Pull Quote: ‘…stigma is terrifying because it destroys a person’s identity and devalues that person in other persons’ eyes from being a whole person to now becoming tainted and discounted; the person is discredited’
QUITE RECENTLY, my research presentations on HIV/AIDS seem to be troubling parts of the private media, and inducing some to aggressively enter the realm of speculation and idle and unintelligent gossip. One such speculation enquired whether I am now engaged in HIV/AIDS research and have given up on the government. Well, the private media czars, probably, would like me to give up on the government of Guyana, but let me say to these czars: I am still very much with the government of Guyana, and quite satisfied in being a part of it.
In this context of rumour-mongering, I wonder why some of these people do not try to acquire a ‘real’ job rather than parading as ‘journalists’. Some of these seemingly lurk in the shadows like something evil, eagerly waiting to contaminate the environment. Look! In this country, there still is considerable fundamental work outstanding on theory-based interventions in HIV/AIDS, and for this reason, receptivity to evidence-based research for population health inclusive of HIV/AIDS should be forthcoming.
And with regard to my recent HIV/AIDS presentations, let me set the record straight as they pertain to my interests in public health. I have been working in public health since the 1990s. I was the Associate Public Health Epidemiologist with the New York City Department of Health Bureau of HIV Prevention Intervention, and Primary Care Coordinator in Graduate Medical Education at the Interfaith Medical Centre, SUNY. During this time, the U.S. Journal AIDS Patient Care and STDs carried two of my papers as follows: Partner notification as a prevention strategy: A social system perspective.  AIDS PATIENT CARE AND STDs (January 1999); and Behavioural interventions for Black and Latino men who have sex with men.  AIDS PATIENT CARE AND STDs, Volume 11, 1997. I did Postdoctoral work in Public Health at Columbia University. There are my other public health research and consultancy experiences which I will leave for now.
And the University Press of America, a Division of the Rowman and Littlefield Publishing Group, quite recently approved for publication my book manuscript on HIV/AIDS Knowledge and Stigma-related Attitudes among High School Students. As Pro-Chancellor, I continue to sustain my academic range through research and publications. And for these reasons, consistent with my recent HIV/AIDS presentations, I will in this week’s perspective focus on a revised version of language and stigma in HIV/AIDS, largely applying the ideas of Irving Goffman, Sapir, and Whorf.

Goffman states that stigma is terrifying because it destroys a person’s identity and devalues that person in other persons’ eyes from being a whole person to now becoming tainted and discounted; the person is discredited. People receive a stigma on the basis of what they have done and/or because of who they are. People Living with HIV/AIDS (PLHIV) may see themselves through these frequent negative judgments. And these judgments come about through scrutiny by others. The so-called ‘normal’ people see PLHIV as deviants.

In experiencing this inspection, the PLHIV may engage in impression management where they present themselves to others in the most favourable light, which may very well not be the PLHIV’s true circumstances. Therefore, it is very important for health care professionals, when providing prevention interventions and care and support, to be cognisant of, and be responsive to, the PLHIV’s ‘impression management’ behaviour. If not, health workers could be applying therapy to a false behaviour. Therefore, knowing the role of impression management is critical for addressing stigma.

Knowing the values shaping morality also is critical for addressing stigma, and the values also may clash with stigma. These are values of what is right from what is wrong. This clash may create three divisions in society: (1) ‘Us’ (uninfected) and ‘them’ (infected); (2) projection of guilt/innocence on how the infection happened; and (3) gender bias, meaning that women bear the brunt of this infection, and they are expected to maintain and defend morality.

And in this culture of stigma, ‘normals’ and stigmatised people do mix, having what Goffman calls mixed situations. Goffman describes the mixed situations, thus:  Both ‘normals’ and stigmatised people attempt — through a distinctive arrangement of their lives, often under tremendous duress — to avoid an interaction; stigmatised people also experience excessive self-consciousness, displaying considerable anxiety and uneasiness. And then stigmatised people have to manage this stigma: Accepting forced awareness where people attach disparaging labels to them; and experiencing an invasion of privacy in the guise of sympathy hand-outs.

Within the HIV/AIDS behavioural intervention domain, language is the main driver for a culture of stigma among healthcare professionals, caregivers, PLHIV, and the general public.  Stigma is shared. And without language, we will be unable to transmit stigmatised thoughts, emotions and beliefs. Therefore, the potential for stigma to be extensively transmitted through language should not be underestimated and should alert all to the necessity of carefully using words, expressing beliefs and providing actions.

This language, too, helps us to give meaning to the world of the PLHIV. The PLHIV’s world has no meaning until the PLHIV themselves give it meaning through their own culture. People working to provide care and support to PLHIV must recognise that it is mainly through language that we impose stigma and become discriminatory in this helping relationship.

There is another aspect to language that can inhibit stigma. Speakers of a particular language will interpret their world through the vocabulary and grammar that that language provides. The Sapir-Whorf hypothesis suggests that “the worlds in which different societies live are distinct worlds, not merely the same world with different labels attached.” The hypothesis implies that healthcare workers will have to understand the world of the PLHIV from the PLHIV’s standpoint; understanding the PLHIV’s vocabulary and grammar. This is true even within the same language, because people at different social class levels use different vocabulary and grammar in the local vernacular.