HIV is a deadly reality in South African communities, where people living with HIV do not only face physical sickness but also severe stigmatisation. Literature shows that spiritual leaders can have a very meaningful role in the reduction of HIV stigma. This article reports on part of a comprehensive community-based HIV stigma reduction intervention with PLWH and people living close to them, which included partners, children, family members, friends, community members and spiritual leaders. The focus of (...) this article is on the experiences of spiritual leaders during and after the HIV stigma reduction intervention. The research took place in both an urban and rural setting in the North-West Province of South Africa and data collection was done by means of in-depth interviews with the spiritual leaders. The interaction with PLWH during the intervention activated new experiences for spiritual leaders: acceptance and empathy for PLWH, an awareness of their own ignorance, a stronger realisation of God's presence and a realisation that they could inspire hope in PLWH. A greater awareness was created of HIV and of the associated realities regarding disclosure and stigma. The inclusion of spiritual leaders as well as PLWH brought about a positive shift in the attitudes of communities through the increase of knowledge and understanding of HIV stigma. They saw themselves playing a much greater part in facilitating such a shift and in reducing HIV stigma in their own congregations and their communities at large. (shrink)

_ Source: _Volume 5, Issue 2, pp 273 - 289 The impact of the stigma often associated with chronic illness cannot be explained by sociology alone, yet sociology has a significant contribution to make, most obviously through the analysis of stigma relations as social structures. This paper draws on critical realist philosophy and advances a _jigsaw model_ comprising _logics, relations_ and _figurations_ to assist empirical enquiry. A case is made for focusing on interrelations between the logic of shame (...) and the relations of stigma it gives rise to and other logics/relations across a range of figurations. A new framework for understanding and explaining stigmatising illness is put forward and subsequently applied to contemporary programmes of stigma reduction. The principal thesis of the paper is that across many of the figurations in which chronic illness features the logic of shame and its relations of stigma have lost ground to the logic of culpability and its relations of deviance. In short, people with chronic illness are increasingly being held culpable for their condition. (shrink)

Purpose: There is a widespread recognition that biomedical explanations offer benefits to those diagnosed with a mental disorder. Recent research points out that such explanations may nevertheless have stigmatizing effects. In this study, this ‘mixed blessing’ account of biomedical explanations is investigated in a case of philosophical interest: Tourette Syndrome. Method: We conducted a vignette survey with 221 participants in which we first assessed quantitative attributions of blame as well as the desire for social distance for behavior associated with Tourette (...) Syndrome. Results: In our study, it is confirmed that in the case of biomedical explanations, less blame is attributed than in the case of psychosocial explanations. When presented with a mixed explanation stressing an entanglement of biological and psychosocial factors this did not increase blame attribution. The desire for social distance is unaffected by the type of explanation but the participants’ free text feedback indicates this might obfuscate an underlying dilemma between stigma and blame revealed in recent research. Conclusion: There seems to be potential for blame reduction in explanations where biological and psychosocial factors are entangled. However, dynamic, ‘epigenetic’, explanations require further qualitative research to be performed as well as a philosophical framework to account for the ‘mixed blessings’ account. (shrink)

As Jonathan Mann observed, the problem of AIDS-related stigma is inextricably bound to issues of health, human rights, and the law. Such stigma translates into feelings of fear and hostility directed at people with HIV. It finds expression in avoidance and ostracism of people with HIV, discrimination and violence against them, and public support for punitive policies and laws that restrict civil liberties while hindering AIDS prevention efforts. Being the target of stigma inflicts pain, isolation, and hardship (...) on many people with HIV, while the desire to avoid it deters some from being tested for HIV, seeking treatment, or practicing risk-reduction. (shrink)

As Jonathan Mann observed, the problem of AIDS-related stigma is inextricably bound to issues of health, human rights, and the law. Such stigma translates into feelings of fear and hostility directed at people with HIV. It finds expression in avoidance and ostracism of people with HIV, discrimination and violence against them, and public support for punitive policies and laws that restrict civil liberties while hindering AIDS prevention efforts. Being the target of stigma inflicts pain, isolation, and hardship (...) on many people with HIV, while the desire to avoid it deters some from being tested for HIV, seeking treatment, or practicing risk-reduction. (shrink)

