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Table of Contents
SPECIAL FEATURE: COMMENTARY
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 58-61

The dilemma of intimacy and other social stigmas associated with HIV-AIDS and COVID-19


Independent Public Health Researcher, Bhubaneswar, Odisha, India

Date of Submission23-Oct-2020
Date of Acceptance07-Dec-2020
Date of Web Publication4-Mar-2021

Correspondence Address:
Janmejaya Samal
Independent Public Health Researcher, C/O. Mr Bijaya Ketan Samal, Pansapalli, Bangarada (PO), Gangapur (Via), Ganjam 761 123, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_92_20

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How to cite this article:
Samal J. The dilemma of intimacy and other social stigmas associated with HIV-AIDS and COVID-19. J Clin Sci Res 2021;10:58-61

How to cite this URL:
Samal J. The dilemma of intimacy and other social stigmas associated with HIV-AIDS and COVID-19. J Clin Sci Res [serial online] 2021 [cited 2021 Apr 12];10:58-61. Available from: https://www.jcsr.co.in/text.asp?2021/10/1/58/310772



Cases of pneumonia with unknown aetiology got reported in Wuhan city of Hubei province, China, by the last week of December 2019.[1] These cases started spreading to different parts of China and other parts of the world after some days. It was then observed that most of these cases do have a contact of a history of seafood market of Huanan city. Many of these cases were reported with fever and cough.[2] The novel coronavirus was identified from the throat swab of one of the patients by the Chinese Center for Disease Control and Prevention on 7 January 2020. The virus was subsequently named the 2019 nCoV by the World Health Organization (WHO).[3] The WHO declared it as a public health emergency of international concern (PHEIC) looking at the grave situation that the virus started impacting.[4] On February 11 , 2020, the causative agent was renamed the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses.[5] Subsequently, the disease was renamed the coronavirus disease 2019 (COVID-19).[6] Several achievements have already been attained in the fight against this monster especially in the front of virus identification, understanding clinical manifestations and diagnosis of the disease, however no effective treatment has been found out till date.[7],[8],[9]


  Concept of Social Stigma Top


Stigma is the occurrence of labelling, stereotyping, separation, loss of status and discrimination in the context in which power is exercised.[10] Furthermore, as stigma incorporates the concepts of labelling and stereotyping, it is different from discrimination.[11] Stigma, in the context of public health, is a well-evidenced hindrance to health-seeking behaviour, engagement to care and treatment adherence across a range of health problems globally.[12] According to Goffman, stigma enables a variety of discriminations that culminate in the denial of social acceptance to an individual or a group, reduces opportunities and fuels social inequality.[13],[14] Furthermore, stigma adversely influences the health outcomes by worsening, undermining and impeding a number of social processes such as psychological and behavioural responses, relationships in social sphere, stress, availability of resources and aggravation of poor health.[15] There are certain factors that influence the outcome among the affected individuals, groups and institutions that ultimately impact the health and the society because of stigmatisation. These factors include drivers and facilitators, stigma 'marking' and stigma manifestation.[16] The drivers vary with the health conditions, however they are mostly the negative ones and may range from fear of infection through contact for communicable disease, loss of production in chronic conditions, to authoritarianism, social judgement and blame.[17] On the contrary, facilitators could be either positive or negative influences, for instance, the presence or absence of personal protective equipment may minimise or exacerbate the stigmatising behaviour towards people with infectious disease by healthcare providers. The drivers and facilitators determine the 'marking of stigma' to specific individuals or groups. Once stigma is applied, it manifests in a range of experiences and practices.[18] The manifestations could be 'self-stigma', 'perceived stigma', 'anticipated stigma' and 'associative stigma'.[19],[20],[21],[22]


