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Hatred, Violence and AIDS-Related Stigma
Psychodynamic Processes of a Social Phenomenon
http://www.du.edu/
Daniel Whelan,
Ph.D. Student
Graduate School of International Studies
University of Denver
Denver, CO
June
1999
Note: This paper is a draft, and is not to be
distributed or quoted without express authorization from the
author. It is a seminar paper submitted for the course,
"Hatred and Group Conflict," INTS 4948 (Professor
David Levine).
Comments are welcomed and encouraged. Please send them to me
at: dwhelan@du.edu
Introduction:
HIV/AIDS-Related Violence
Discrimination against
people living with or otherwise affected by HIV/AIDS
has been dubbed "the third epidemic" of HIV/AIDS,
the first being the spread of the virus itself, followed by
the clinical disease, acquired immune deficiency syndrome
(AIDS). Every society in the world has provided evidence of
HIV/AIDS-related discrimination and violence. As with most
forms of discrimination, its manifestations range from the
subtle to the fully institutionalized. Some countries have
adopted legal protections for people living with HIV/AIDS;
however, there is no evidence whether these measures have
resulted in reductions in the incidence of HIV/AIDS-related
discrimination or violence. In most countries, the law is
silent about HIV/AIDS-related forms of discrimination and
violence perpetrated by either public or private actors.
In the public health
literature—and, increasingly, in the human rights literature
as well—writers and analysts have paid a great deal of
attention to the influence that violence has on the pace of
the epidemic and its social, economic and political
consequences. Consequently, combating discrimination and
violence have become central to world-wide efforts to respond
effectively to the pandemic.
Research exploring the gender dimensions of HIV/AIDS risk and
vulnerability have demonstrated that male-on-female violence
or the threat of violence thwarts efforts aimed at preventing
the spread of HIV. Scores of studies show that when women
propose risk-reduction strategies such as the reduction of
sexual partners on the part of male partners, and the use of
barrier methods (e.g., male condoms), violence or the threat
of violence is the result.
Analysts have demonstrated the counter-productivity of other
forms of discrimination on slowing the epidemic, proving that
measures such as forced hospitalization, quarantine, and
restrictions on freedom of movement and association actually
contribute to societal vulnerability to HIV.
Fear of reprisals or other government sanctions thwarts public
health efforts by driving hard-to-reach populations away from
the HIV/AIDS-related prevention, care and treatment services
and messages.
Thus, the prevention of violence against people living with
HIV/AIDS, and punishment of those responsible, are among the
most prevalent human rights activities related with HIV/AIDS
work.
Although violence itself
has remained a prominent subject in the HIV-human rights
literature, practically all writing and analysis on the
subject follows a familiar pattern of: (a) describing the
various manifestations of HIV/AIDS-related violence; (b)
discussion of overall prevalence and/or incidence trends
associated with other societal reactions to the epidemic,
and; (c) recommendations for educational, public health,
legislative, and judicial actions to reduce the prevalence and
incidence of HIV/AIDS-related violence. Rarely is there any
discussion of the motivations of people who perpetrate such
violence. The conclusion is that such violence is a "hate
crime," a term which seems to bear significant meaning or
explanatory value.
Fear is often cited as
the primary motivation for HIV/AIDS-related discrimination and
violence. Fear in this sense is the fear of contagion,
disease, and those who have it. While this seems to make
logical sense, it falls short of a much more complex set of
psycho-dynamics. In order to gain a deeper insight into the
phenomenon of HIV/AIDS-related violence, this paper will
explore the literature on psychodynamic processes that further
explain violence against people living with HIV/AIDS or
perceived to be HIV-positive. It will especially focus on the
concept of the stigma of HIV/AIDS as disease and
product of other stigmatizing conditions and behaviors. By
doing so, the paper will unpack the supposed role of hate as a
motivator for violence, and examine the ways in which shame,
jealousy, envy, and power contribute to this "third
epidemic."
HIV/AIDS as Disease
HIV/AIDS is an
infectious (not contagious) disease caused by a viral agent
that destroys the human immune system over a period of several
years. The virus is transmitted through the commingling of
bodily fluids between people. The most common medium of
exposure is unprotected vaginal, anal, or oral sexual contact.
There are no reported cases of exposure through kissing,
biting, or spitting. The second most common means of exposure
is perinteral: receiving transfusions of infected blood or
blood products, accidental exposure from tainted skin-piercing
instruments, or through the sharing of needles and other
"works" associated with IV drug use. The third means
of exposure is perinatal: between infected mother and fetus (in
utero) or between mother and infant during childbirth or
breast-feeding.
