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symptoms stigma
Lecture ILO
To demonstrate an understanding of
culture, notions of gender and stigma on
the experience of symptoms
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stigma is becoming a priority interest
of public health. It is also a matter of
particular interest because stigma is
such a prominent feature of many
chronic diseases and health problems
throughout the world
What is stigma?
• Stigma is a negative response to human
differences. These may be obvious visible
signs or differences in behavior, or they
may be more subtle.
• If these are related to a health
condition, we call this response ‘healthrelated stigma ,At the other end of the
spectrum is overt negative behavior, often
called discrimination
What is
Discrimination is the treatment
of an individual or group with
partiality or prejudice.
What is
The people who are perceived to
be ‘different’ are often labelled,
e.g. as a ‘leprosy sufferer’ or
‘mental case’.
Society tends to have stereotypes that go with
these labels, particular views of what such a
person is like (very contagious, cursed, sinful,
rejected by society in the case of leprosy; or
dangerous, unreliable and not able to take
decisions in the case of mental illness)
Ogden and Nyblade divide stigma into four loosely defined groups: physical, social, verbal and institutional.
and forms
of stigma
• Social stigma
Isolated from community
Voyeurism: any interest may be morbid curiosity or mockery rather than
genuine concern
Loss of social role/identity: social `death`, loss of standing and respect
Physical stigma
Isolated, shunned, abandoned
Separate living space, eating utensils
Forms of stigma (contd.)
• Verbal stigma
Gossip, taunting, scolding
• Institutionalized stigma
Barred from jobs, scholarships, visas
Denial of health services
• Stigma exists when the following
interrelated components converge:
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Stigma exists when the following interrelated
components converge:
1. people distinguish and label human
2. labeled persons are linked to undesirable
characteristics -- to unwarranted negative
3. labeled persons are viewed as an out group as
“them” and not “us”
4. people experience emotional reactions to labeled
people – fear, repulsion, disgust and labeled persons
may feel shame, embarrassment, humiliation
5. labeled persons experience status loss and
discrimination as a consequence
6. stigma is dependent on power
1- Fear . This may be fear of catching disease
that is infectious (or perceived to be so), such
as leprosy or HIV / AIDS. In the case of leprosy
2-Unattractivenes: some conditions can cause
people to be perceived as unattractive,
particularly n cultures where outward beauty is
highly valued
Very visible conditions may make people feel
uneasy or uncomfortable. They may not know
how to behave in the presence of a person with
such a condition and therefore choose to avoid
the person
4- Association
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What are the causes of stigma?
One condition may also become
more stigmatized, because of
association with another condition.
A good example is that of
tuberculosis and its association
with HIV / AIDS.
What are the causes of stigma?
• 5- Values and beliefs Values
• Examples divine curse or is caused by sin in a previous life. Religious
values regarding sexual relationships and marriage may cause HIVrelated stigma if HIV is perceived to be the result of marital infidelityare
beliefs regarding the cause of a condition, such as the belief that leprosy
is a
• 6- Lack of confidentiality
• Unwanted disclosure of one’s condition can be due to the way test
results are handled or due to deliberate disclosure by health staff or
careless handling of confidential data. This may be completely
unintended, such as the sending of a reminder letter or a visit by a
health worker in a vehicle marked with the programmed logo
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Who stigmatizes?
Stigma can come
from anyone;
• family members,
• neighbors,
• employers,
• classmates,
• fellow believers in church or at the
mosque or temple, but, importantly
also from health workers. Stigma
from health workers can be
particularly hurtful, since they may
be the people a person turns to for
Infectious disease-related stigma:
Several infectious diseases—for example, TB, HIV/AIDS and leprosy—illustrate
common and distinctive features of stigma.
Stigma has a substantial impact on the experience of illness, help-seeking and
treatment adherence for TB in various ways.
In areas with high prevalence of TB and HIV, stigma of TB may be enhanced by
association with AIDS, which in turn has been shown to contribute to treatment
delay for TB in an HIV high-prevalence
Mental illness and Stigma
As it relates to mental illness:
•Negative attitudes and beliefs that lead to:
What can be done to reduce stigma?
Once we understand how stigmatization works, we can take relatively simple
measures that will help to reduce stigma!
1- make people aware that we may stigmatize without realizing it
2- void labelling persons with a certain health condition,
3- recognize and avoid using stereotypes.
4-o address stigma more systematically and on a larger scale, we need to use specific intervention
Gender differences in felt stigma and barriers to help-seeking
Gender is a factor in health-seeking behavior, and health care is a
by-product of the culture in which it is generated.
Though both men and women experience stigma, they tend to
experience it in much different ways. For examples HIV/AIDSrelated stigma is compounded by gender stigma, which reinforces
existing economic, social, educational, cultural, and access issues
associated with sex
World Health Organization's Department of Gender and Women's Health
suggests that women are perhaps more affected due to differing social
norms associated with appropriate sexual behavior
A UNAIDS study:
• Found that in seven different clinical settings, men where scarcely questioned about
how they contracted the disease and were simply provided treatment.
• Women, on the other hand, often were accused of engaging in extramarital sex and
received lower levels of care and support.
• Such factors limiting access to resources may result in a more rapid progression of disease
for women and a poorer psychosocial adaptation.
Lecture materials
1- The International Federation of Anti-Leprosy Associations (ILEP) and the
Netherlands Leprosy Relief (NLR), London / Amsterdam, 2011
2- he World Health Organization. Gender and Health. Geneva, Switzerland: The
World Health Organization Department of Gender and Women's Health. November