Stigmatization and AIDS: critical issues in public health

From Goffman's classic sociological work on stigma to Sontag's popular works on metaphors, stigma has captured academic and general public interest. The severity of the AIDS pandemic has transformed our lives profoundly, and the stigma experienced by persons with AIDS has grave consequences for public health efforts. Fears of the consequences of open discourse and self-identification have created a silence that threatens all of us. Using analyses of Western imagery and African ethnographic accounts, this paper explores the differences between AIDS in America and in Africa with respect to epidemiology, socio-economic and cultural illness patterns, and experiences of stigmatization. Several research questions are posed to stimulate discussion of future ethnographic work on illness and stigma in Africa. The paper concludes with a discussion of the impact on public health of four types of AIDS stigmatization: theologically-based blame, liberal concern for the health of those not afflicted, risk group problem and civil rights problem. From the point of view of enlightened management of public health, the civil rights issue poses the most serious threat. The tension between the rights of the individual, who is at risk of exposure and condemnation because of stigma, and the rights of the rest of society, interferes with the development of large-scale, effective public health programs.