By Marc Kolman, M.S.P.H.
November 18, 2009
Two weeks ago we held a pastor's forum here in Durham, North Carolina. About 20 pastors came from both black and white Christian congregations. Stigma became the main topic. One of the things that surprised me most were the challenges of talking about health issues period -- let alone more controversial issues like HIV/AIDS.
One pastor shared that one partner of a couple in his congregation has a health issue that they won't talk about with anyone other than the pastor -- and this health issue is not even a stigmatized disease like HIV, but something like high blood pressure, diabetes, or cancer. But if the couple doesn't share their problem, the congregation can't effectively support them.
Another couple has a gay son who is HIV positive. The son has moved to NYC. Since the couple won't raise the issues with their church community, they are left alone to deal with the significant issues related to gay oppression and HIV. Because they don't talk about it, they don't get the benefits of support from their faith community. And in the Southern US as elsewhere, church communities are strong, numerous and influential.
Stigma is the effect of oppressions and works both externally and internally. External oppression is the combination of forces working throughout our society to target individuals for who they are -- their life choices, identities, cultures, beliefs. Oppressions are ubiquitous. They operate throughout society and target everyone. Though oppressions towards a lot of groups, such as racism and sexism, are much more blatant, common-place, and egregious, no one is immune from oppression. Yes, there is oppression towards heterosexual, middle-age, Protestant, white men (the oppressor of last resort). The result is that everyone is saddled with the effects of oppression and can be targeted -- stigmatized -- if it serves at the time. Internal oppression is what people experience when they turn the external oppression on themselves -- they believe the messages about themselves and others in their group or constituency that can then be turned inwards on ourselves or outwards on those we love and cherish. Internal oppression serves to keep the external oppression functioning in the society.
Stigma serves to keep us separate, confused and feeling like potential victims. Stigma operates around HIV, but targets anything -- race, religion, class, etc. To end stigma would be to truly end the oppressions of all people -- to change the world to become a place where differences are respected and honored, where people care about others, where people can truly and safely be who they are.
Several of the pastors at our forum said they need ongoing dialogue in support of ending the stigmas in their congregations. They need education and information about HIV. They need support in addressing significant moral issues within their congregations. And they need help coordinating outreach and ministry activities. They also need their deacons, members of their congregations, and other pastors to back and support them. It takes courage to move forward against stigmas that are so prevalent and challenging.
Marc is Executive Director of the Piedmont Health Care Consortium in Durham, NC.
To contact Marc, click here.
Comment by: Dave
Sun., Jul. 10, 2011 at 4:54 pm UTC
Stigma does exist no doubt especially in the south, since my diagnosis and battle with menegitis I have tried to get help through the VA the Aids of alliance and although I do get meds from the VA its obvious their health care team only knows trauma cases and they try cognitive behavior. HIV is a disease which can affect the brain and no matter how much Talk therapy is used thats all it is. It doesnt open doors to employment, financial services or clothes or shoes. It is a way of keeping people in the system so they get paid as clinical professionals nothing more....I have become more and more disenchanted with their services I now know why all those vets you see holding cardboard signs would rather be out there then dealing with VA red tape and beauracracy. Its appaling Vets are seen as a cash cow for the VA to charge our government to fund their programs. I have seen many HIV patients at the VA, all tired, run down and I think to my self why do you bother...its because they have been put in the believe thats thats all there is...After working 30 years and paying taxes I am appaled to come back to a state that has such an economic diversity, the rich and the poor...plain and simple, I suspect those clinicians and shrinks are the ones living in the fancy homes in Chapel Hill while the patients are the ones homeless or soon to be.
Comment by: Greg Griffin
(Los Angeles, California)
Tue., Nov. 24, 2009 at 12:18 am UTC
It is true that any illness carries a certain stigma--the stigma of being sick in a society that places a high value on youth and healthiness. The stigma associated with HIV however, is more pervasive, and still has much to do with the homophobia in our society. Churches, especially those in the South, have been big time provocateurs of homophobia, and thus whatever they sanctimoniously claim about helping the sick, are very culpable as far as stigma goes and HIV. I've been positive since the early 1980's and things are immensely better than they once were, especially here on "the coast". But I still here preachers spilling their garbage about the evils of AIDS and homosexuality. I think if you are going to the Church's well to draw some anti-stigma soothing water (sorry about the metaphor), you are likely to be drawing some pretty rancid water, especially in the South. Let's face it: these people are our enemies, your 20 pastors perhaps being exceptions! Good luck on changing many attitudes--You will need it . . . .
