Stigma and Stigmatization

Abstract

As Weiss and Ramakrishna noted in 2006, stigma is “a social process or personal experience characterized by exclusion, rejection, blame or devaluation that results from experience or reasonable anticipation of an adverse social judgment about a person or group.” In HIV related stigma, this judgment is conferred by one’s HIV-seropositive status. Framed as an individually constructed trait, early research on HIV stigma has focused on stereotype formation and its behavioral and emotional consequences. Studies have identified two categories of stigmatization—enacted and felt stigma, distinguished by experiences of actual discrimination (enacted stigma) and one’s perceived fear of encountering stigmatizing practices (felt stigma). Both forms of HIV-related stigma are intertwined with the illness course and uniquely sustained or mitigated by the responses of broader society, friends, and families. Moreover, there are multiple layers of stigma particularly among women and ethnic and sexual minorities living with HIV. Perceptions of marginalization and social rejection, for example, could be perpetuated by virtue of one’s serostatus, risk behaviors associated with HIV transmission, undocumented immigration status, gender, or sexual orientation. The immediate consequence of enacted HIV-related stigma is a loss or diminution of individual status. People living with HIV (PLHIV) who experience status loss often report poor mental health outcomes (depression, negative self-worth, social isolation), delayed access to and inconsistent utilization of HIV care, poor medical treatment adherence, and avoidance of serostatus disclosure, particularly among racial and ethnic minorities in the USA and groups that contend with inequalities that predate learning about their HIV serostatus.