People living with HIV
(before the onset of AIDS) rarely manifest physical signs of
the disease. In the final stage of the illness (AIDS), the
weakened immune system is increasingly unable to cope with any
other infectious disease. Commonly associated with late stages
of AIDS are skin lesions associated with a rare skin cancer (Kaposi’s
sarcoma) and severe weight loss (commonly referred to as
"wasting"). Other physically disfiguring conditions
include AIDS-related dementia complex, oral thrush (candidiasis,
a white film on the tongue) and infection with molluscum
contagiosum, causing disfiguring lesions on the mouth and
face.
Since its identification
in 1981, HIV/AIDS has appeared in every country of the world.
Current estimates place the cumulative number of infections
(i.e., since the mid-1970s) at over 47 million. In 1998, 2.5 million
people lost their lives to the disease, adding to the 11
million that have died since start of the pandemic.
The World Health Organization recently announced that HIV/AIDS
is now the fourth leading cause of death throughout the world,
and is responsible for more deaths than any other infectious
disease.
HIV/AIDS therefore
invokes a wide range of mental imagery associated with the
body and violence to it. The letting of bodily fluids through
piercing and cutting; images of bleeding and blood;
deterioration and marking of the skin through eruptions, the
notion of "invasion" of the body by an outside
agent; loss of mental capacity; wasting and deterioration. In
this sense, HIV/AIDS is no different from any other
disfiguring disease or condition, in that it invokes a sense
of unease to the person confronted with it. As Alonso and
Reynolds describe it, "[d]isease is essentially a
deviation from what we expect or what we have been told to
expect by medical authorities. However, some diseases are
imputed with additional meaning and significance…"
The phenomenon of
HIV/AIDS is largely socially constructed. Since the beginning
of the epidemic, anxiety and fear have predominated as major
subtexts of this construction. The language used to describe
the epidemic and those associated with it serve as ample
demonstration. In the early years, we spoke of the "AIDS
crisis." A sense of clearly demarcated boundaries is
reinforced by the construction of two camps: "risk
groups" and the "general population."
In an attempt to mobilize scarce resources in many countries,
agencies produce reports that describe an epidemic that is
"out of control." The illness is "uniformly
fatal;" the epidemic "potentially
catastrophic."
These images tend to
provoke group anxiety. Herek and Glunt suggest that the sense
of urgency and vulnerability lead to a "hypervigilant"
style of decision-making.
Feeling the sense that there is little time to carefully weigh
alternatives to dealing with the "problem,"
decision-makers tend to resort to paths of least resistance.
They find excuses for adopting politically
"expedient" solutions based on scapegoating and the
assignment of blame on particular groups of people. While this
in itself is not the central argument of this paper, I believe
such attitudes, especially when legitimized through the
political process, play a role in removing important sources
of inhibition to those who eventually commit acts of violence
against people living with HIV/AIDS.
HIV/AIDS as Dis-Ease
To many researchers, the
recognition that HIV/AIDS is stigmatizing for its very nature
as deterioration of the body is often interrelated to its
association with already stigmatizing conditions and
behaviors associated with the disease and its transmission. As
Herek and Glunt observed in the relatively early years of the
epidemic in the U.S., HIV/AIDS-related stigma "is a
socially-constructed reaction to a lethal illness that has
been most prevalent among groups that already were targets of
prejudice."
This might suggest that
we can ignore the stigma associated with the illness itself
and move on to a focus on those who have it and why. But it is
the combination of stigmas—disease and its identity—which
leads to possible explanations of motivations for
HIV/AIDS-related violence. One "take" on this issue
is that a life-threatening illness (such as HIV/AIDS)
confronts the non-infected with a sense of mortality,
discomfort, dis-ease, which provokes a sense of
anxiety. As Herek and Glunt see it, "healthy individuals
distance themselves from death by defining the illness as an
affliction of others."
The "others"—drug users, prostitutes, gay men,
immigrants, even hemophiliacs (who are already ill)—become
objects of projection of this "dis-ease" from the
non-infected to the infected. Associated with these
projections (more of which I will turn to below) is the
concept of "transmission." The virus is transmitted,
as are blame, shame and feelings of anxiety and anger
transmitted in a dynamic movement in and out of psychic
realities.