Comment by: Scott
Fri., Nov. 20, 2009 at 9:39 am UTC
Nonsense. I've had Cancer 2x and I am poz. Trust me, the only response I ever received from someone who knew had had cancer was compassion. To liken the stigma of cancer to HIV is ridiculous
Comment by: Ndungu
Fri., Nov. 20, 2009 at 7:01 am UTC
Good article. I think the main reason HIV/AIDS is stigmatized compared to other life threatening illnesses is due to the fact that the illness is associated with promiscuity. When one gets a condition such as cancer people will be sympathetic towards him. However, if i inform my friends that i have contracted HIV/AIDS they will alienate me from their circle because they'll assume i contracted HIV as a result of my sexual behaviour i.e having multiple sexual partners, being reckless in my sexual practices by not practicing safe sex etc. Hence the element of behaviour comes in and that's the reason why people are likely to stigmatize someone with HIV. Most people are ignorant when it comes to HIV especially regarding issues to do with modes of transmission and that's why they stigmatize. I think we need to go an extra mile by breaking the silence and tackle stigma and discrimination by speaking about it in different fora especially using the print media, broadcast media etc. I think HIV should not define who we are as persons. We are all unique human beings created by a loving God whether HIV positive or HIV negative. Underneath, most people who are living with HIV are lovely persons. HIV is a virus and is not a moral issue. I have learnt that HIV does not spare anyone. I have seen engineers, doctors, lawyers i.e elites who have contracted the virus as well as the have-nots in society and hence we should not stigmatize and discriminate those with this illness. The church should be at the forefront in tackling stigma/discrimination and the leaders need to be empowered so that they can be in a position to disseminate information pertaining to HIV/AIDS including HIV modes of transmission to their congregations.
Comment by: Bren
Thu., Nov. 19, 2009 at 9:55 pm UTC
You may be interested to read Susan Sontag's "Illness as Metaphor and AIDS and Its Metaphors" where she attempts to dispel the idea that people get sick because of their personality. It includes the famous quote about moving from the Kingdom of the Well to the Kingdom of the Sick. A useful metaphorical concept to help explain a patient's perception of themselves and the changes in their life that their condition creates.
Comment by: John-Manuel Andriote
Thu., Nov. 19, 2009 at 9:01 pm UTC
This is an interesting, and different, perspective on stigma and oppression. I'm not sure I'd agree about the oppressed white, straight Protestant middle-class males in this country, but regardless. I'd say stigma is a result of the erroneous meanings we attach to things like skin tones, illnesses, and other things that make it possible to distinguish this ("good") one from that ("bad") one. HIV infection has been a stigmatized illness because of the erroneous meanings people insist on attaching to it--mainly as a way of denying their own mortality. Rather than accept the fact that HIV is a microbe, with no meaning and no implicit moral significance, these people assert that it "means" those unfortunate enough to have crossed its path are "immoral," "irresponsible," etc. It's a safe way of kidding oneself into believing "they" are at fault for having this particular virus because "they" are somehow different (from us clean, moral, good, etc. others). It's a virus. Period. It's a different skin tone. Period. It doesn't "mean" anything except we live in an unsafe world and that not all members of the human race (the only "race" that matters) look alike. It's as easy--and difficult to accept for some--as that.
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The Ins and Outs of HIV/AIDS Stigma
Marc Kolman, M.S.P.H.
Marc Kolman is a long-term public health administrator and advocate. With a passion for social justice, Marc has worked in many settings, including state and local governments and non-profit agencies. Primary interests include HIV and issues affecting the deep south. Marc is currently the executive director of the Piedmont Health Care Consortium which envisions a society in which no one is limited by oppressions, health disparities, or social injustices. Marc lives in Carrboro N.C., is an avid cyclist and is the father of three daughters.
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