Mitigating the adverse impact of health-related stigma

Abstract

Stigma targeting health problems contributes to suffering, and it interferes with timely help seeking and effective treatment. It may also influence social policy by limiting resources for health services, prevention programs, and research. The basis and features of the disqualification from full social acceptance, which is a cardinal feature of stigma targeting different diseases and disorders, may varies across cultures and for different stigmatised health problems. People may not recognize the value of treatment for schizophrenia, or they may overemphasize the risk of violence. Victim blaming may be a feature of the stigma attached to substance abuse and HIV/AIDS. Insofar as promoting safe sex is key to preventing HIV/AIDS, and promoting a sense of invidual responsibility for problem drug use is a part of treatment for substance dependence, it may sometimes be difficult to distinguish health promoting from stigmatizing interventions.

Collaborative study of the cultural epidemiology of stigma at the Swiss Tropical Institute (STI) and the Department of Psychiatry of the KEM Hospital Mumbai has led to clinical and community studies of mental health focussing on social stressors, cultural values, and both the determinants and effects of illness-related stigma. This research has focussed on the sociocultural aspects of life in an urban slum that contribute to mental health problems. Questions about the social disqualification that defines stigma, and which contributes to the illness burden from social suffering and by discouraging effective medical help seeking, have motivated this research, with attention to practical implications for planning community services for mental health.

Other STI collaborative studies have examined the cultural epidemiology of tuberculosis and gender with particular attention to determinants of self-perceived stigma. These studies have also considered the impact of stigma on key aspects of TB control, and particular ways in which gender interacts with sociocultural variables to influence illness-related experience and behaviour. This research has produced methods for examining the nature and the determinants of illness-related stigma targetting chronic disorders, with particular attention to illness-related stigma in low and middle-income countries.

A focus on stigma, health, and illness in these research collaborations is examining theoretical and practical questions about the particular features of stigma targeting specific health problems. The research collaboration at KEM Hospital is developing a new line of stigma studies in North-South partnerships focussing on adverse social responses to mental health problems, tuberculosis, epilepsy, and HIV/AIDS. Studies of illness-related experience, meaning, and behaviour and ways in which cultural epidemiology explains stigma elaborate disease-specific social contexts of illness. Each condition has unique features that influence the nature of stigma targeting people with these health problems. The research aims to show how stigma-mitigating interventions may be effective by focusing on eliminating the illnesses that are targets of stigma, influencing the attitudes and behaviour of stigmatisers, and supporting people who are targets of stigma.

Contact addresses:

Dr. Mitchell Weiss
Professor and Head
Dept. Public Health & Epidemiology
Swiss Tropical Institute
Socinstrasse 57,
Post Box
CH-4002 Basel
Switzerland

Tel: +41 61 284 82 84
Email: Mitchell-G.Weiss@unibas.ch

Dr. S. R. Parkar
Professor & Head
Department of Psychiatry
Seth G.S. Medical College & KEM Hospital
Parel
Mumbai 400 012
India

Tel: +91 22 2413 6051
Email: pshubhangi@mantraonline.com