.
Each answered a questionnaire about the most distressing affects of stigma in six settings (friends, family, healthcare, partner, work, and leisure).
The questionnaire allowed people to select from eleven types of stigma
- advice to conceal HIV infection or not to disclose,
- blame,
- increased physical distance,
- excessive hygiene,
- indifference,
- exclusion,
- awkward social interactions,
- exaggerated kindness, and
- aggression.
People may mean well
Friends caused the most upset with their awkwardness and excessive kindness.
Family caused a lot of upset if they tell you to hide your HIV, avoid you, or were excessively kind were all associated with distress if experienced from family members.
In healthcare stigma caused the greatest upsets if health staff are indifferent (don’t seem to care) or if social interactions are awkward.
In our close relationships, being told to hide HIV, and being over-kind caused more upset.
Proven links
They did a statistical analysis and found that only four types of stigma are really linked to psychological distress.
Three of the four linked stigma types were within the family:
- being told to hide HIV,
- family members avoiding you, and
- being over-kind to you
were all statistically proven.
The only other example of upsetting stigma that is statistically significant is in healthcare when there are awkward social situations.
Family upsets hurt
“Stigmatiszation by family may be particularly detrimental as families are not chosen and often considered an important source of unconditional love and support”, write the investigators, who suggest that experiencing stigma from family members may threaten the fundamental human “need to belong.”
Healthcare stigma worse because unexpected
Healthcare professionals should know about HIV, so when healthcare workers stigmatise, that is unexpected and more distressing because it is from people whose job it is to care for you.
George House Trust comment
This is interesting but of limited use.
It only examined 11 types of stigma, in certain situations, and the sample was heavily biased to older, well-educated white gay Dutch men.
Physical violence, denial of rights or services, and sacking people, are all examples of stigma they did not investigate. Many people would say that these are all much more upsetting examples of stigma and discrimination than some of the types of stigma they did look into.
People from other groups - eg young people, migrants, Africans, injecting drug users, among others, may have very different experiences of stigma to older, well-educated, white gay men.
Source and reference details
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