HIV AIDS AND RACISM

 

WHY  RACISM IS RELATED TO HIV AIDS?

        

• It is increasingly acknowledged that those most deeply affected by the HIV epidemic are also among the most severely disadvantaged, whether as a result of the race, economic status, age, sexual orientation, or gender. As with other stigmatized health conditions such as tuberculosis, cholera, and plague, fundamental structural inequalities, social prejudices, and social exclusion explain why women, children, sexual minorities, and people of color are disproportionately impacted by AIDS and the accompanying stigma and discrimination

•  The two-decade-long global history of the HIV epidemic reinforces the well-documented interaction of disease, stigma, and ‘spoiled’ social identities based on race or ethnicity, and sexuality.

The strong linkages of HIV/AIDS with gay men and other so-called ‘risk groups’ established early on seem to have blinded social researchers and others to the factors of racial, class, and gender relations that frame AIDS not as a medical problem alone but as a social one.

 Race, class, and gender have been found to serve as important determinants of a person’s health status and well-being affecting his/her perception of illness, health-seeking behavior, accessibility to services, and coping mechanisms. Because these factors usually operate in tandem, they severely compromise the person’s overall health status and ability to respond to the problem. Although there is some empirical evidence that links poverty and gender to HIV/AIDS, there is still insufficient research on the relationship between HIV/AIDS, ethnicity, and race. 

The phenomena: Racism, racial and AIDS-related discrimination

Race is a form of ‘group identity’ and arguably the basis of some of the most extreme and serious acts of discrimination and violations of human rights globally. In the domain of health, race is identified as “a central determinant of social identity and obligations [and] an empirically robust predictor of variations in morbidity and mortality.”To understand how race is relevant to questions of public health, care and treatment issues, it is important to first examine the phenomena of stigma and discrimination in general, and how it is related to illness and disease.

STIGMA

The concept of ‘stigma’ was first elaborated in the classic work of the sociologist Erving Goffman. He defined stigma as “an attribute that is significantly discrediting” and which serves to reduce the person who possesses it in the eyes of society. Relating the concept to conditions of mental illnesses, physical deformities and socially deviant behaviours such as homosexuality, Goffman argued that the stigmatized individual was seen to be a person with “an undesirable difference”. In other words he maintained that stigma is constructed by society on the basis of perceived ‘difference’ or ‘deviance’ and applied through socially sanctioned roles and sanctions. The result is a kind of ‘spoiled identity’ for the person concerned. Goffman identifies three kinds of stigma. 

The first he called stigma derived from physical deformities; the second is associated with perceived ‘blemishes of individual character’ (e.g. due to mental disorder or homosexuality); and the third, ‘the tribal stigma of race, nation and religion’. This third type of stigma, “transmitted through lineages” and possessed equally by all members of a family, implies that group membership and group identity could in themselves be sources of stigma.

Race or ethnicity then is one such group identity that is a source of stigma, prejudice and discrimination for those possessing that identity. When the racial identity combines with a health condition such as HIV/AIDS, it contributes to “double stigma” (tribal stigma and stigma due to HIV/AIDS status). An early work of Postell, ‘Health of Slaves on Southern Plantations’, made pictorial representations of the popular public images of African American group identity in relation to diseases and health care.

 The health-seeking behaviour of black Americans, for instance, is symbolized in one picture by a black woman on foot, with images of quackery-chicken’s head, frog and snake parts – representing her health practices and beliefs – and dense vegetation and darkness framing her background.

 This picture is contrasted with that of a white American doctor on a buggy, with images of medicinal bottles – the tools of his trade – and a sunlit background with limited vegetation. The image so created is one of backwardness, ignorance and cultural inferiority of the black people. Wailoo provides other examples. Thus the hookworm was designated the ‘germ of laziness’ because of the lethargy it produced in its patients, a majority of whom were black. 

The fight against tuberculosis 85 Racism and HIV/AIDS among the black population was described as not just a fight against the disease, but “…against physical, mental and moral inferiority, against ignorance and superstitions, against poverty and filth.”In these and other descriptions, notes Wailoo, one image that dominated was that of “the carriers – a portrait of a social menace whose collective superstitions, ignorance and carefree demeanour stood as a stubborn affront to modern notions of hygiene and advancing scientific understanding… [a people best understood as] …a disease vector…”

 He goes on to show how the scientific advancements of that time in the field of bacteriology gave rise to the notion of ‘human disease vectors’ in the context of ‘Typhoid Mary’ or the ‘asymptomatic carrier’.

