HIV/AIDS and the Gendering of Stigma in Tamil Nadu, South India

Abstract

Drawing on the seminal theoretical work on stigma by Goffman, this article analyzes stigma through the lens of Parker and Aggleton, who call for the joining of Goffman and Foucault to better grasp relationships among stigma, power and social inequality. Studies on the social impact of HIV/AIDS globally have demonstrated that women tend to be blamed for the spread of HIV/AIDS, and as a result, HIV-positive women face greater stigma and discrimination than HIV-positive men. Based on ethnographic research among 50 HIV-positive women in South India in 2002-2003 and 2004, my research supports this standard argument. However, my findings suggest that the gendering of stigma and discrimination is more complex and context specific. The gendering of stigma varies depending on the social context of private versus public spheres. The tendency to stigmatize women is due in part to cultural constructions of gendered bodies and not only to a gendered double standard of sexual morality, as has been previously reported. Even when a cultural argument about women's wayward sexuality is evoked, this rhetoric must be understood in part as a strategy to mask economically motivated responses, rather simply being attributed to sexist ideology per se.

Women Living with HIV in India: Looking up from a Place of Stigma, Identifying Nexus Sites for Change

“…Although Ho and Holloway [2] and Parker and Aggleton [17] identified the operation of HIV related stigma in both public and private spheres, only Van Hollen [6] conceives of a stigma continuum permeating all aspects of the life of a WLH. It is proposed here that such a continuum is aligned with Engel's [19] biopsychosocial complex model.…”

“…Many women in South India, particularly poor rural women, are unaware of the risk of HIV transmission from their husbands [6,15,26]. Furthermore, cultural and historical expectations of a wife's subordination to her husband mean that women often have little control over marital sexual activity or safe-sex practices [12,26].…”

“…In 2014, women represented 41% of Indians diagnosed with HIV, a percentage that continues to increase [5,6]. The number of Indian PLH had decreased over the preceding five years, both in total and among the segments of the population at greatest risk: sex-workers, men who have sex with men, and injecting drug users [5,7].…”

“…Representing an estimated 1.5 million persons, these at-risk groups are at the forefront of advocacy and treatment campaigns [5]. However, this focus, evidenced for example in preventative educational advertisements [6] and statistics on advances made in controlling HIV in India [5], reinforces vernacular perceptions that HIV is on decline, and is a disease afflicting only people who engage in immoral behaviours [8]. Over time such associations become accepted societal truths [8].…”

“…Although HIV disease progression is not related to the biological sex of an individual patient, Indian women's illness experience is reported to differ from that of Indian men: for example, women are 30% less likely to access antiretroviral drug treatment (ARDT) than men, men are typically diagnosed at a more advanced stage of the disease, and women experience greater social stigma than men [3,6,14]. The major factor limiting regular use of ARDT by women living with HIV (WLH) is stigma [1,3].…”