STIGMA AND HIV
The Experience of African American Men
Terrell J.A. Winder
Charles Lea
Shannon L. Dunlap
DEFINING STIGMA
How do we define stigma?
What are the first words that come to mind when we think of stigma?
DEFINING STIGMA
Link and Phelan (2001, pg. 367), expand Goffman’s seminal work (Notes on a
Spoiled Identity, 1963) further by developing four processes of stigma:
• 1) “human differences are labeled by others;
• 2) dominant culture stereotypes these labels;
• 3) categories of labels separate the labeled group from larger society; and
• 4) status loss and discrimination leads to unequal outcomes.”
TYPES OF STIGMA
Enacted Stigma
• Negative reactions to
stigma, especially in
social settings” and
• “episodes of
discrimination
experienced by those
with the stigmatizing
attribute”
Saewyc, E. M., Poon, C. S., Homma,
Y., & Skay, C. L. (2008); Lekas, H. M.,
Siegel, K., & Leider, J. (2011)
Internalized Stigma
Anticipated Stigma
“self-directed prejudice in
response to adapting one’s
self-concept to be
congruent with stigmatizing
responses by society”
“The degree to which
individuals expect that
others will stigmatize them
in various settings”
Herek, Gillis, & Cogan, 2009
Quinn & Chaudoir, 2009
TYPES OF STIGMA
Concealable Stigma
Associative Stigma
• “A stigma that can be kept hidden
from others but carries with it a social
devaluation”
• “A stigma due to association (typically
a caregiver, sibling, parent, partner,
friend) of someone who carries a
concealable stigmatized identity.”
Quinn & Chaudoir, 2009
Quinn & Chaudoir, 2009
COMPONENTS OF STIGMA
Centrality
Salience
MINORITY STRESS THEORY
Illan Meyer(1995, 2003), UCLA’s Williams Institute
Combines stress theory (Lazarus and Folkman, 1984), social psychological
theories, and social stress theories to understand both chronic and recent
stress experiences of LGB people.
Minority stress theory incorporates “(a) external, objective stressful events and
conditions, (b) expectations of such events and the vigilance this expectation
requires, and (c) the internalization of negative societal attitudes” (Meyer,
2003).
INTERSECTION OF STIGMA
Institutional Individual Temporal
•
•
•
•
•
•
•
Gender
Race/ethnicity
Sexual orientation
Behavior
Religion
Geography
Others?
Compiling stigma – multiple stigmas, sometimes over many years
FINDING SELF, DEVELOPING COMMUNITY, AND
BECOMING ADULTS: YOUTH DEVELOPMENT
ORGANIZATIONS IN THE MAKING OF SEXUAL AND
RACIAL MINORITY IDENTITY
Terrell J.A. Winder (2013)
• Some of the words used to describe their sexualities based in religious reasoning included:
• “abomination”
• “a sin”
• “[all gays are] going to hell”
• ”morally wrong” or “immoral”
• “against God”
• “[should be] prayed away”
• “damnation”
INTERVIEW EXCERPT
• Me: Ok. What are some of the messages you’ve received about being
• bisexual?
• Rahsaan: Well black and bisexual… the first message that I received was
• that I’m going to hell…um, and it was a sin, and it was a choice I made on
• my own…Um, my parents really didn’t approve, well they definitely didn’t
• approve of any homosexuality at all. The message I got after that would be
• that um…any gay man had HIV and that they were sick or disgusting…and
• that was pretty much the first two messages that I got…about that.
WHAT DOES THE RESEARCH SAY?
Impact of stigma and on stigma......
• Adherence (clinic appointments; HAART adherence within past week)
• Depression, anxiety, hopelessness
• Receipt of psychiatric care
• Greater HIV-related symptoms
Those who reported HIV transmission likely due to IV drug use or sex with
multiple partners reported significantly more stigma than those reporting HIV
transmission due to sex with one partner.
SMALL GROUP ACTIVITY
Billboards
STIGMA IN THE HEALTHCARE
SETTING
• What are some ways that people with and affected by HIV experience
stigma in the healthcare setting?
• How can stigma impact care?
• What can we do to mitigate stigma experienced within healthcare settings?
STIGMA INSTRUMENTS
• INSTRUMENT TITLE: STD Related Stigma and STD Related Shame
•
SOURCE ARTICLE: Fortenberry, J. D., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., et al. (2002). Relationships of stigma
and shame to gonorrhea and HIV screening. American Journal of Public Health, 92, 378-381.
• INSTRUMENT TITLE: Visser HIV-related stigma
•
SOURCE ARTICLE: Visser, M. J., Kershaw, T., Makin, J. D., & Forsyth, B. W. C. (2008). Development of parallel scales to measure HIVrelated stigma. AIDS and Behavior, 12, 759-771.
• Berger HIV-Stigma Scale (40-items)
•
Berger, B.E., Ferrans, C.E., & Lashley, F.R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV Stigma Scale.
Research in Nursing and Health, 24, 518-529.
• Youth Stigma Scale (Revised Berger)
•
Wright, K., Naar-King, S., Lam, P., Templin, T., & Frey, M (2007). Stigma Scale Revised: Reliability and validity of a brief measure of stigma
for HIV+ youth. Journal of Adolescent Health, 40, 96-98.
REFERENCES
• Goffman, E. (1963). Stigma: Notes on a spoiled identity. New York: Simon and Schuster.
• Herek, Gillis, & Cogan (2009). Internalized stigma among sexual minority adults: Insights from a social psychological
perspective. Journal of Counseling Psychology, 56, 32-43
• Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual review of Sociology, 27, 363-385
• Meyer, I.H (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues
and research evidence. Psychological Bulletin, 129, 674–697. doi: 10.1037/0033-2909.129.5.674
• Meyer, I.H (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38-56.
• Quinn, D.M. and Caudoir, S.R. (2009). Living with concealable stigmatized identity: The impact of anticipated stigma,
centrality, salience, and cultural stigma on psychological distress and health. Journal of Personality and Social
Psychology, 97, 634-651.
• Saewyc, E. M., Poon, C. S., Homma, Y., & Skay, C. L. (2008); Lekas, H. M., Siegel, K., & Leider, J. (2011). Stigma
management? The links between enacted stigma and teen pregnancy trends among gay, lesbian and bisexual
students in Brittish Columbia. Canadian Journal of Human Sexuality, 17, 123-139.