Examining stigma: Us vs. Them

Hey all,

I thought I would share a recent blog post I was privileged to write at a friend's recommendation. (Thanks Jen!) While I am not deeply involved in the AIDS response, I have always been interested (more like intrigued) by the concept of stigma and how it plays out in my life and in other's lives. I think of how I react when a clearly mentally ill person is near, my danger tentacles rise. Or even someone sniffling and sneezing next to me on the bus; I recoil. 

Regardless of the physiological aspects of disease and illness, we all have certain 'ways' we react, whether with compassion, fear or disgust. These have the potential to fuel or quench "othering" in society: the process whereby you identify people as different from yourself or from the norm and deliberately or not, create dominance and subordination in society (Johnson et al, 2004)

We have the power, let's use it effectively. 

Why do people draw a line between “them” and “us”?

Posted on CrowdOutAIDS African English Forum [ http://www.crowdoutaids.org/]

Guest Blogger: Folake Soetan

The great thing about a concept like crowdsourcing is that you get the input of many individuals from varied backgrounds on one topic of interest. Like noses, everyone has an opinion and a suggestion on how to improve the current AIDS situation including improving the lives of young people living with HIV. This is of course what the CrowdoutAIDS campaign is looking for.

While reading through the contributions left by several participants in the Africa forum, I noticed two ‘sides’ beginning to emerge: one was obvious and the other was not. Contributors often referred to a certain group as “they” and “them”, this group being youths living with HIV. Several comments encouraged “them” to disclose their status; “they” should become ambassadors for change; “they” should speak out… This instantly brings up the question: who is on the other side of the equation? If there is a “them”, there will certainly be an “us”.

We recognise that stigma is still one of the strongest driving forces against getting tested and status disclosure. Stigma also intensely restricts the impact of education and advocacy. Even as great strides have been made and many youths are risking their social acceptance and even lives to take a stand against the spread of HIV, there is still intense stigma surrounding a young person who discloses their HIV-positive status, not just to their family, but among other youth.

In seeking to involve youth more in developing an effective AIDS response strategy, it is important for government,  NGOs and/or UNAIDS to recognise both sides of the stigma equation – young people living with HIV and those living without. It is reasonable to expect HIV-positive youth to take a lead in the HIV response with education and encouragement of their peers to get tested. But all potential ‘stigmatisers’, that is the “us”, also have a leading role to play in the response.

Organizations like UNAIDS can create an environment that welcomes openness about one’s status by conducting well-rounded training sessions for youth that include relationship management between those living with and without HIV. How would you respond if your close friend reveals he/she is HIV positive? How would you respond if you discover one of your classmates/colleagues has HIV but you don’t know who? Is it acceptable to ask a person living with HIV questions? What questions would you ask? Asking questions like this in a training environment will reveal inmost prejudices, and prepare all youths to take a stand, even if it is a lonely one, alongside a HIV-positive youth.

Any strategy that seeks to create an empowering environment for people living with HIV must target us, not just them. Youths living without HIV have a vital role to play in the AIDS response. If you are living without HIV, it’s time to stop seeing yourself on the other side of the equation. Only when them and us become we can the issue of stigma in AIDS advocacy be properly tackled.

I used to hate politics....

It's been a while! Quite a lot has happened since my last post that I would love to share in detail. However, due to recall bias (poor use of the term but I must practice my research methods lingo or die), I am unlikely to remember everything I had hoped to share.

The majority of my time has been occupied with writing a 2000 word essay (or better phrased, critical analysis) discussing 'The political barriers to the sustainable financing of health systems in low-income countries'. This topic jumped out at me from a list of 7 options. Mind you there were a lot of other extremely interesting choices such as discussing HIV/AIDS as a security issue (is it a security issue??) but being a citizen of the great state of Nigeria, I couldn't help but think about our current health system.

You might know far more than I do on this topic; no contest, but I saw this as an opportunity to understand what a health system is, what keeps it going and the constraints it faces particularly in developing countries like ours. Without going into too much detail, it is clear from the literature that the challenges faced in development and maintenance of a good health system are created through politics. Of course it follows then that the solutions to these problems are also political! Indeed that is what I have found!

A good health system isn't just having doctors and hospitals, although these are necessary. Instead it is really about making healthcare available and accessible to all people. This means that regardless of your income, who you are (big-man syndrome??) or where you live, you have access to healthcare at the point when you need it. It also means that not only can you afford to access the care at that point, but that in getting care, you are not driven below the poverty line. How many of us have heard stories of families struggling to pay gargantuan hospital bills? Or of people dying  because they were turned away at a health centre due to lack of money? (I read one such story as a kid and never forgot.... the story ended with something like "as she stood  outside the hospital clutching her dying baby, it gave one final shudder and cry, stretched out (as if in pain) and died..." It sounds unbelievably dramatic but as the Yorubas say "aimoye" - only God knows how many people have died or been disabled similarly.

I had a discussion with one of my professors, a normal bubbly and enthusiastic lady. To be perfectly honest it wasn't the greatest conversation for other reasons but in the course of discussing a potential topic for my dissertation (due next year) she said point-blank: "universal [health] coverage is not on the Nigerian policy agenda". I could not agree or disagree...I had no idea! So slowly but surely, I am happening on a potential area of research for myself, the makings of what I hope will be a great dissertation. So I'm getting into politics after all. Ah well even Moses was once reluctant... lol

In Pursuit of what? Many things, but definitely change!!