摘要：We examined the social roots of stigma by means of a case study of HIV/AIDS management among young people in a South African community (drawing from interviews, focus groups, and fieldworker diaries). We highlight the web of representations that sustain stigma, the economic and political contexts within which these representations are constructed, and the way in which they flourish in the institutional contexts of HIV/AIDS interventions. Stigma serves as an effective form of “social psychological policing” by punishing those who have breached unequal power relations of gender, generation, and ethnicity. We outline an agenda for participatory programs that promote critical thinking about stigma’s social roots to stand alongside education and, where possible, legislation as an integral part of antistigma efforts. Stigmatization of people living with AIDS is a key obstacle to HIV prevention and AIDS care. It is now generally accepted that efforts to reduce stigma should be an integrated part of all HIV/AIDS programming. 1 However, discussions of the form such efforts should take remain in their infancy. Here we discuss the social roots of stigma in the interest of contributing to debates about appropriate stigma reduction interventions, drawing on a case study of HIV/AIDS management among young people in South Africa. The existing HIV/AIDS literature points to 3 antistigma strategies. The first is information-based awareness programs designed to reduce ignorance about people with AIDS. However, while ignorance often plays a key role in perpetuating stigma, providing people with factual information about the contagiousness of illnesses does not lead to widespread stigma reduction. 2 The second strategy is institution of legal safeguards making discrimination against people with AIDS a punishable offense. Antidiscrimination legislation has the potential to reduce the explicit and public stigmatization of such individuals. 3 However, manifestations of stigma are often too subtle to be immediately apparent, rooted within individual psyches, families, and communities and beyond the reach of the legal system. Thus, while education and legal safeguards may arguably be necessary conditions for fighting stigma, they are certainly not sufficient ones. The third strategy—which we believe should go hand in hand with the first 2—involves participation of local community members in antistigma efforts. Our interest in this strategy informs the discussion provided here. Although community participation is repeatedly advocated, there is a lack of clarity regarding precisely what community members should participate in and how this participation should take place. Much work remains to be done in providing specific direction to calls for participatory initiatives, lest they result in nothing more than programs in which participants are encouraged to tell one another that stigma is a bad thing and that they should not contribute to it. Such didactic approaches are less likely to succeed than initiatives promoting debate and dialogue within a group of people, especially in marginalized communities where social obstacles may undermine attitude or behavior change. It is through such dialogue that a group may develop critical understandings of the social roots of health-damaging attitudes or behaviors, enhancing their awareness of the obstacles to change they will have to overcome and, ideally, leading to collective action to challenge such obstacles. 4 What are the social roots of stigma? The theoretical literature emphasizes that stigma results not only from fear of physical contagion but also from fear of “symbolic contagion,” a threat to both the health and well-being of individuals and to the well-being and legitimacy of the status quo. Whereas the form and content of stigma will vary from one context to another, various forms of stigma are united by the way in which they serve to support systems of social inequality and social difference and to reinforce the interests of powerful social actors seeking to legitimize their dominant status. 3 We examine the form taken by stigma in 1 small local community in the interest of understanding some of the ways in which stigmatization of people with AIDS is situated within other patterns of material and symbolic social exclusion. We conclude by discussing the implications of our findings for participatory strategies that challenge stigma.
