Resisting a stigmatized identity
Patients’ strategies for the management of the HIV/AIDS stigma in a public hospital in Uruguay
DOI:
https://doi.org/10.1558/sols.v1i2.163Keywords:
stigma, self-effacing strategies, deviancy, resistance, morality, HIV/AIDSAbstract
The socio-cultural complexities that subsume the HIV/AIDS stigma are examined in relationship to the notions of illness and deviancy as explained in the ‘sick role model’ theory. It is argued that in conversations with their physicians, patients use self-effacing arguments and conversational strategies with the communicative intention of redressing their human images, and as a way of resisting the stigma. The data comprise 46 interviews collected in Uruguay at a public hospital. Some of the self-effacing strategies include: violation of the quantitative maxim, reformulation, and pre-announcement strategy. While self-effacing strategies are the patients’ ways of resisting the stigma, the use of these strategies is seen as culturally linked to moral frames entrenched in the Uruguayan culture. It is observed that the patients’ arguments and strategies used to resist stigmatization might, paradoxically, perpetuate the HIV/AIDS-related stigma.
References
Barrán, J. P. (1993) Medicina y Sociedad en el Uruguay del Novecientos: El Poder de Curar (Vol 1) Montevideo, Uruguay: Ediciones de la Banda Oriental.
Barrán, J. P. (1995) Medicina y Sociedad en el Uruguay del Novecientos: La Ortopedia de los Pobres (Vol 2) Montevideo, Uruguay: Ediciones de la Banda Oriental.
Brimlow, D., Cook, J. and Seaton, R. (eds) (2003) Stigma and HIV/AIDS: a review of the literature. U.S. Department of Health and Human Services. Retrieved on 20 May 2006 from www.AIDSstigma.net
Brown, L., Trujillo L. and MacIntyre, K. (2001) Interventions to reduce HIV/AIDS stigma: what have we learned? Horizons Program, Tulane University. Retrieved on 20 May 2006 from http://www.popcouncil.org/pdfs/horizons/litrvwstigdisc.pdf
Carriego, E. (1913) Obra Completa. Prólogo y Notas. (Posthumous poems). In M. Ciruzzi (1999) (compiler). Buenos Aires: Ediciones Corregidor.
Center for Disease Control and Prevention (2000) HIV-related knowledge and stigma – United States. Journal of the American Medical Association 284(24): 3118–19.
CEIPU (1998) Comision Especial Impacto Psicosocial del VIHSIDA. Actitudes y practicas sobre VIHSIDA. Encuesta anonima a medicos y practicantes. Revista Medica del Uruguay 14(1): 5–21.
Clatts, M. C. and Mutchle, K. M. (1989) AIDS and the dangerous other: metaphors of sex and deviance in the representation of disease. Medical Anthropology 10(2): 105–14.
Constitución de la República Oriental del Uruguay (1997) [1967] (Second edition.) Montevideo. Uruguay: Fundación de Cultura Universitaria.
Diaz Berenguer, A. (2004) La Medicina Desalmada: Aportes a una Polémica Actual. Montevideo, Uruguay: Ediciones Trilce.
Echavarren, R. (1998) Arte Andrógino. Buenos Aires: Editorial Colihue.
Farmer, P. (2003) Pathologies of Power: Health, Human Rights, and the new War on the Poor. Berkeley: University of California Press.
Friedson, E. (1970) Profession of Medicine. New York: Dodd, Mead.
Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books.
Goffman, E. (1963) Stigma. Notes on the Management of Spoiled Identity. Englewood Cliff. NJ: Prentice Hall.
Goffman, E. (1967) Interaction Ritual: Essays on Face-to-Face Behavior. Garden City, New York: Doubleday, Anchor Books.
Goffman, E. (1974) Frame Analysis: An Essay on the Organization of Experience. New York: Harper and Row.
Goffman, E. (1981) Forms of Talk. Philadelphia: University of Pennsylvania Press.
