Social Science Series #4: Stigmatization of Infectious Diseases
What are infectious diseases?
Infectious diseases are caused by microorganisms in our body such as viruses, bacteria or fungi, which are collectively called pathogens. It is important to understand that infection does not necessarily lead to disease when the immune system of an individual is fully functional, therefore symptoms may not be developed. However when the immune system is compromised, pathogens are able to disrupt the body’s useful cell functions and multiply damaged cells resulting in the presentation of symptoms of the infectious disease. These illnesses can be spread by an infected individual to another through contact with bodily fluids/droplets via coughing, sneezing, and saliva. Previously, some infections greatly decreased with the discovery and usage of antiviral medication. However, with the development of drug-resistant bacteria, lethal affections such as the Human Immunodeficiency Virus (HIV) have caused a great level of unease among people. In conformity with this, infectious diseases are the second leading cause of death and the leading cause of disability-adjusted life worldwide.
(Source: International Society for Infectious Diseases, ISID.org)
What is stigma?
Stigma is a negative response to human differences. This includes negative beliefs, attitudes and behaviour. The term ‘stigma’ originates from ancient Greece, where it was used in reference to a visible mark, brand or label placed on members of tainted groups such as slaves, criminals and traitors. Nowadays, rather than being an actual mark that is burned onto a person’s body, stigma is understood as part of a social process linked to circumstances or characteristics that cause a person or group to be negatively labelled, based on a preconception or misinformation. Today, there is widespread stigma surrounding health conditions such as infectious diseases. The consequence of stigma may be obvious visible signs or differences in behaviour towards stigmatised people, or they may be more subtle actions of people who are unaware of the potentially harmful effects of their responses.
The six types of stigmas related to infectious diseases
Occurs when other people endorse negative stereotypes and prejudices, resulting in discrimination against people with infectious diseases.
Self-stigma happens when a person with the illness internalizes public stigma and holds negative views of themselves.
This is when a person chooses not to seek health treatment to avoid being assigned a stigmatizing label. Label avoidance is one of the most harmful forms of stigma.
Stigma by association occurs when the effects of stigma are extended to someone linked to a person with an infectious disease.
It involves institutional/social structures that discriminate due to stigmatized beliefs that result in diminished opportunities for people with an infectious disease.
This takes place any time a health professional allows stereotypes and prejudices about the illness to negatively affect a patient’s care.
(Source: American Psychological Association)
Infectious diseases and stigma
Among some of the infectious diseases that these types of stigmas may apply to, are the new coronavirus, HIV and leprosy. People with these diseases face interpersonal and social challenges universally. Stigma related to infectious diseases results in prejudices and discrimination among family, friends, employers and even health professionals. Therefore it is important to understand the aetiology and the stigmas of coronavirus, HIV and leprosy in order to get rid of misconceptions and destigmatize these diseases.
(Source: Stigmatised Illnesses and Health Care, Paths of Medicine)
Coronavirus is a form of respiratory virus. The recent strain of coronavirus emerged in December 2019. Due to its widely and fast spread, the World Health Organization declared COVID-19 a pandemic of great concern with more than 138,000,000 cases and 2,900,000 deaths reported across 119 countries by March 2021.
Although the origin of the latest coronavirus is still to be confirmed, research found that transmission of coronavirus occurs when droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth.
Mild cases of coronavirus usually last for a short amount of time, and symptoms may include fever, cough, headaches, body aches, loss of taste and difficulty breathing. Additional symptoms have been reported with coronavirus. Some people infected with the coronavirus have mild COVID-19 illness, and others have no symptoms at all. In some cases, however, COVID-19 can lead to respiratory failure and death etc.
Prevention of coronavirus involves physical distancing, mask-wearing, hand hygiene and staying away from others if symptoms occur. Mild coronavirus symptoms can be treated at home. If symptoms are severe, you may need medical care until you recover. While staying at home with coronavirus, mild symptoms can be eased by resting, drinking lots of fluids and taking painkillers. Treatment for severe coronavirus infections in hospitals, aims to relieve symptoms and reduce the effects of the virus while your body fights the infection, such as breathing support or medicine to reduce inflammation in your body caused by the virus. Furthermore, newly produced vaccines, such as Pfizer, are now believed to help prevent infection with SARS-CoV-2, the coronavirus that causes COVID-19.
(Source: Coronavirus, World Health Organisation)
Stigma surrounding coronavirus
Anxiety is caused by coronavirus lockdowns, and uncertainty around COVID-19 and fear of being infected has increased stigma in local communities. Stigmatization developed worldwide fuelling discrimination and attacks against people including:
- Certain racial and ethnic minority groups, and particularly Asian Americans due to coronavirus being first reported in China and believed to have been ‘caused’ by Chinese people.
- Affected populations including COVID-19 survivors, suspected or quarantined cases, and people returning from overseas.
- Certain sub-populations such as persons suspected of having COVID-19, discharged individuals from quarantine, and people returning from overseas.
- People who show symptoms such as coughing, even though it might just be a mere cold.