ABSTRACT Public health communication campaigns have been credited with helping raise awareness of risk from chronic illness and new infectious diseases and with helping promote the adoption of recommended treatment regimens. Yet many aspects of public health communication interventions have escaped the scrutiny of ethical discussions. With the transference of successful commercial marketing communication tactics to the realm of public health, consideration of ethical issues becomes an essential component in the development and application of public health strategies. Ethical issues in (...) public health communication are explored as they relate to eight topics: ‘targeting’ and ‘tailoring’ public health messages to particular population segments; obtaining the equivalence of informed consent; the use of persuasive communication tactics; messages on responsibility and culpability; messages that apply to harm reduction; and three types of unintended adverse effects associated with public health communication activities that may label and stigmatise, expand social gaps, and promote health as a value. We suggest that an ethical analysis should be applied to each phase of the public health communication process in order to identify ethical dilemmas that may appear subtle, yet reflect important concerns regarding potential effects of public health communication interventions on individuals and society as a whole. (shrink)

Albinism in Tanzania causes fierce health-related stigma. Little research has focused on the impact of stigma reduction strategies aiming to reduce albinism related stigma. Therefore, this research assessed the impact of two short video interventions among high school students in Tanzania on their attitude towards people with albinism: a contact intervention (n = 95) and an education intervention (n = 97). A mixed method design was used. Directly before and after the interventions impact was measured among (...) all participants through the Albinism Social Distance Scale for Adolescents (ASDS-A), knowledge items, and entertainment items. After these measurements focus group discussions were conducted, 16 in total (n = 80). Both interventions caused a significant increase in the levels of correct knowledge about albinism. The education intervention entailed a significant positive change in attitude measured through the ASDS-A, whereas the contact intervention did not have a significant effect. In terms of entertainment value, the respondents were more enthusiastic about the contact intervention. The study suggests that education interventions on their own can be a successful tool in decreasing albinism related stigma. Additionally, qualitative findings show many positive outcomes for the contact intervention. Therefore, we would recommend using a combination of these two interventions, which has also proved successful in the past. However, more research on the effect of a combination of the two strategies is recommended. (shrink)

People who inject drugs are often the target of stigma that puts this already at-risk group at greater risk of harm. Past research has shown that holding stigmatizing views of people who inject drugs increases risky behaviors and is a barrier to their engagement in important medical and public health interventions. One explanation is that the negativity surrounding the group causes increased levels of anticipated emotional exhaustion, discouraging positive engagement. However, there has been minimal research focused on addressing this (...) negativity to reduce levels of held stigma against people who inject drugs. We hypothesized that giving people an imagined positive contact exercise about people who inject would lead to a reduction in stigma, since exposure to positive empathy may create new mental associations between stigmatized groups and more positive emotions and experiences. Secondarily, we hypothesized that positive empathy strategies would be more effective than traditional informational or learning based techniques, and that the latter would be more effective than a control condition. Our sample consisted of 375 participants recruited online. Participants were assigned to one of three study conditions: a positive empathy condition, an informational learning condition, or a control condition, and completed a posttest social distance measure. Results demonstrated that subjects exposed to the positive empathy stigma reduction condition experienced a significant reduction in held stigma while participants exposed to traditional informational learning techniques showed no significant reduction in held stigma. Positive empathy-based stigma interventions should be further researched as a promising avenue to reduce the effects of drug-related stigma. (shrink)

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs (...) to be actively challenged and reduced. Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma. (shrink)

Alcohol and other drug-related stigma is a growing concern. Many organizations have called for a reduction in such stigma through law reform, but there is little sense of how, precisely, this might be achieved. This paper reports on a new method to examine the relationship between stigma and the law and establish a framework that can guide and inform future law reform efforts.

Empathy is an emotional response that may facilitate prosocial behavior and inhibit aggression by increasing empathic concern for others. But the vicarious experience of other’s feelings may also turn into personal distress when the person has poor regulation skills and holds stigmatizing beliefs. In thinking about the processes that may trigger the experience of personal distress or empathic concern, research on the influence of psychological flexibility and inflexibility on stigma is showing promising results. Both processes are assessed with the (...) Acceptance and Action Questionnaire–Stigma. The current study sought to carry out a validity study of a Spanish version of the AAQ-S with a sample of adolescents aged 11–17 years. The study included an expanded test of its predictive validity with measures at three times to evaluate the role of psychological flexibility and inflexibility as risk or protective variables for the development of personal distress and/or empathic concern in the stigmatizer. Statistical analyses confirmed a two-correlated-factor solution, the adequate reliability of both factors, and their construct and predictive validity in the expected direction. The stigmatizer’s inflexible reaction to their stigmatizing thoughts predicted the occurrence of personal distress, whereas the stigmatizer’s flexible reaction to their stigmatizing thoughts predicted the occurrence of empathic concern for others. These findings confirm the importance of considering the role of regulatory skills in the experience of empathic concern or personal distress in the presence of stigmatizing thoughts, with possible implications for the promotion of prosocial behavior and the reduction of aggressive behavior among adolescents. (shrink)

