Dan Constantinescu

Prof. Edwards

Disease and Discrimination

1/29/99

Gilmore, N. and Somerlville, M., A. 1994. Stigmatization, Scapegoating and Discrimination in Sexually Transmitted Diseases: Overcoming ‘Them’ and "Us".

Soc. Sci. Med. 39:1339-1358

In this paper Gilmore and Somerville investigate the nature of stigmatization, scapegoating, and discrimination in regard to sexually transmitted diseases (STDs), particularly AIDS. The authors explore the causes of these reactions, the roles they play, and their effects. They also examine the counter-reactions, mainly respect for persons and human rights. The authors conclude that we must realize that everyone has to deal with AIDS together, and that the concepts of "them" and "us" must be overcome.

Gilmore and Somerville begin by discussing stigmatization. The authors define stigmatization as a mark or sign of disgrace, discredit or infamy. The section begins by discussing four discernable characteristics of stigmatization. First, there must be a problem which can cause a stigmatizing response that can somehow spare the stigmitizer from the problem or allow him to control it. Second, the party stigmatized must be distinguishable. Third, the stigma must be associated with the party stigmatized. Fourth, there must be a reaction which distances the stigmatized from the stigmitizer. The authors, believe there are several purposes of stigmatization: protection, strengthening or homogenizing a community, and social control. Stigmatization can also be thought of as an exercise of power, or as a response to threats to the values of a party. According to the authors, stigmatization can cause several harms to the group stigmatized. In terms of disease, it can result in restricted access to prevention and treatment services. It can result in emotional or even physical pain due to violence, and sometimes the characteristics suggested by the stigmatization can be adopted by the stigmatized.

The authors then shortly discuss scapegoating, stereotyping, and discrimination. They define scapegoating as blaming a party who is innocent of being responsible for a particular evil such as a disease. It is a means for society to blame its problems on a certain party. They define stereotyping as a reaction which leads to stigmatization and discrimination. Stereotyping is generally the result of fear, prejudice and ignorance. The authors discuss discrimination in terms of the legal system and focus on the attempts by the law to reduce discrimination of all sorts against a party.

The paper then centralizes on the specific issue of AIDS. The authors write that AIDS is partly stigmatized due to its association with homosexuals, prostitutes, and drug users. Because it is an STD there is also stigmatization due to disclosure oh one’s intimate behavior. Therefore People with AIDS can face three stigmas: for having AIDS, for having an STD, and for being associated with certain "deviant" groups.

The authors then investigate counter responses which have developed in response to stigmatization. scapegoating, and discrimination. First, there have formal statements by certain organizations such as the International AIDS Society’s Declaration: Scientists Against AIDS Discrimination. Much counter-response has come from the stigmatized communities themselves especially in the case of AIDS and has resulted in tighter group solidarity. These responses have often created symbols such as NAME project and the Red Ribbon campaign.

The paper is concluded by a section titled: "We are all ‘us’". In this section the authors concisely explain the more recent movement by society to examine its actions and realize that the wrongful nature of stigmatization, scapegoating, and discrimination. Specifically, in the case of AIDS we have realized that the best health practice can only be achieved if there is good human rights practice. By understanding that we are all on this planet together facings AIDS and if we cooperate we are more likely to find better treatment or a cure.

Generally, the paper is well written, thorough, and insightful. They are able to cover a lot of information due to the clear organization, such as the division of the paper into eight subheadings. Terms are usually defined or explained when needed so that laypersons can fully understand their ideas. At the same time, however, the paper is informative enough so that the expert in the field can benefit from it.

The paper is directed to everyone. This can be observed from the conclusion of the authors that there is no "them" and "us" and that we are in this all together. Similarly, the authors would agree that this paper is not for "them" or "us", but for everyone. Both the stigmitizer and the stigmatized benefit from reading this paper as well as the few who have not encountered a situation in which they have been on one side. The stigmatizer is helped to understand why he is reacting in the manner that he is towards a certain party. This potentially allows him to see the cause of his feelings and hopefully persuades him to see his possible error and definite lack of sympathy and respect for human rights. The stigmatized learn that they are not directly responsible or at fault for these harsh reactions, and that they are not inherently evil or wrongdoers. As for the individual who has not experienced such a situation he is free to see both sides and know how to react in the future event of being in the position to stigmatize and discriminate or being stigmatized and discriminated against.

Overall, Gilmore and Somerville successfully attempt to dissect the different characteristics of negative reactions towards people who have STDs. Their study is very informative and touches upon the psychological, social, and slightly scientific aspects of stigmatization and discrimination. Their discussion particularly focuses on AIDS, but they develop their arguments in such a manner that their discussion of these characteristics can apply to many diseases and to an extent even to non-disease based stigmatization and discrimination. Therefore, it encompasses many different situations and applies to every one of us. They provide valuable information regarding the causes and effects of stigmatization and discrimination and along the way force us to question the motives for our behavior in certain situations with the effect of making us understand that disease affects us all and hiding from it by attempting to isolate it through stigmatization, scapegoating, and discrimination is an ineffective method of abolishing it.