Stigma occurs in most societies, although its triggers and severity may vary based on culture, religion and history. Even in our society–which prides itself on an anything-goes attitude – you do not have to go very far to find it.
Stigma can be a barrier to public health and a hazard to patients. One factor contributing to the HIPAA regulations was to reduce the disclosure of information that might result in stigma. Stigma must be understood and addressed if all patients are to get the best possible care. Throughout this article, we suggest medical calculators healthcare providers can use to identify and measure stigma.
Conformity and Fear
Stigma may arise for several reasons. In some cultures it arises from fears which may be poorly articulated. In others it is a reaction to a person who does not conform to a group’s societal norms. A person raised in a culture may internalize these reactions, resulting in a negative self-image if a behavior is “unacceptable.”
When an infection is communicable and it cannot be treated, the only way to avoid becoming sick may be to avoid an infected person. Leprosy is a classic example, with an infected person seen as “unclean” and someone to be ostracized. Tuberculosis was (and perhaps may be in the future) a reason people were avoided. A person with a sexually-transmitted disease may be shamed by peers or family. When faced with this reaction the natural tendency is for a person to hide an infection or try to keep it secret. Aids and stigma often are intertwined and create challenging situations for patients and providers.
- Stigma Associated with Tuberculosis
- Stigma in China Associated with HIV or a Sexually Transmitted Disease
A person’s appearance may also be a reason to be stigmatized. A deformity or disability may label a person as undesirable, defective or of lesser value. Some people will go to great lengths to hide a blemish rather than risk being ridiculed by others and “shamed.”
Stigma can have a number of effects. It may encourage people to conform to a set of norms valued within a group and so be a source of cohesion. Unfortunately it also encourages an affected person to hide a problem and to avoid disclosing it to others. An affected person may become isolated from others, even family and friends. The affected person may avoid treatment or refuse to disclose contacts in order to protect others. Under these circumstance stigma can have negative economic and social consequences.
It is therefore important to understand stigma and its impact on patients. Stigma can be measured and monitored over time using a variety of scales. It is important for clinicians to generate trust with patients and to have a non-judgmental demeanor in order for a patient to feel comfortable in discussing all of their problems.
Take Home Messages
Stigma is a social phenomenon that can have a significant impact on a patient’s health. Fear may cause the patient to deny or hide a problem from others.
Clinicians need to understand the origins of stigma and to control any negative attitudes directed towards an affected patient. Medical algorithms can help the clinician identify and respond to a situation where stigma could pose a problem.