  Relationship Between Stigma Associated with HIV and COVID-19 Top


Understanding of the historical construct of stigma associated with HIV-AIDS can inform stigma mitigation of COVID-19. Let us look at the different facets that are associated with COVID-19 stigmatisation among people and the connection with HIV-AIDS. Evidences suggest that the practice of 'othering', a concept that defines as separate, distant and disconnected from the host communities.[23] can result in social distancing through reduced interaction with the stigmatised people.[24] Incidentally, the suggested public health measure to prevent the transmission of COVID-19 is the practice of social distancing.[25] Albeit social distancing is an integral part of containment,[26] how is this ensured that this activity does not exacerbate stigma and discrimination?[27] Putting social distancing in the context of HIV-AIDS may not have a direct relevance, however intimacy and physical contact during the pandemic of HIV-AIDS could be better understood. During the epidemic period of HIV-AIDS, there was long contended tension between negotiating intimacy among partners. One of the publications during the HIV-AIDS epidemic in 1983 – 'How to have sex in an epidemic: One approach' – explored care, love and intimacy as reasons for safer sex motivation. The most significant message through this publication is that if affection informs sexual relationship, there exists a motivation to protect each other from the disease.[28] Similarly, as per the suggestions of the UNAIDS and WHO, building connections via caring and kindness, leaving the fear of contracting COVID-19 behind, can motivate people to involve in non-stigmatising social-distancing behaviour.[29],[30] In the case of COVID-19, it is clearly known that the disease is not transmitted through sexual mode of transmission, however the droplet infection and infection through contact mode and the measures to contain the infection through quarantine and isolation hinder physical intimacy. All these measures can have a negative impact in making love and physical intimacy among the partners as the same can pose a potential risk of transmission of COVID-19. This can, to some extent, also negatively impact the relationship among the partners in some communities.

Furthermore, it is evident from the multiple bodies of HIV-related stigma research that multiple dimensions of stigma can negatively impact health practices and outcomes.[31] Thus, COVID-19 stigma mitigation should take into account acts of discrimination and mistreatment, demeaning community norms and values; the ways in which persons accept negative perspectives towards a group they belong to and concerns that one will receive future bias and discrimination.[32] In addition, there are international crises in relation to fund crunch for HIV and other health-related issues as well;[33],[34] thus, it becomes imperative, at the present juncture of COVID-19 emergency, to harness political investment in challenging social inequities including that which exacerbate the COVID-19's impact on refugees and immigrants.[35] According to the United Nations High Commissioner for Refugees, of the 196 countries affected by the pandemic of COVID-19, 79 countries are refugee-hosting countries reporting local transmission.[36] COVID-19 is going to inevitably spread to these highly vulnerable displaced groups which needs urgent attention with the past experience of SARS, MERS and Ebola as well.[37]

There are documented evidences that social disparities lead to health disparities.[16] Evidences show that stigma unduly impacted depression among newly diagnosed HIV cases and lesbian, gay, bisexual, and transgender persons.[38],[39] Albeit the status of similar research in the field of COVID-19 is at the nascent stage, it will also have analogous mental health impacts including on healthcare providers.[40],[41]

Thus, it becomes imperative that public health strategies directed towards mitigating stigma associated with COVID-19 should take into account multiple factors that lead to bias and discrimination. These multi-level strategies can address stigma drivers and facilitators.[16] In addition, public health players should challenge the languages that create stigmatisation in public health messaging and in media.[42],[43] COVID-19 stigma mitigation strategies should apply a multisectoral lens that intersects with gender, race, immigration status, housing status and health status among others. Public health actors should balance between the bioscientific approach and psychosocial approach in preventing and controlling the pandemic of COVID-19. This would inform immediate and remote strategies to build empathy and social justice in the current situation and may do so in future pandemics as well.[16]

Albeit the characteristic features of these two diseases are different, these two diseases share some common characteristic features in relation to social stigma associated with these two diseases, which could effectively be applied to either one of them and more specifically to COVID-19 to aid in the control and prevention of the disease. It has been more than three decades now since the pandemic of HIV-AIDS, and much is now known to the world and much research on social stigma associated with HIV-AIDS has ushered the ways and means to mitigate the global pandemic of HIV-AIDS. Many of them can be applied to the pandemic of COVID-19, thus it is significant to apply such experiences in mitigating the stigma and discrimination that are associated with COVID-19. This will aid in the control and prevention of COVID-19. In addition to HIV-AIDS social stigma is also associated with many other diseases like SARS, MERS, Ebola, among others. Thus, the lesions learnt from these epidemics should also be applied in other situations as appropriate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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