Stigma and HIV/AIDS
According to Alonso and
Reynolds, "stigma is a broad and multidimensional concept
whose essence centers on the issue of deviance."
Stigma can include "the entire field of people who are
regarded negatively, some for having violated…rules, others
just for being the sort of people they are or having the
traits that are not highly valued."
Goffman views stigma as
…a powerful discrediting and tainting social label that radically
changes the way individuals view themselves and are viewed as
persons. When individuals fail to meet normative expectations
because of attributes that are different and/or undesirable,
they are reduced from accepted people to discounted ones.
Thus, the discrepancy between what is desired and what is
actual, ‘spoils’ the social identity, isolating the
individual from self, as well as, social acceptance.
The
word "stigma" has its etymological origins from the
Greek word "to brand" or "to mark" (for
runaway slaves), and thus "was extended to embrace any
mark or sign for perceived or inferred conditions of deviation
from a norm."
Oddly enough, the word (in its plural form, stigmata,
is also used to describe the marks of the crucified Christ
that have been documented to have been physically manifested
on a small number of "elect" people throughout
history. Taking this other meaning of what it is to be
"stigmatized" conforms to the psychodynamic
phenomenon of projective identification (in the form of envy)
felt by the perpetrator of violence toward the stigmatized
HIV-positive person.
Envy
One
way to begin to conceive of a complex psychodynamic process
between victim (the person with AIDS, PWA) and the perpetrator
of the violence is to consider how it might be possible for
the perpetrator to envy the PWA. According to Klein and
Riviere, a need to "secure oneself against the loss or
danger within and without induces some people to accumulate
and store up all the good they can lay hold of," leading
to a cycle of envy.
In the psychic reality of the perpetrator, PWAs have many
things: power, attention, compassion. They have the power to
infect, and thus hold the key to causing fear among others,
the power to threaten. They have attention: their condition,
their "plight" as a community receives media
attention. Resources from governments and other agencies and
charities are provided for them. There are "AIDS
Walks" and "AIDS Rides." People pay attention
to them, and give them things they need. Finally, and most
importantly, they receive love and compassion. Goffman
suggests that no matter how small or bad off a particular
stigmatized group is, they are generally given some kind of
public presentation.
Alonso and Reynolds also point out that "[t]elevision and
films, aside from newspapers and magazines, are voracious
consumers of human interest stories which allow us to
vicariously enter the world of the deviant, the distressed,
and the stigmatized. These sources of information have the
capacity to enlighten, to liberate and to focus attention and
generate sympathy and compassion."
This
photograph, produced in 1992 by the United Colors of Benetton
Company, portrays just such a display of love and compassion.
Ironically, it also plays on the concept of the
"good" stigma of Christ, given the remarkable
resemblance between David Kirby (the subject of the photo and
a British AIDS activist) and Jesus Christ. This photo campaign
generated a great deal of public protest and condemnation.
Another
example of the role of envy in hate of people with AIDS can be
found by looking closely at the public statements of the
Westboro Baptist Church and its leader, Fred Phelps. The
organization’s website, "God Hates Fags" offers a
whole host of answers to those who want to understand their
vitriolic hatred of gays and anything associated with them,
including AIDS. In response to the question "Why do you
say ‘Thank God for AIDS?’", the response is:
Because God is a sovereign God, and should be thanked for all of His
righteous judgments, whether you like them or not. Everyone
who gets AIDS gets it as a direct result of God's will
(including babies and people who get it from blood
transfusions), and He should be blessed for it.
Could
this be envy? To receive God’s will, even in the form of
punishment from Him, is a considerable source of envy for
those who may never receive any form of attention from God, or
never know "God’s will." After all, God
"should be thanked for all of His righteous judgements."
Another
source of envy of PWAs could also emanate from the
associational stigma of HIV/AIDS with behaviors of those
stigmatized by the disease itself. In reviewing several
different stigmatic frameworks associated with HIV/AIDS,
Alonso and Reynolds cite six main sources of HIV/AIDS-related
stigma. In their view, the illness is:
- associated with deviant behavior;
- viewed as the responsibility of the individual;
- represents a character blemish because it is though to be
contracted through a morally sanctional behavior;
- perceived as contagious and threatening to the community;
- associated with an undesirable and unaesthetic form of death,
and;
- not well understood by the lay community and viewed negatively by
health care providers.