Suicide is a public health problem which will require an integrated cross-sector approach to help reduce prevalence rates. One strategy is to include the legal system in a more integrated way with suicide prevention efforts. Caine explored a public health approach to suicide prevention, depicting risk factors across the socio-ecological model. The purpose of this paper is to examine laws that impact suicide prevention at the individual, relational, community, and societal levels. These levels are fluid, and some interventions will fall (...) between two, such as a community-level approach to training that enhances provider-patient relationships. At the individual level, we will review laws to improve screening requirements across systems. At the relational level, we note interventions with couples having conflict, such as protection orders and access to attorney consultations, which have been known to be injury prevention mechanisms. At the community level, we discuss legislation that recommends suicide prevention efforts for key individuals working as frontline providers in the medical and educational systems. At the societal level, we explore public awareness campaigns that target stigma reduction for those suffering from mental health burden and enhance linkage to care. The article closes with the discussion that laws are good, but their implementation is essential. (shrink)

The world of mental health has become used to the notion of co-production as a good thing. While the paper is not a critical analysis of co-production, the authors make the case that while it is a good thing, it is not the only good thing; and it is neither sufficient, nor necessary for good things to happen in mental health services. Alternative concepts of progressive innovation in this field are introduced. Real world case studies (most of them previously unpublished) (...) are then worked through to test which concept(s) – co-production, or the alternatives, or neither – are the better fit, bearing in mind the complex relationships to be negotiated, not just between service users and mental health professionals, but between service users and members of other professions, and of the general public. Finally, the question is raised as to whether there is anything (such as the flattening of hierarchies or stigma reduction) which all these innovations – co-production and the alternatives – have in common. (shrink)

While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma (...) drivers (triggers of stigmatisation), facilitators (factors positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction. (shrink)

Abnormal body weight has been subject to varying assessments over time. The stigmatization of obesity for aesthetic reasons only began in the Western world in the second half of the 19th century, and in the 20th century its association with increased mortality was recognized. Body weight is associated with social and cultural meanings that affect human identity, and discussions about it generate considerable emotion. Words used to refer to body weight can influence people's self-perceptions, attitudes and behavior. Experimental studies have (...) shown that even brief exposure to body-related words can trigger automatic judgements and evaluations about body shape and weight. These negative and often implicit associations are symptomatic of a wider social stigma associated with weight. Recent evidence points to globalization and the presence of weight stigma in both developed and developing countries around the world. Numerous studies further indicate that weight shaming does not lead to weight reduction but rather to weight gain. Therefore, from a public health perspective, it is important to develop messages that are at least non-stigmatizing. The aim of this article is to present existing research on stigmatizing content in the media, as well as to analyze three selected social campaigns related to obesity. (shrink)

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, mask usage, skin lesion vigilance, (...) and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This (...) study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities. (shrink)

In 2005, Ethiopia changed its abortion law to curb its high maternal mortality. This has led to a considerable reduction in deaths from unsafe abortions. Abortion is now legal if the woman’s pregnancy is a result of rape or incest, if her health is endangered, if the fetus has a serious deformity, if she suffers from a physical or mental deficiency, or if she is under 18 years of age. The word of the woman, if in compliance with the (...) law, is sufficient to qualify for an abortion. In this context, where the law makes the door slightly open, health workers become important in deciding who gets access to safe services and who doesn’t, thus creating considerable ethical dilemmas. The objective of this study was to explore abortion service providers’ personal experiences and reflections, perceptions of the abortion law, and ethical and dilemmas that arise. Data collection took place from March to May 2016 in Addis Ababa, at different health clinics providing abortion services. Thirty in-depth interviews and three focus group discussions were conducted with 41 abortion service providers at governmental and non-governmental clinics. Content analysis was drawn upon in the interpretation of the findings. When working in a context where the law has slightly opened the door for abortion seeking women, the health workers describe conflicting concerns, burdensome responsibilities, and ambiguity concerning how to interpret and implement the law. They describe efforts to balance their religious faith and values against their professional obligations and concern for women’s health and well-being. This negotiation is particularly evident in the care of women who fall outside the law’s indications. They usually handle ethical dilemmas and decision-making alone without guidance. Moreover, many health workers face a stigma from fellow colleagues not performing abortions and therefore keep their job a secret from family and friends. Health workers in Ethiopia experience ethical dilemmas trying to maneuver between the abortion law, their personal values, and their genuine concern for the health of women. More research is needed to further explore this. (shrink)

