Stigma and Discrimination Defined

[Erving] Goffman defined stigma as an "attribute that is deeply discrediting" that reduces the bearer "from a whole and usual person to a tainted, discounted one." Since Goffman, alternative definitions have varied considerably. Two reasons for this variation are that the concept has been applied to an enormous array of different circumstances -- from schizophrenia to exotic dancing -- and that it has been studied from the perspective of many disciplines. We attempt to advance the study of stigma by proposing a definition that encompasses these differences and that attends to important critiques noting that much theory about stigma is uninformed by the lived experience of the people being studied and that research on stigma has an individualistic focus, viewing stigmas as something in the person rather than a designation that others affix to the person. We conceptualize stigma as a process. It begins when dominant groups distinguish human differences -- whether "real" or not. It continues if the observed difference is believed to connote unfavorable information about the designated persons. As this occurs, social labeling of the observed difference is achieved. Labeled persons are set apart in a distinct category that separates "us" from "them." The culmination of the stigma process occurs when designated differences lead to various forms of disapproval, rejection, exclusion and discrimination. The stigma process is entirely contingent on access to social, economic and political power that allows the identification of differentness, the construction of stereotypes, the labeling of persons as different and the execution of disapproval and discrimination.

Canadian HIV/AIDS Legal Network and Canadian AIDS Society
HIV/AIDS and Discrimination: A Discussion Paper (1998)

http://www.aidslaw.ca/Maincontent/The UNAIDS Definition

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed a protocol for the identification of discrimination against people with HIV/AIDS. (See Protocol for the Identification of Discrimination against People Living with HIV (2000); available at: http://www.unaids.org/publications/documents/human/law/JC295-Protocol-E.pdf)

According to the protocol, HIV/AIDS-related discrimination is defined as follows: Any measure entailing any arbitrary distinction among persons depending on their confirmed or suspected HIV serostatus or state of health.

The protocol distinguishes between legitimate and illegitimate discrimination. Illegitimate discrimination is unjustified, disproportionate, and arbitrary. A measure or an action is unjustified if it lacks rational and objective reasons. It is disproportionate if the means employed and their consequences far exceed or do not achieve the aims pursued. It is arbitrary if it seriously infringes the rights of the individual and is not necessary to protect the health of others.

The protocol recognizes that "[d]iscrimination against people living with HIV/AIDS also extends to those with whom AIDS is associated in the public mind (homosexuals, prostitutes, drug addicts, hemophiliacs, and family members and associates of HIV-positive people)."

The New South Wales Anti-Discrimination Board Definition

In 1991 the Anti-Discrimination Board in the state of New South Wales, Australia, held a public inquiry into HIV/AIDS-related discrimination. (See Discrimination-The Other Epidemic. Report of the Inquiry into HIV and AIDS Related Discrimination. The Board (1992); available at: http://www.lawlink.nsw.gov.au/adb.nsf/pages/index)

The Board observed that HIV/AIDS-related discrimination can take a variety of forms, which may be more or less obvious: It can range from almost imperceptible attitudinal hostility through to physical violence. It can manifest itself in forms which appear reasonable and justifiable, or in extremes of pathological behaviour. It is sometimes blatantly explicit, but more often subtle, sophisticated and difficult to define.

The Board identified eight forms of discrimination:

1. direct discrimination: discrimination that is explicitly based on characteristics of or attributed to the individual against whom the discrimination is directed, including characteristics attributed on the basis of stereotyping.

2. indirect discrimination: discrimination that is based on the establishment of rules, policies or conditions that do not in themselves appear discriminatory, but that have the effect of discriminating against particular groups of people who are unable, or less able, to comply with the conditions.

3. reactive discrimination: discrimination that occurs when a person is confronted with someone who is, or who is assumed to be, a member of a group against which the person holds strong prejudices; such discrimination is not intentional or planned.

4. proactive discrimination: discrimination that is intentional and planned; it is often found in the development of policies, procedures, and rules that have as their purpose to preclude certain groups, or to exclude them if they are found to be present.

5. passive discrimination: discrimination that occurs by failure to act, when the particular needs of particular groups are not met, often with the justification of providing equal treatment for all, but, in fact, failing to meet the special needs of some.

6. scapegoating: discrimination that seeks to subject people to punishment, usually on the basis that they are to blame for some social evil, and that involves actively seeking out and victimizing the objects of prejudice.

7. harassment: discrimination that involves subjecting a person to psychological, emotional, and sometimes physical discomfort, because of characteristics s/he has or are attributed to him/her; it may range from refusal to acknowledge or deal with a person, through indirect and direct verbal ridicule or abuse, to interference with property, and to the extreme of physical assault.

8. vilification: discrimination that involves making statements about a group of people on the basis of their characteristics or of stereotypical assumptions about them that bring members of the group into hatred, ridicule or contempt.

