AIDS Related Stigma in Social Relations: A Qualitative Study in Turkey

Article excerpt

The prevalence of HIV/AIDS in Turkey is considered to be low (Altan, 2008). Eastern European countries have one of the fastest-growing HIV epidemics in the world, and Central Asia also has a high incidence of HIV/AIDS. Turkey's position is between these two regions (Altan, 2008). In Eastern Europe, there were 250,000 new cases in 2001 (www.unaids.org). It can be said that HIV/AIDS is accepted as an emerging disease in Turkey.

According to the Country Report prepared by Altan (2008) for UNGASS, a total of 1,922 HIV cases were reported in Turkey from 1985 to 2004. It was also reported that 551 of the infected individuals had developed AIDS, of whom 63 had died in 2004. The total cases of HIV infection were 2,711 by the end of June 2007, whereas by the end of 2008, the number of HIV cases increased to 3,307. The most common mode of transmission was heterosexual contact; 75 percent of the transmissions were attributed to heterosexual practice, and approximately seven percent were infected through intravenous drug use (Altan, 2008).

The actual number of HIV/AIDS cases in Turkey is unknown, and certainly the actual number of HIV/AIDS cases is higher than the number of cases reported (Ay & Karabey, 2006). The main reason involves the recording system for illnesses in Turkey and a long asymptomatic period of HIV (Duyan & Yildirim, 2003). The number of women contracting HIV has been rising due to the lack of education about AIDS and infections. Most of the victims remain silent about their HIV status because of the fear of being exposed to stigmatization and discrimination (Greef et al., 2008).

Stigma

In his famous work on stigma, Goffman (1963), defines stigma as "an attribute that is deeply discrediting" (p. 3). According to Goffman, stigma is a process by which the reaction of others spoils normal identity. This is because an individual with an attribute that is highly discrediting in a society faces rejection. Therefore, to understand how stigma is constructed in a society, it is crucial to focus on attributions on a sociological level.

Goffman (1963) identified "three grossly different types of stigma: abominations of the body, blemishes of individual character, and tribal stigma" (p. 4). The first one includes the negative attributes attached to physical deformities; the second type includes the negative attributes attached to personal character. And the last type includes the negative attributes attached to a community with a specific nationality, religion, race, etc.

On the other hand, Herek (1999) based on his studies about HIV/AIDS, divided HIV-related stigma into two types: "instrumental" and "symbolic." Instrumental stigma is a reflection of fear and apprehension that is likely to be associated with any deadly and transmissible illness, whereas symbolic stigma includes all kind of attitudes towards the social groups or lifestyles perceived to be associated with the disease. Thus, we can also divide attributions into two types: Those attached to a disease that is perceived as deadly and those attached to a person or social group who has this disease.

Although they used different labels, it is obvious that there are similarities between Goffman and Herek, and a combination or transformation of their conceptualizations is presented in Figure 1.

[FIGURE 1 OMITTED]

There is also another distinction that should be taken into consideration: "Enacted" and "felt" stigma (Scambler, 1998). Enacted stigma refers to actual discrimination or unacceptability whereas felt stigma refers to the fear of such discrimination. This distinction lets us consider the stigmatized individuals' personal feelings. Stigma is a complex social phenomenon that involves interplay between social and economic factors and psychological issues of affected individuals. Enacted stigma is strongly associated with pre-stigmatizing conditions prior to HIV.

HIV and AIDS carry most of the characteristics associated with heavily stigmatized medical conditions. …