Given the rise of genetic etiological beliefs regarding psychiatric disorders, a growing body of research has focused on trying to elucidate the effects that such explanatory frameworks might be having on how mental disorders are perceived by patients, clinicians, and the general public. Genetic and other biomedical explanations of mental disorders have long been seen as a potential tool in the efforts to destigmatize mental disorders, given the harshness of the widespread negative attitudes about them and the important negative clinical (...) and social impacts of this stigma. The conventional wisdom has appeared to be that because the effects of genes are seen as falling outside individual control, conceiving of mental disorders as caused by genes casts patients as blameless, thereby reducing stigmatization. Indeed, the results of experimental and correlational research have now robustly linked genetic and other biomedical explanations for mental disorders with reductions in the extent to which people are blamed for their psychiatric symptoms. However, research examining the impact of genetic and other biomedical explanations of mental disorders has also suggested that they can have significant downsides. The most consistently observed negative effect of these kinds of explanations is that they can apparently lead to the assumption that mental disorders are unlikely to improve or abate. Genetic and other biomedical explanations of mental disorders can also increase people’s confidence in the effectiveness of biomedical treatments (such as pharmacotherapy) but decrease their confidence in the effectiveness of “nonbiomedical” treatments (such as psychotherapy). (shrink)

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making (...) study nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. (shrink)

Since the introduction of drugs to prevent vertical transmission of HIV, the purpose of and approach to HIV testing of pregnant women has increasingly become an area of major controversy. In recent years, many strategies to increase the uptake of HIV testing have focused on offering HIV tests to women in pregnancy-related services. New global guidance issued by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) specifically notes these services as an entry point for (...) provider-initiated HIV testing and counseling (PITC). The guidance constitutes a useful first step towards a framework within which PITC sensitive to health, human rights and ethical concerns can be provided to pregnant women in health facilities. However, a number of issues will require further attention as implementation moves forward. It is incumbent on all those involved in the scale up of PITC to ensure that it promotes long-term connection with relevant health services and does not result simply in increased testing with no concrete benefits being accrued by the women being tested. Within health services, this will require significant attention to informed consent, pre- and post-test counseling, patient confidentiality, referrals and access to appropriate services, as well as reduction of stigma and discrimination. Beyond health services, efforts will be needed to address larger societal, legal, policy and contextual issues. The health and human rights of pregnant women must be a primary consideration in how HIV testing is implemented; they can benefit greatly from PITC but only if it is carried out appropriately. (shrink)

Bureaucratic selectivity mechanisms are the true colours of welfare states, stigmatising benefit recipients while hampering their trust in institutions and society at large. Universal policies such as the Universal Basic Income could protect recipients’ trust by circumventing selectivity paraphernalia. By analysing regressions on the Finnish UBI experiment’s survey data, we assess the links from policy selectivity to trust in the benefit-providing institution and generalised trust through the pathway of reduced bureaucratic experience. More specifically, we analyse whether receipt of UBI leads (...) to greater trust directly or while accompanied by an actual or perceived reduction in bureaucracy. According to our results, UBI is accompanied by greater trust, while selectivity does not necessarily lead to less trust or perception of less bureaucracy. However, in our analysis, policy selectivity did not directly correlate to recipients’ reported bureaucratic experiences, and their relationship with trust proved tricky: selectivity did not risk recipients’ trust in the policy-implementing institution, but generalised trust in other people was lowered. Thus, selective benefit recipients might be prone to self-inflicted stigma, hampering their trust in other people, regardless of actual bureaucratic experiences or trust in the welfare system. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other (...) preventive measures. In this sense, it represents a new bio-technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV‐based pre‐exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at‐risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother‐to‐child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other (...) preventive measures. In this sense, it represents a new bio‐technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource‐poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

