If there is one ultimate, undeniable truth about HIV; is that it is complicated. There is no denying that. However, HIV stigma is the one challenge that permeates all aspects of HIV and is arguably the most difficult.
We have written a brief overview of stigma on our website. In a nutshell, it refers to negative attitudes and prejudice directed to HIV and can be experienced from a variety of sources including individuals or communities or inflicted by a system or structure.
Stigma can also be internalised by a person. This is where an individual devalues themselves or has feelings of shame about their status.
Stigma feeds and drives fear and misconceptions about HIV. It has far reaching impacts on the entire community. For example, it:
- Has individual psychological impact through a person feeling devalued or ashamed
- Discourages people from getting tested or accessing treatment
- Discourages people from feeling safe to disclose their status
- Impedes institutions and systems from implementing human rights responses to HIV
In bed together: blame culture and stigma
Many of our sexual health messages are at odds with one another. If we really want to challenge HIV stigma we have to examine our health discourse and prevention messaging.
If we are to 1) reduce stigma and 2) reduce HIV transmission we need to examine our health discourse as a whole. This is because we don’t only receive health messages from the health sector, but also from beliefs, cultures and our laws.
The two dominant and opposing health concepts in sexual health are the notions of shared responsibility versus attribution of blame (or the blame culture). These concepts/messages are so opposing it is like comparing apples to oranges. It is like asking a person to be loud and quiet at the same time.
Shared responsibility refers to HIV, BBV and STI prevention being a shared undertaking by consensual sexual partners. The responsibility of HIV prevention does not rest solely on one party- but equally with the HIV positive and HIV negative (or HIV unknown) person. Shared responsibility is by no means a new concept but it is fundamental to a rational and supportive HIV response. A successful HIV response must encourage shared responsibility for the complex factors that surround behaviours associated with transmitting or contracting HIV.
Shared responsibility is clearly at odds with a blame culture. The harms of blame culture can be witnessed most in people’s attitudes towards the criminalisation of HIV disclosure, exposure and transmission. Criminal laws utilise the blame culture which perpetuates HIV stigma. In the 2009 UK study ‘Sexually charged: the views of gay and bisexual men on criminal prosecutions for sexual HIV transmission’ gay and bisexual men were asked about their views on criminal prosecutions for sexual transmission of HIV and their implications for health promotion planning.
In that study, the concept of blame in the bedroom emerged across all camps; from those who agreed with prosecuting HIV transmission to those who disagreed or were unsure about it. When discussing the effects of blame culture, the investigators commented:
“…Health discourses are increasingly attributing blame. The stigma that accompanies blame (or outward signs of blameworthiness, such as having HIV infection) serves a critical social function in maintaining social divisions and power imbalances”
There was also interesting commentary surrounding some of the responses blaming the person who acquired HIV who in their minds ‘should have known better’. The blame culture can goes both ways and is equally destructive and entrenches stigma.
As active health consumers engaged with the issues of HIV, we must remain vigilant and not fall in the trap of using the blame culture to fight HIV stigma. Let’s eradicate stigma by banning blame in the bedroom.
After all, are you fighting stigma or using it?