Grice, H. P. (1975) Logic and conversation. In P. Cole and J. Morgan (eds) Syntax and Semantics: Speech Acts 3:41–58. New York: Academic Press.
Greene, K. and Baneriee, S. C. (2005) Disease-related stigma comparing predictors of AIDS and Cancer stigma. Journal of Homosexuality 50(4): 185–209.
Gumperz, J. (1982) Discourse Strategies. Cambridge: Cambridge University Press.
Hamilton, D. L. (1979) A cognitive-attributional analysis of stereotyping. In L. Berkowitz (ed.) Advances in Experimental Social Psychology 12. New York: Academic Press.
Herek, G. M. (1997) The HIV epidemic and public attitudes toward lesbians and gay men. In M. P. Levine, P. Nardi and J. Gagnon (eds) Changing Times: Gay Men and Lesbians Encounter HIV/AIDS 191–218. Chicago: University of Chicago Press.
Herek, G. M. (1999) AIDS and stigma. American Behavioral Scientist 42 (7:1106–16.
Herek, G. M. and Capitanio, J. P. (1999) AIDS stigma and sexual prejudice. American Behavioral Scientist 42(7): 1126–43.
Herek, G. M., Capitanio, J. P. and Widaman, K. F. (2002) HIV-related stigma and knowledge in the United States: Prevalence and trends 1991–1999. American Journal of Public Health 92: 371–7.
Herek, G. M. and Glunt, E. K. (1993) Public attitudes toward AIDS-related issues in the United States. In J. B. Pryor and G. D. Reeder (eds) The Social Psychology of HIV Infection 229–61. Hillsdale, NJ: Lawrence Erlbaum.
Hewstone, M. and Howard, G. (1986) Social groups and social stereotypes. In W. B. Gudyhunst (ed.) Intergroup Communication: Review and Model of Communication Breakdown 10–20. London: Edward Arnold.
Infante, C., Zarco, A., Cuadra, S.M., Morrison, K., Caballero, M., Bronfman, M. and Magis, C. (2006) HIV/AIDS-related stigma and discrimination: the case of health care providers in Mexico. Salud Pública Mexico. 48(2): 141–50.
Jacoby, A. (1994) Felt versus enacted stigma, a concept revisited. Social Science and Medicine 38: 269.
Johnstone, B. (1994) Repetition in Discourse Interdisciplinary Perspectives 2. Norwood, New Jersey: Ablex Publishing.
Johnstone, B. (1996) The Linguistic Individual, Self-expression in Language and Linguistics. Oxford Studies in Sociolinguistics: Oxford University Press.
Lakoff, G. (1996) Moral Politics: What Conservatives Know that Liberals Don’t. Chicago: The University of Chicago Press.
Lancaster, R. (1994) Life is Hard: Machismo, Danger and the Intimacy of Power. University of California Press.
Lemert, C. and Branaman, A. (1997) The Goffman Reader. Massachusetts and Oxford. Blackwell Publisher.
Liu, J. X. and Chai, K. (2006) Experiences of social discrimination among men who have sex with men in Shanghai, China. AIDS Behavior. Retrieved on 20 May 2006 from www.pubmed.gov
Lupton, D. (1992) Discourse analysis: a new methodology for understanding the ideologies of health and illness. Australian Journal of Public Health 16: 145–50.
Mawar, N., Saha, S., Pandit, A. and Mahajan, U. (2005) The third phase of HIV pandemic: social consequences of HIV/AIDS stigma and discrimination and future needs. Indian Journal Medical Research 122(6): 471–84.
Mishler, E. G. (1984) The Discourse of Medicine. Dialectics of Medical Interviews. Norwood, New Jersey: Ablex Publishing.
Murphy, R. (1998) The damage self. In P. J. Brown (ed.) Understanding and Applying Medical Anthropology 322–33. Mountain View, CA: Mayfield Publishing.
Nardi, P. (1990) AIDS and obituaries: the perpetuation of stigma in the press. In D. Feldman (ed.) Culture and AIDS 159–69. New York: Praeger Publisher.