A
focus on the first three is illuminating, since they may
indeed represent the most important reasons why HIV is
stigmatizing. They also represent significant associations
with enviable character traits. Numbers four and six, which
are often cited as "reasons" for the passage of
discriminatory policies and practices to "protect"
the public health, mask the deeper lying causes of stigma. The
association of HIV/AIDS with deviant behavior could be thought
of as envy of behavior that is "free of
responsibility." The stigmatized (in this case, PWAs) are
an expression of the vitality that those "outside"
lack.
Envy
produces feelings of inadequacy and a sense of anger and
injustice. However, perpetrators of violence identify with
their victims through envy of what they have. It may thus
create the first of the necessary conditions for hatred to
turn into violence. Through a process of projection,
perpetrators must be able to sense in their victims a place
where they can feel justified in taking away from them those
things that make them the object of envy: their vitality.
Projection
Projection
is a psychodyamic process wherein the perpetrator projects
some part of himself onto another person by attributing to
that person qualities that will therefore provoke a response
consistent with the attainment of a sense of justice.
"All painful and unpleasant sensations or feelings in the
mind are by this device automatically relegated outside
oneself; one assumes that they belong elsewhere, not in
oneself…we blame them on to someone else."
Feeling that the danger is placed outside of us, perpetrators
of violence are then in a position to channel the anxiety and
anger they feel toward this object (person) who now contains
the evil. They are now a suitable target for aggression.
Another
concept that is helpful in thinking about projection as a
process for stigmatizing people living with HIV/AIDS is
projective identification. We may split the externalization of
our feelings and search for "containers" to carry both
good and bad qualities about ourselves. The concept of shame
is critical here, as the projection of shame onto an external
community is a powerful mechanism for ridding ourselves of
this feeling. And studies show that people living with AIDS
absorb these projected feelings of shame, turning the psychic
fantasy of the persons projecting the shame into an actuality.
In
this sense, attitudes toward people living with HIV/AIDS can
be understood according to the psychological needs they meet.
According to Herek and Glunt, anti-gay attitudes help
"fix past or anticipated experiences with gay
men/lesbians into existing cognitive categories. Expressing
those attitudes can help individuals improve their
self-esteem, reduce anxiety, secure social support.
So, for example, a fundamentalist Christian will condemn a gay
men in order to affirm her vulnerable sense of self as a
"good Christian." She then interprets AIDS as
God’s punishment for homosexuality. In order to conform to
the notion of being a good Christian, she will further condemn
a person living with HIV/AIDS to boost her self-esteem even
more.
The
connection between projection, responsibility, blame and
condemnation (and, even action) is a powerful one. Following
the model used by Volkan,
the projection of one’s "good" self into a
container for that good (such as a Christian community) means
that we also need a place to project our "bad" self
(feelings of shame) into an "enemy" community:
people with AIDS. But in order not to lose the good and bad of
ourselves, we need to continue an identification—a lasting
relationship—with those containers. So a person stays active
in the Church, and continues to condemn and attack PWAs and
homosexuals. This seems to make perfect sense in understanding
what motivates Fred Phelps and his right-wing organization
(called a "church") to actually place on their
website an image of murdered gay college student Matthew
Shepard, surrounded by flames, screaming for help from the
depths of hell.
Achieving
a sense of justice for that which a perpetrator has lost into
the projected object (a sense of vitality) or in order to be
"good" by attacking that which is "bad" is
that which allows a perpetrator to dismantle the truth and
remove those barriers that separate impulse to act from the
actual act itself.
When considering the social weight that burdens individuals
stigmatized for their sexuality, the psychic pain of being gay
(especially when being gay is so closely associated with
getting HIV) might be enough to lead to violence through of
fit of evacuation. Gilligan’s contention that psychic pain
is worse than physical pain is useful for thinking about this
particular psychodynamic process.
Conclusion
This
paper has explored some of the psychodyamic processes that
contribute to violence against people living with HIV/AIDS.
Scores of stories about such violence, from people being
beaten or otherwise abused physically, taunted, harrassed,
fired from jobs, or having their houses burned, are legion
throughout the world. Violence against people living with
HIV/AIDS has been shown to fuel a larger cycle of
vulnerability to the epidemic and its social and economic
impact.