All psychiatric disorders have a neurobiological basis. This has led to a better understanding of these disorders and a reduction in the social stigma associated with them. But the claim that mental states can be explained entirely in neurobiological terms may give us de-stigmatization at the cost of de-personalization. A holistic view of the mind as distributed among the brain, body and environment provides the best model to guide interventions that will have the most salutary ef ects on (...) the brain and the mind. (shrink)

Assisted reproductive technology treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Twelve first-time mothers who conceived and gave live birth using ART (...) treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’, ‘ensuring health and safety of the foetus’, and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes. (shrink)

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally in (...) other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities. (shrink)

According to a dominant view of stigma, a person is stigmatized within a community if sufficiently many people within that community hold a bad view of her. I call this the 'Bad View Model'. In this paper, I argue against the Bad View Model on the grounds that such beliefs are neither necessary nor sufficient for stigma, and that the account cannot explain the distinctive phenomenology of stigma, including certain vulnerabilities to shame. I then develop an alternative (...) that explains these features of stigma, which I call the 'Shaming Model'. On this view, a person is stigmatized within a community if she is shamed by members of that community, and this is explained by their belief that she has deviated from some social norm and/or standard. (shrink)

How should we interpret the popular objection that stigmatised subjects are not treated as individuals? The Eidelson View claims that stigma, because of its connection to stereotypes, violates an instance of the general requirement to respect autonomy. The Self-Presentation View claims that stigma inhibits the functioning of certain morally important capacities, notably the capacity for self-presentation. I argue that even if we are right to think that stigma violates a requirement to respect autonomy, this is insufficient to (...) account for the full weight of the charge that stigmatised subjects are not treated as individuals. We need the Self-Presentation View to explain a special threat to agency. I then address the worry that focusing on a concern with being treated as individuals opens the door to the suggestion that treating as superior can be just as morally troubling as stigma. This objection is fatal for the Eidelson View. But the Self-Presentation View has a number of resources for deflating the worry. We should not exclude the possibility of a moral symmetry between some cases of stigma and some cases of treating as superior. Rather, we should provide a nuanced account of the circumstances in which either phenomenon is detrimental for self-presentation. (shrink)

In this article, I address the question of the apportionment of the consequences of organizational misconduct to individual members of the organizational elite. I argue that this process can be best understood by marrying the behavioral aspects of stigma theory to the economic mechanisms of ex post settling up. Viewed in conjunction with stigmatization, ex post settling up following organizational misconduct can be seen as the result of attempts to avoid stigma by association. Efforts at stigma avoidance (...) on the parts of various stakeholders produce the diminished social interaction associated with ex post settling up: departure from the focal firm, and loss of seats on other boards. This also suggests that the process of stigmatization, and hence ex post settling up, can be influenced by characteristics of social interaction unrelated to the misconduct itself. (shrink)

Would a just society or government absolutely refrain from shaming or humiliating any of its members? "No," says this essay. It describes morally acceptable uses of shame, stigma and disgust as tools of social control in a decent (just) society. These uses involve criminal law, tort law, and informal social norms. The standard of moral acceptability proposed for determining the line is a version of perfectionistic prioritarian consequenstialism. From this standpoint, criticism is developed against Martha Nussbaum's view that to (...) respect the dignity of each person, society absolutely must refrain from certain ways of shaming and humiliating its members and rendering them objects of communal disgust. (shrink)

The notion of reduction continues to play a key role in philosophy of mind and philosophy of cognitive science. Supporters of reductionism claim that psychological properties or explanations reduce to neural properties or explanations, while antireductionists claim that such reductions are not possible. In this book, I apply recent developments in philosophy of science, particularly the mechanistic explanation paradigm and the interventionist theory of causation, to reassess the traditional approaches to reduction in philosophy of mind. I then elaborate (...) and defend a pluralistic framework for philosophy of mind, and show how reductionist ideas can be incorporated into it. This leads to a novel synthesis of pluralism and reductionism that I call pluralistic physicalism. (shrink)

This paper proposes a theoretical framework for understanding fat stigma and its impact on people’s well-being. It argues that stigma should never be used as a tool to achieve public health ends. Drawing on Bruce Link and Jo Phelan’s 2001 conceptualization of stigma as well as the works of Hilde Lindemann, Paul Benson, and Margaret Urban Walker on identity, positionality, and agency, this paper clarifies the mechanisms by which stigmatizing, oppressive conceptions of overweight and obesity damage identities (...) and diminish moral agency, arguing that the use of obesity-related stigma for public health ends violates the bioethics principles of nonmaleficence, autonomy, and justice. (shrink)

