The work of Foucault and Goffman and – in relation to HIV – Richard Parker, however, reminds us of richer constructions of stigma of stigma as it works on, between and within different groups to regulate behaviours and preserve or undermine existing power balances. While no one would argue that HIV stigma does not present a major barrier to HIV treatment and care, this “metricisation” proposes a simplified construction of stigma: as something bad that “society” does to people with HIV or as something to be eradicated by interventions.
Thus, HIV stigma has emerged as pretty much the only ‘social’ metric used by public health systems to measure the effectiveness of responses to HIV. But intervening on the social/political level is more complicated.Ĭonsensus in the early 2000s that HIV stigma compromises both the health of people with HIV and HIV prevention efforts led to the establishment of global targets for the reduction of stigma and the proliferation of instruments to measure stigma. Likewise, we can measure the effectiveness of interpersonal interventions to improve knowledge and change behaviours. The challenge for public health systems is to formulate effective responses on all three fronts and to measure effectiveness, we need metrics.ĭemonstrating the efficacy of biomedical interventions is relatively straightforward. Like all diseases, HIV has bio-medical, interpersonal and social/political dimensions. However, in the intervening decades, the concept of HIV stigma has itself been transformed: HIV stigma has been metricised.
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Recent cinematic histories such as How to Survive a Plague and United in Anger show us that HIV stigma, and the response to it were messy, political, confrontational and often theatrical. Perhaps it was because the symptoms of HIV were so visible in the 1980s that those who first wrote about it were cultural theorists such as Sander Gilman and Simon Watney.