 Coming from the pioneering scientists of that time, such images also bore the stamp of scientific authenticity. Wailoo cites the noted hookworm researcher Charles W. Stiles, who declared that the incidence of the disease, “possibly indicates that the Negro has brought [it] with him from Africa…and we must frankly face the fact that the Negro … because of his unsanitary habit of polluting the soil…is a menace to others”.

 Thus, observes Wailoo “one important feature of stigma in public health was associated with contemporary scientific and social ideas about ‘the carrier’ of disease.” It is clear from these examples that the notion of the ‘disease vector’ is quite old and that it was used to stigmatize the black character itself. When Goffman elaborated his concept of stigma in the early 1960s he referred to this negative characterization as the creation of ‘spoiled identity’. 

The stigmatization of African American identity in relation to diseases in the early 20th century shows a remarkable continuity today in the context of HIV/AIDS. An illustration is the stigmatization and harassment of Haitian people in the early 1980s, who were accused of having brought AIDS into the United States.

Aids-related stigma and discrimination

In recent years concern about AIDS-related stigma and discrimination has grown.Parker and Aggleton seek to conceptualize stigma and discrimination not just as individual processes but as social and cultural phenomena linked to the actions of whole groups of people, not the consequences of individual behaviour. They combine the works of Foucault which emphasize the cultural production of difference in the service of power, and the work of Goffman that relates to stigma associated with deviance, to make the point that stigma and stigmatization function at the point of intersection between culture, power and difference. So conceptualized, stigma is not merely an expression of individual attitudes or of cultural values, but is central to the constitution and continuity of a given social order.

 Within such a conceptual framework, it is possible to understand and analyse racism and racial discrimination related to HIV status. AIDS-related stigma and discrimination are complex social processes. They are neither unique nor randomly patterned.They usually build upon and reinforce pre-existing fears, prejudices and social inequalities pertaining to poverty, gender, race, sex and sexuality, and so on.

 In this sense, racist attitudes and racial discrimination linked to HIV/AIDS status play into, and reinforce, already existing racial stereotypes and inequalities concerning people of colour in general. Like other forms of stigma, AIDS-related stigma also results in social exclusion, ‘scapegoating’, violence, blaming, labelling and denial of resources and services meant for all. Research shows that it is not necessary for people to experience stigma directly or personally (enacted stigma); stigma may be perceived or presumed to be there (felt stigma). This latter type of stigma is psychologically more damaging and difficult to challenge in public.

Race, gender, class and HIV/AIDS: the intersection

The linkage between race and HIV/AIDS cannot be seen in isolation from the dimensions of gender, class and sexual orientation. As Aggleton notes, “intersectionality is central to an understanding of how gender, race, age, sexuality combine together to determine who is infected and once infected who is able to access medications and health care”. This intersectionality contributes to double and sometimes multiple stigmas and stigmatization of the infected. Gender differences in patterns of HIV infection vary widely around the world.

 In regions where HIV transmission is mainly heterosexual, more young women are infected than men. In most of Africa infection rates among young women are at least twice those among young men. In some parts of Kenya and Zambia, teenage girls have rates of 25 per cent compared with 4 per cent among teenage boys. The gender dimension of the HIV epidemic is closely related to patriarchal values and norms and to the fact that women bear the major consequences of the epidemic on account of loss of livelihood, economic pressures, care of sick family members and the stigma of AIDS.

In many parts of Asia it is marriage that poses a greater risk of HIV infection to women who themselves report monogamous behaviour. The impact of this can only be imagined in countries where marriage is a cultural ideal and near universal, as in India. Gender 88 Dimensions of Racism norms and values in these countries ordain that women accept their ‘lot’ in marriage and dare not question their husbands’ demand for sex. Further, they prevent women from seeking knowledge about sex, sexuality and reproductive health matters. 

Women and young girls thus lack the necessary information resources and power to make choices, such as in matters of contraceptive use, by which they may reduce the risk of infection. Lack of adequate education and training for earning livelihood further marginalize women, particularly those from disadvantaged racial and ethnic backgrounds. In situations of armed conflict, migration and crisis displacement, again it is the women who bear the consequences of sexual assault and rape. Evidence gathered from Croatia, Bosnia and Herzegovina, and Rwanda suggest how rape and sexual abuse are used as weapons of war, so enhancing the risk of HIV and other sexually transmitted infections (STIs) for women.