(Source: Social Stigma in the time of Coronavirus, European Respiratory Journal)
Human Immunodeficiency Virus (HIV)
HIV is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and diseases.
HIV is found in the body fluids of an infected person, that includes semen, vaginal and anal fluids, blood and breast milk. This infectious agent is a fragile virus and does not survive outside the body for long. HIV cannot be transmitted through sweat, urine or saliva. Most people who get HIV, get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment (for example, cookers).
Most people experience a brief flu-like illness 2 to 6 weeks after HIV infection, which can last 1 or 2 weeks. After these symptoms disappear, HIV may not cause any symptoms for many years, although the virus continues to damage your immune system. This means many people with HIV do not know they are infected.
There is currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life. With an early diagnosis and effective treatments, most people with HIV will not develop any HIV related illnesses and will live a near-normal life style.
(Source: Health Conditions, NHS and Centers for Disease Control and Prevention)
Leprosy is an infection caused by bacteria called Mycobacterium leprae. These bacteria grow very slowly and it may take up to 20 years to develop signs of the infection.
It is not known exactly how leprosy, also called Hansen’s disease, spreads between people. Scientists currently think it may happen when a person with Hansen’s disease coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria. Prolonged, close contact with someone with untreated leprosy over many months is needed to catch the disease.
The disease can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). The bacteria strikes the nerves, which can become swollen under the skin. This can cause the affected areas to lose the ability to sense touch and pain, which can lead to injuries, like cuts and burns. Usually, the affected skin changes colour and either becomes: lighter/darker, often dry/flaky, with loss of feeling and reddish, due to inflammation of the skin. If left untreated, the nerve damage can result in paralysis of hands and feet. In very advanced cases, loss of toes and fingers.
Hansen’s disease is treated with a combination of antibiotics. This strategy helps prevent the development of antibiotic resistance by the bacteria, that can be created due to the duration of the treatment prescribed. It generally lasts between 1 and 2 years. The illness can be cured if treatment is completed as prescribed.
(Source: Leprosy, World Health Organization)
Stigma surrounding leprosy
The fear of leprosy leads to stigma and discrimination and is due to lack of understanding and knowledge about leprosy, which increases misconceptions about the disease’s transmission and treatment. The fact that most of those with untreated leprosy end up with severe deformities and disfigurements has contributed to the stigma. Other than this:
- It is considered mostly as a disease of poverty and associated with those living in poor hygienic environments or working in menial jobs or close to soil.
- Several classical Hindu scriptures state that if there is leprosy in the family, one should not have any matrimonial alliances with such. There are several references in the Bible that affirms leprosy is caused by divine intervention or as a punishment.
- It is believed to be a disabling disease because the patient progressively becomes deformed and mutilated until it is helpless and destitute, even after treatment.
(Source: Leprosy Information Services, infolep.org)
Impact of stigma surrounding infectious diseases
- Encourages people to hide the illness to avoid discrimination and prevent them from seeking health care, immediately leading to delayed treatment or no treatment.
- Findings from 50 countries, indicate that roughly 1 in every 8 people living with HIV are being denied health services because of stigma and discrimination.
- Exclusion from social settings, for example, research conducted in India found those with leprosy were excluded from familial and school settings. Moreover when marriage proposals are brought up, individuals with leprosy are rejected because of their illness.
- Self-stigmatization of individuals with HIV. This can be interpreted as feeling ‘dirty’ or ‘shameful’ and believing that they do not deserve to have a partner, children, friends or work.
- Stigma can lead to discriminations, for example, violent assaults towards Asians during the coronavirus outbreak.
- Stigma profoundly changes how people feel about themselves and the way others see them. It can affect a person’s mental health and well-being.
(Source: Infectious Diseases and Stigma, Unicef.org)
Combating stigma around infectious diseases
Stigma can negatively affect the emotional, mental, and physical health of groups and communities individuals live in. Stigmatized individuals may experience isolation, depression, anxiety, or public embarrassment. Stopping stigma is important, making all communities and community members safer and healthier. Everyone can help stop stigma-related to infectious diseases by:
- Learning the facts: educating yourself about mental illness including substance use disorder.
- Being aware of your attitude and behaviour: examining your own judgmental thinking, reinforced by upbringing and society.
- Choosing your words carefully: the way we speak can affect the attitudes of others.
- Educating others: passing on facts and positive attitudes; challenge myths and stereotypes.
- Following and being part of media campaigns to correct misinformation and change the image of the diseases.
- Seeking psychological treatment for self-stigmatization or the consequences of stigma and talking to a counsellor/psychiatrist.
- Reading “The Equality Act 2010” which makes it illegal for employers to discriminate against an individual on grounds of disability, including living with infectious diseases such as HIV.
- Ensuring that a supportive legislative environment exists so that discrimination can be tackled in relation to infectious diseases.
- Ensuring that both prevention and care services are accessible to all sectors of the population, making efforts to overcome the barriers of racial, gender and other discrimination.
(Source: Addressing Stigma, Centre for Addiction and Mental Health)