For
some of the individuals who perpetrate such violence, public
health campaigns aimed at educating the public about the
realities of HIV/AIDS may only reinforce a strong sense of
already-existing envy. For those people, no blanket policy or
campaign to reduce HIV/AIDS-related stigma may ever influence
their real or potential violence. However, for many other
potential perpetrators, the strengthening of those barriers
between impulse and action—those other "realities"
that may allow a person to think for a moment before
evacuating a rage upon a victim—may alleviate some instances
of HIV/AIDS-related violence. But as this paper has also
shown, it is critically important for those designing
stigma-reducing policies and programs to recognize the
intricate relationship between different stigmas that interact
at the intersection of HIV/AIDS, including gender and
sexuality. Furthermore, care must be taken so as not to fuel
one kind of public anxiety in an attempt to "get the
message out" or respond to a sense of "out of
control" urgency. These efforts have been shown, in many
instances, to exacerbate public anxiety about HIV/AIDS.
Notes
Throughout
this paper I will be using the term "HIV/AIDS" to describe the
bio-medical/health condition that begins with infection by the
human immunodeficiency virus (HIV), progresses toward a set of
clinical conditions that together constitute a diagnosis of
acquired immune deficiency syndrome (AIDS). Where a
distinction is made between "HIV" on the one hand and "AIDS"
on the other, it is because I am referring specifically to,
for example, the clinical definition of AIDS (i.e., a CD-4
count at or below 200 per cubic milliliter of blood, and one
or more of a series of "opportunistic infections" commonly
experienced by people with severely suppressed immune systems.
.
See, for example, U.N. Commission on Human Rights, Second
International Consultation on HIV/AIDS and Human Rights,
Report of the Secretary-General. U.N. Doc. E/CN.4/1997/37.
Daniel Whelan, Gender and HIV/AIDS: Taking Stock of
Research and Programmes, (United Nations Joint Programme
on HIV/AIDS, 1999), 11.
Sofia Gruskin, Katarina Tomasevski and Aart Hendriks,
"Human Rights and Responses to HIV/AIDS," in
Jonathan Mann and Daniel Tarantola, eds., AIDS in the World
II (London: Oxford University Press, 1996), 327.
For example, there have been studies that have looked at
correlations between the rise or fall of reported HIV-related
violence and, for example, a famous person "coming
out" with the news of his HIV-positive condition.
Robert D. Redfield and Donald S. Burke, "HIV Infection:
The Clinical Picture," in The Science of AIDS: A
Scientific American Reader (New York: W.H. Freeman and
Co., 1989), 68-70.
United Nations Joint Programme on HIV/AIDS (UNAIDS) and the
World Health Organization (WHO), AIDS epidemic update:
December 1998, 2
UNAIDS, "AIDS Moves Up to Fourth Place Among World
Killers," UNAIDS Press Release , May 11, 1999.
Angelo A. Alonzo and Nancy R. Reynolds, "Stigma, HIV and
AIDS: An Exploration and Elaboration of a Stigma
Trajectory," Social Science and Medicine (41)
1995, p. 305.
Gregory M. Herek and Eric K. Glunt, "An Epidemic of
Stigma," American Psychologist (43) 1988, p. 888.
Alonso and Reynolds, 303.
A. Birenbaum and E. Sagarin, Norms and Human Behavior
(New York: Praeger) 1976, p. 33, as cited in Alonso and
Reynolds, p. 304.
E. Goffman, Stigma: Notes on the Management of Spoiled
Identity (New Jersey: Prentice-Hall) 1963, as cited in
Alonso and Reynolds, p. 304.
Bernard Weiner, Judgements of Responsibility: A Foundation
for a Theory of Social Conduct (New York: Guilford Press)
1995, pp. 53-54.
Melanie Klien and Joan Riviere, Love, Hate and Reparation
(New York: Horton) 1964, p. 25.
Goffman, 25, as cited in Alonso and Reynolds, 304.
Alonso and Reynolds, p. 304.
Westboro Baptist Church Website, "Frequently Asked
Questions (FAQ)", http://www.godhatesfags.com/wbcfaq.html#AIDS
Alonso and Reynolds, p 305.
Klein and Riviere, 11.
Gill Green, "Attitudes Towards People with HIV: Are They
as Stigmatized as People with HIV Perceive Them to be?" Social
Science and Medicine, (41,4) 1995, 558-559.
Herek and Glunt 889.
Vamik D. Volkan, The Need for Enemies and Allies: From
Clinical Practice to International Relationships (New
Jersey: Jason Aronson) 1994.
Westboro Baptist Church Website, http://www.godhatesfags.com/memorial.html
See generally, James Gilligan, Violence: Reflection on a
National Epidemic, (New York: Vintage Books) 1996.
Gilligan, 33.
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