Research on natural and artificial brains is proceeding at a rapid pace. However, the understanding of the essence of consciousness has changed slightly over the millennia, and only the last decade has brought some progress to the area. Scientific ideas emerged that the soul could be a product of the material body and that calculating machines could imitate brain processes. However, the authors of this book reject the previously common dualism—the view that the material and spiritual-psychic processes are separate and (...) require a completely different substance as their foundation. -/- Reductive Model of the Conscious Mind is a forward-thinking book wherein the authors identify processes that are the essence of conscious thinking and place them in the imagined, simplified structure of cells able to memorize and transmit information in the form of impulses, which they call neurons. The purpose of the study is to explain the essence of consciousness to the degree of development of natural sciences, because only the latter can find a way to embed the concept of the conscious mind in material brains. The book is divided into three parts. Part 1 works to convince readers that the emergence of consciousness does not require detailed knowledge of the structure and morphology of the brain, with the exception of some specific properties of the neural network structure that the authors attempt to point out. Part 2 proves that the biological structure of many natural brains fulfills the necessary conditions for consciousness and intelligent thinking. Similarly, Part 3 shows the ways in which artificial creatures imitating natural brains can meet these conditions, which gives great hopes for building artificially intelligent beings endowed with consciousness. Covering topics that include cognitive architecture, the embodied mind, and machine learning, this book is ideal for cognitive scientists, philosophers of mind, neuroscientists, psychologists, researchers, academicians, and advanced-level students. The book can also help to focus the research of linguists, neurologists, and biophysicists on the biophysical basis of postulated information processing into knowledge structures. (shrink)

Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss (...) the causes and consequences of stigma related to mental illness. (shrink)

The consequences of stigma are preventable. We argue that individual attention should be provided to patients when dealing with stigma. Also, in order to deal with the impact of stigma on an individual basis, it needs to be assessed during routine clinical examinations, quantified and followed up to observe whether or not treatment can reduce its impact. A patient-centric anti-stigma programme that delivers the above is urgently needed. To this end, this review explores the experiences, treatment (...) barriers and consequences due to stigma. We also offer putative solutions to this problem. (shrink)

A prominent view of phenomenal consciousness combines two claims: (i) the identity conditions of phenomenally conscious states can be fully accounted for in terms of these states’ representational content; (ii) this representational content can be fully accounted for in non-phenomenal terms. This paper presents an argument against this view. The core idea is that the identity conditions of phenomenally conscious states are not fixed entirely by what these states represent (their representational contents), but depend in part on how they represent (...) (their representational attitudes or modes). The argument highlights the myriad liabilities and difficulties one must accrue when one tries to appeal only to what phenomenally conscious states represent in accounting for their phenomenal individuation. (shrink)

This paper discusses the alleged reduction of Thermodynamics to Statistical Mechanics. It includes an historical discussion of J. Willard Gibbs' famous caution concerning the connections between thermodynamic properties and statistical mechanical properties---his so-called ``Thermodynamic Analogies.'' The reasons for Gibbs' caution are reconsidered in light of relatively recent work in statistical physics on the existence of the thermodynamic limit and the explanation of critical behavior using the renormalization group apparatus. A probabilistic understanding of the renormalization group arguments allows for a (...) kind of unification of Gibbs' approach with contemporary understanding of the reduction problem. (shrink)

The concept of self-stigmatization is guided by a representational account of selfhood that fails to accommodate for resilience against, and recovery from, stigma. Mainstream research on self-stigma has portrayed it only as a reified self, that is, as collectively shared stereotypes representing individuals’ identity. Self-stigma viewed phenomenologically, however, elucidates what facilitates a stigmatized self. A phenomenological analysis discloses the lived phenomenon of stigma as an act of self-objectification, as related to the experiential self, and therefore an (...) achievement of subjectivity. Following a phenomenological account, the stigmatized self can thus return to a state-of-being, similar to that Jean-Paul Sartre once referred to as bad faith. Regarding your identity as analogous to an inanimate thing is ultimately self-deceptive. Self-stigma is here phenomenologically illuminated as constituted by basic discretion, that is, as a minimal form of agency. The study found that basic discretion can uphold the possibility for emancipation from a stigmatized self. (shrink)