Health Resources and Services Administration, HIV/AIDS Bureau
Stigma and HIV/AIDS: A Review of the Literature (2003)

http://hab.hrsa.gov/publications/stigma/stigma_defined.htm

HIV-related stigma refers to all unfavorable attitudes, beliefs, and policies directed toward people perceived to have HIV/AIDS as well as toward their significant others and loved ones, close associates, social groups, and communities. Patterns of prejudice, which include devaluing, discounting, discrediting, and discriminating against these groups of people, play into and strengthen existing social inequalities--especially those of gender, sexuality, and race--that are at the root of HIV-related stigma. HIV infection fits the profile of a condition that carries a high level of stigmatization (Goffman, 1963; Herek, 1999; Jones et al., 1988). First, people infected with HIV are often blamed for their condition and many people believe HIV could be avoided if individuals made better moral decisions. Second, although HIV is treatable, it is nevertheless a progressive, incurable disease (Herek, 1999; Stoddard, 1994). Third, HIV transmission is poorly understood by some people in the general population, causing them to feel threatened by the mere presence of the disease. Finally, although asymptomatic HIV infection can often be concealed, the symptoms of HIV-related illness cannot. HIV-related symptoms may be considered repulsive, ugly, and disruptive to social interaction (Herek, 1999).

The discrimination and devaluation of identity associated with HIV-related stigma do not occur naturally. Rather, they are created by individuals and communities who, for the most part, generate the stigma as a response to their own fears. HIV-related stigma manifests itself in various ways. HIV-positive individuals, their loved ones, and even their caregivers are often subjected to rejection by their social circles and communities when they need support the most. They may be forced out of their homes, lose their jobs, or be subjected to violent assault. For these reasons, HIV-related stigma must be recognized and addressed as a life-altering phenomenon.

HIV-related stigma has been further divided into the following categories:

Instrumental HIV-related stigma--a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness (Herek, 1999)
Symbolic HIV-related stigma--the use of HIV/AIDS to express attitudes toward the social groups or "lifestyles" perceived to be associated with the disease (Herek, 1999)
Courtesy HIV-related stigma--stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people (Snyder, 1999, based on Goffman, 1963).

Merriam-Webster Dictionary

Stigma

http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=stigma&x=19&y=17
Etymology: Latin stigmat-, stigma mark, brand, from Greek, from stizein to tattoo

1a: archaic: a scar left by a hot iron
1b: a mark of shame or discredit
1c: an identifying mark or characteristic; specifically : a specific diagnostic sign of a disease

2a: stigmata plural : bodily marks or pains resembling the wounds of the crucified Christ and sometimes accompanying religious ecstasy

3a: a small spot, scar, or opening on a plant or animal
3b: the usually apical part of the pistil of a flower which receives the pollen grains and on which they germinate

Discrimination

http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=discrimination&x=10&y=14
1a: the act of discriminating
1b: the process by which two stimuli differing in some aspect are responded to differently

2a: the quality or power of finely distinguishing

3a: the act, practice, or an instance of discriminating categorically rather than individually
3b: prejudiced or prejudicial outlook, action, or treatment <racial discrimination>

Salvator Niyonzima, UNAIDS Advisor for the Greater Involvement of People Living with or affected by HIV and AIDS
Understanding HIV-Related Stigma (2003)

http://www.developmentgateway.org/node/130685/special/hiv/HIV_Special-Expert_Perspective.pdf

Theoretically, stigma can be defined as the imposition of a special, discrediting and unwanted mark on a person or a specific category of persons in such a way that they are looked at as fundamentally and "shamefully different". The mark is imposed on people who have or are believed to have a distinctive status or a "deviance," as it is called in sociology.

The mark is usually non-material but, in certain instances, the differentiation process has gone as far as translating into material things (e.g. mutilations to the human body, tattoos, brands). In these cases, stigmatized persons are not only looked at as different, they appear unmistakably different, i.e. their difference shows. Sometimes, confinement in specially designated areas is also used as a material way to visualize the difference and to draw a boundary that separates from other human beings. Quarantining is one among the most striking examples.

HIV/AIDS-related stigmatization starts as soon as information (accurate or not) regarding a person's serostatus is known. It is the process whereby the person is looked at in many different ways, all of them negative and judgmental soon after he/she is known or suspected to be HIV positive.

Substance Abuse and Mental Health Services Administration
Improving Substance Abuse Treatment: The National Treatment Plan Initiative: Changing the Conversation (2000)

The Greeks coined the term stigma to refer to "bodily signs designed to expose something unusual and bad about the moral status of the signified." Today, stigma generally connotes ignominy, a discrediting effect, an "undesired differentness" (Goffman, 1963).

There are three general categories of stigmas:

Abominations of the body: various physical deformities;
Blemishes of individual character: weak will, domineering, deviant passions, distorted beliefs, and dishonesty, evidenced by, for example, substance abuse, alcoholism, mental disorder, prostitution, imprisonment, or suicidal tendencies; and
Tribal stigma: race, religion, nationality and gender (Goffman, 1963).

In all three types of stigma, the same sociological features are found: "An individual who might have been received easily in ordinary social intercourse possesses a trait that can obtrude itself upon attention and turn those of us whom he meets away from him, breaking the claim that his other attributes have on us. He possesses a stigma, an undesired differentness from what we had anticipated.... [W]e believe the person with a stigma is not quite human. On this assumption we exercise varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances" (Goffman, 1963).