Osimani, M. L. (2003) The challenge of implementation of preventive programs in a developing country: experiences, situations, and perspectives in Uruguay. Clinical Infectious Diseases 37(5): S422–6.
Pan American Health Organization (2003) Understanding and Responding to HIV/AIDS-Related Stigma and Discrimination in the Health Sector. Retrieved on 18 May 2006 from http://www.paho.org/Project.asp?SEL=OR&LNG=ENG&ID=445&PRGRP=books
Parker, R. and Aggleton, P. (2001) Estigma, Discriminacao e AIDS, Cidadania e Direitos. Rio de Janeiro: Associacao Brasileira Interdisciplinar de SIDA.
Parsons, T. (1951) The Social System. New York: Free Press.
Plantin, C. (1998) La Argumentación. Barcelona: Ariel.
Poder Ejecutivo (1992) Reglamentación sobre conducta médica y derechos del paciente. Decreto del Poder Ejecutivo N. 258/92. Montevideo, Uruguay: Imprenta del Palacio Legislativo.
Powell-Cope, G. M. and Brown, M. A. (1992) Going public as an AIDS family caregiver. Social Science and Medicine 34(5): 571–80.
Quam, M. (1990) The sick role, stigma and pollution: The case of AIDS. In D. Feldman (ed.) Culture and AIDS 29–45. New York: Praeger Publishers.
Rueda, S., Park-Wyllie, L.Y., Bayoumi, A.M., Tynan, A.M., Antoniou, T.A., Rourke, S.B. and Glazier, R.H. (2006) Patients support and education for promoting adherence to highly activate antiretroviral therapy for HIV/AIDS. The Cochrane Database of Systematic Reviews. Issue 3.
Sarangi, S. and Roberts, C. (1999) Talk, Work and Institutional Order: Discourse in Medical, Mediation and Management Settings. New York: Mouton de Gruyter.
Scrambler, G. (1989) Epilepsy. London: Routledge.
Scrambler, G. and Hopkins, A. (1986) Being epileptic, coming to terms with stigma. Sociology of Health and Illness 8: 26–43.
Sheper-Hughes, N. and Lock, M. (1998) The mindful body: a prolegomenon to future work. In P. J. Brown (ed.) Understanding and Applying Medical Anthropology 208–25. Mountain View, California: Mayfield Publishing.
Shneider, J. and Conrad, P. (1996) In the closet with illness: epilepsy, stigma potential and information control. In D. H. Kelly (ed.) Deviant Behavior: A Text Reader in the Sociology of Deviance 243–160. New York: St. Martin’s Press.
Sontag, S. (1989) AIDS and its Metaphors. New York: Farrar, Straus and Giroux. Sociedad Uruguaya de SIDA. Retrieved on May 2005 from http://www.susida.com.uy
Stewart, M. (1999) The Spanish Language Today. London and New York: Routledge.
Stewart, M. C., Keel, P. K. and Schiavo, R. S. (2006) Stigma of anorexia nervosa. Internal Journal of Eating Disorders 39(4): 320–25.
Stoddard, T. (1994) Don’t call it AIDS: HIV disease is more appropriate. The New York Times. 17 August, Sect. A:15.
Terasaki, A. K. (2004) Pre-announcement sequences in conversation. In G. H. Lerner (ed.) Conversation Analysis: Studies from the First Generation 171–223. John Benjamins: Amsterdam Netherlands.
UNAIDS (2002a) A conceptual framework and basis for action: HIV/AIDS and discrimination. UNAIDS, Geneva 2002, UNAIDS/02.43E.
Wong, V. and Wong, L. (2006) Management of stigma and disclosure of HIV/AIDS status in healthcare settings. Journal Health Organization Management 20(23): 95–114.
World Health Organization (2002) 25 Questions & Answers on Health & Human Rights. Health & Human Rights Publication Series 1, July.