Stigma has become an important concept in public health law. It is widely accepted that certain diseases are disfavored in society, leading to discrimination against people identified with them, which in turn has the tendency to drive an epidemic underground—i.e., to make it more difficult for voluntary public health programs to reach and succeed among populations bent on concealing their disease or risk status. The need to reduce stigma and its effects has been used to justify the passage (...) of privacy and antidiscrimination law to protect people with HIV. More recently, stigma has been part of the arsenal of justification for special genetic antidiscrimination and privacy law. Despite its importance, however, there is no single widely accepted definition of stigma in social science, and its relationship to law has been generally under-theorized and unsupported by data, reducing our ability to effectively deploy law and other tools in the anti-stigma cause. (shrink)

The word stigma comes from ancient Greece, and was initially used in reference to signs or symbols physically cut into or burned onto the bodies of those deemed to be of an inferior status. It was a marking of one's tarnished and flawed character. Today, stigma is more often attached to one's social standing, personality traits, or psychological makeup. "People are no longer physically branded; instead they are societally labeled—as poor, as criminal, homosexual, mentally ill, and so on. (...) These labels influence public perceptions and behavior and lead to devaluation and denigration of those who are so labeled" (Wahl 1999, 11–12).The modern usage of the term stigma and contemporary focus on the concept as a topic of .. (shrink)

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social (...) constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems. (shrink)

Stigma has become an important concept in public health law. It is widely accepted that certain diseases are disfavored in society, leading to discrimination against people identified with them, which in turn has the tendency to drive an epidemic underground—i.e., to make it more difficult for voluntary public health programs to reach and succeed among populations bent on concealing their disease or risk status. The need to reduce stigma and its effects has been used to justify the passage (...) of privacy and antidiscrimination law to protect people with HIV. More recently, stigma has been part of the arsenal of justification for special genetic antidiscrimination and privacy law. Despite its importance, however, there is no single widely accepted definition of stigma in social science, and its relationship to law has been generally under-theorized and unsupported by data, reducing our ability to effectively deploy law and other tools in the anti-stigma cause. (shrink)

This paper offers a critical analysis of the strategic use of biomedical models of mental illness as a means of challenging stigma. Likening mental illnesses to physical illnesses reinforces notions that persons with mental illnesses are of a fundamentally “different kind,” entrenches misperceptions that they are inherently more violent, and promotes overreliance on diagnostic labeling and pharmaceutical treatments. I conclude that too much has been invested in the claim that the body is somehow morally neutral, and that advocates of (...) this approach oversimplify, misrepresent, and underestimate the personal and social costs of physical illness. (shrink)

In this article I read textual metaphors of ‘untouchability’ in ‘post-AIDS’ representation as an erasure of structures that condition HIV stigmatization in India. Throughout, my discussion is contextualised by the political economy of HIV and AIDS, which has been productive of particular modern sexual subjects. In the film My Brother…Nikhil, the stigmatization of Nikhil, a gay Indian man living with HIV, is constituted through visual and verbal caste metaphors, which draw on existing subject positions that are elided as ‘traditional’, residual, (...) and receding. This stigma is resolved textually through parental acceptance of the gay protagonist and his partner, projecting stigma as traditional and modernity as the resolution. Such metaphors of ‘untouchability’ prevent the representation of queer Dalit subjects in contexts of HIV and AIDS. Yet if addressing shame and social stigma are key to HIV treatment and prevention programmes, caste cannot be set aside simply as a metaphor. Expanding to include textual representations of queer Dalit subjectivity, the article reads a novel, The Boyfriend, and a poem, “Gandu Bagicha,” to show ways in which caste stigma and homophobia intersect in contexts of seroconversion risk. (shrink)

ObjectivesThe breast cancer stigma affects Health-related quality of life, while general resilience resources, namely, sense of coherence, social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.MethodsIn this cross-sectional study, Stigma Scale for Chronic Illness 8-item version, SOC-13, Medical Outcome Survey- Social Support Scale, Brief COPE, and Functional Assessment of Cancer (...) Therapy-Breast were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson’s correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.ResultsAn analysis of 221 women with the mean age of 47.14 showed that stigma was negatively correlated to all HRQoL’s dimensions, SOC, social support, and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support, and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.ConclusionWhile GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn. (shrink)