6/3/20151 Appropriate Responses To Infectious Disease… continued Anthropology 393 – Cultural Construction of HIV/AIDS Josephine MacIntosh

6/3/20152 Modes of Disease Transmission  Vector-borne: transmitted via non-human hosts such as mosquitos, lice, fleas etc  Direct contact: transmitted via respiration, fecal-oral contact or sexual contact  Environmental contamination: transmitted via contact with pathogens living in food, water, air, or on items such as contaminated clothing or needles

6/3/20153 Improve Public Health  Biologically appropriate interventions:  Eliminate source of infection and/or  Eliminate contact with source and/or  Reduce infectivity and/or  Reduce susceptibility  Socially appropriate interventions:  Limit social and economic disruption  Promote stability along prevention/care continuum

6/3/20154 Social Construction of Illness  Meaning is attached to illness based on:  Ill individual, who provides a social circumstance  An ‘other’ who provides a social reaction  A moral judgment made by the ‘other’  Social reactions which stigmatize are:  Often out of proportion w/ pathology of the disease  Often do little to reduce transmission  May increase transmission probability (Brown 1998: Waxler, 1998; Inhorn, 1998; McGrath, 1991)

6/3/20155 Deviance and Immorality  Historically, STIs have been stigmatized because of the connection with deviant or immoral behaviour  Importance of virginity, monogamy, respectability, heterosexuality  Moral judgments are made based on culpability  Lifestyles at fault?  Pronounced ‘guilty’  Naïve partners of the guilty  pronounced ‘innocent’  Children of innocents  pronounced ‘defenseless victims’

6/3/20156 Deviance and Immorality  Fear of moral judgment isolates those:  Infected  Affected  ‘At risk’  Can preclude health preserving behaviours Busza, 1999; Gilmore & Sommerville, 1994; Goldin, 1994  Probable result  accelerated epidemic McGrath, 1991; 1992

6/3/20157 Stigma: Epidemiological View  Behaviours  Use of alcohol, tobacco, or illicit drugs, homosexuality, spousal or child abuse  Structural abnormalities  Facial/skeletal abnormalities, abnormality of skin pigmentation or body size  Functional abnormalities  Abnormalities of motor, sensory or mental functions  Contagious diseases  Leprosy, TB, HIV/AIDS and other STIs (Reingold & Krishnan, 2001)

6/3/20158 The Social Construction of HIV  Negative moral judgments are especially probable with HIV because stigma of the illness is layered upon pre-existing stigmas  Does not encourage interventions which are, at the same time, biologically and socially appropriate  Seriously disrupts social systems which would normally support the prevention/care continuum

6/3/20159 HIV/AIDS: The New Leprosy  Like Hansen’s disease, HIV has a known cause, effective treatments, no known cure and HIV patients, like lepers, are often feared, shunned, refused care, rejected, exiled, etc  Medical facts of both diseases are similar  Initially unremarkable, often results in late diagnosis  Early diagnosis and treatment slows progression  Later, both result in serious & visible medical consequences (Waxler, 1998)

6/3/ The Reality…  HIV is spreading at twice the predicted rate  Limiting exposure to STIs is complex  Many social responses to HIV increase stigma  Fear of stigma is problematic because many:  Dissociate themselves from risk groups  Avoid testing & counseling  Avoid accessing health care  Resist behaviour change

6/3/ The Reality…  Incidence of HIV/AIDS will continue to increase without appropriate interventions  Current public health response is inadequate  Need to address stigma  Need to provide affordable drugs by implementing the WHO ‘3 by 5 plan’  Need concentrated social action to normalize prevention/care/treatment

6/3/ Social Action: Why? Because…  ‘Us’ versus ‘them’ mentality increases stigma  Blaming others is illogical when we have the capacity to eliminate risk of exposure, reduce infectivity, and potentially reduce susceptibility  HIV/AIDS poses a great threat to humanity and if we are to survive, we must adapt

6/3/ The Reality…. “If the pandemic is to be halted, the overarching epidemic of stigma and discrimination that obstructs prevention, care, and treatment for those infected, affected, and ‘at risk’ for HIV must be challenged publicly and politically.” (MacIntosh, 2003) Because… ‘we’ ARE ‘them’ (Gilmore & Somerville, 1994).