AIDS and its Stigmas: Jeanine Cogan & Gregory Herek (1998)

• AIDS-related stigma refers to a pattern of prejudice, discounting, discrediting, and discrimination directed at people perceived to have HIV/AIDS, their significant others and close associates, and their social groups and communities. 
• As with other diseases throughout history, such as the Black Death in the fourteenth century and cholera in the nineteenth century, a stigma has been attached to AIDS as a result of both fears surrounding contagion and preexisting prejudice against the social groups most seriously affected by the epidemic. 
• Like AIDS itself, the AIDS stigma is a global problem. It is manifested around the world through ostracism of people with AIDS (PWAs), discrimination against them, and, in a few countries, quarantines.
• In the United States, the AIDS stigma has been evident in negative attitudes, discrimination, and violence against PWAs and people perceived to be HIV infected. 
• coercive measures such as 
• quarantining of HIV-infected persons, 
• universal mandatory testing, 
• laws making it a crime for people with HIV/AIDS to have sex, and 
• mandatory identification cards for PWAs. 
• Negative attitudes have also been manifested in behavior. 
• AIDS discrimination in employment, housing, school policies, and services has been widespread. 
• Employers have refused to provide insurance coverage for employees with AIDS; 
• property owners have refused to rent to PWAs or have evicted them; 
• parents with AIDS have been faced with legal battles concerning child custody and visitation rights; and 
• PWAs have experienced unwarranted demotions, dismissals, and harassment in the workplace. 
• In addition, some PWAs have been targets for violent attacks because of their HIV status.
• At least four specific characteristics affect the extent to which any disease is likely to be stigmatized. 
• First, a stigma is more likely to be attached to a disease whose cause is perceived to be the bearer's responsibility.
•  The two most common routes of HIV infection in the United States, sexual intercourse and sharing contaminated drug paraphernalia, are widely perceived as controllable and therefore avoidable behaviors. 
• Second, greater stigma is associated with conditions that, like AIDS, are perceived to be unalterable or degenerative. 
• Third, greater stigma is associated with conditions that are perceived to be contagious or to place others in harm's way. 
• Concern about contagion not only exists in the physical realm but also extends to fears that one will be socially or morally tainted by interacting with the stigmatized individual. 
• Finally, a condition tends to be more stigmatized when it is readily apparent to others and is perceived as repellent, ugly, or upsetting. 
• In its more advanced stages, AIDS often causes dramatic changes to one's appearance.
•  Of considerable additional importance is the fact that the AIDS epidemic in the United States has occurred primarily among marginalized groups, such as gay men, injecting drug users, and Haitians, and has been defined socially as a disease of these groups. 
• Consequently, the stigma attached to AIDS also serves as a vehicle for expressing preexisting hostility toward members of disliked social groups.
• In the United States,  the AIDS stigma has been focused principally on homosexuality. 
• Societal and individual reactions to AIDS have often provided a vehicle for expressing condemnation of homosexuality and hostility toward gay men and lesbians. 
• Heterosexuals' attitudes toward gay people have been consistently shown to correlate strongly with their AIDS-related fears, attitudes, and beliefs.
• Acceptance of homosexuality was at its height BEFORE the AIDS epidemic. 
• Furthermore, gay men with AIDS are more negatively evaluated or blamed for their illness than are heterosexuals with AIDS. 
• As the face of the epidemic in the United States changes, it is likely that symbolic expressions of the AIDS stigma will broaden to reflect public hostility to an increasing degree toward other marginalized groups such as immigrants, the poor, and communities of color.
• Because of the AIDS-related stigma, PWAs must bear the burden of societal hostility (stigma) at a time when they urgently need social support. 
• In addition, some PWAs internalize societal stigmatization (Goffman),which can lead to self-loathing, self-blame, and self-destructive behaviors. 
• The AIDS stigma also deters people at risk for HIV from being tested and seeking information and assistance for risk reduction.
• Because of the stigma of AIDS, many people may distance themselves from the disease and deny their potential risk.