Societal stigma refers to “negative labels and societal reactions directed at individuals whose characteristics diverge from established social norms”. In the context of rapid spread of disease – specifically, disease that has been heavily stigmatized or misconstrued by the public eye – societal stigma plays an immense role in the ability `for affected persons to comfortably seek treatment and open up to individuals (doctors, relatives, friends) about their condition and experiences. Societal stigma also halts scientific understanding of disease origins and their spreading patterns – thereby critically limiting necessary scientific research and treatment in the process – and places derogatory opinions on marginalized demographics based on misinformed and propagated social views and stigmas. Specifically denoting societal stigmas around HIV/AIDS, COVID-19, and Ebola Virus Disease (EVD) viruses, these diseases were heavily stigmatized by the public and are still stigmatized today, often being referred to in major headlines as a “gay disease,” “China disease,” and “African disease,” respectively.

With globalization, a process by which societies around the world become increasingly interconnected—not merely economically and politically, but also culturally and socially through the rapid exchange of ideas, behaviors, beliefs, and people—it acts as a positive feedback mechanism, amplifying the misconceptions propagated by the spread of propaganda in and throughout societies around the world. To prevent a repeat of history, as the inevitable introduction and spread of new diseases are bound to take place, we must challenge societal misunderstandings and cultivate truth amid the present stigma to protect vulnerable, targeted demographics.  

In the early outbreak of HIV/AIDS, circa 1981, news outlets coined the rapid spread of the new disease a “gay plague/gay syndrome.” The disease was introduced as GRID (Gay-Related Immune Deficiency)/“gay syndrome,” because it only seemed to affect homosexual men. Around this time, The New York Times wrote the first article on HIV/AIDS, describing it as a “rare cancer observed in 41 homosexuals” (2023). Similarly, when COVID-19 began to have a widespread outbreak in 2020, it was heavily stigmatized in the United States, with then-former (and current) President Donald Trump referring to COVID-19 as the “Chinese virus” on Twitter. He tweeted, “The United States will be powerfully supporting those industries… that are particularly affected by the Chinese Virus…” sparking widespread xenophobic and derogatory comments across the entire social media platform, primarily from U.S. users. In other countries around the world, COVID-19, being a “Chinese virus,” became the norm: headlines read “Chinese-Originated Viral Infectious Disease” as a moniker for COVID-19. Around the peak of the EVD outbreak (2013-2016), it was coined an “African Disease,” and “children were teased in high school, or adults were the butt of jokes at work. People from Nigeria were also stigmatized by the Ebola scare, resulting in stress and hardships for these populations”. 

Growing up as a Black-American teenager in Los Angeles, CA, I vividly remember times when students at my elementary school would often mock individuals of my demographic and mock the fear associated with EVD. For example, students would taunt, “Don’t touch [individuals], you might get Ebola!”, while laughing and joking about this very risky and serious, deadly condition. In 2014, a report from ABC7 Los Angeles Eyewitness News anchor Lucy Yang detailed even further the impact that derogatory comments made towards Senegalese teenagers from the Bronx who were bullied by peers in the midst of the EVD virus had on these individuals: “From children being bullied and beaten at school to parents losing business: 13-year-old Pabe Drame says the kids were yelling Ebola at him, as they punched him at school—this after he tried to rescue his young brother [redacted] [from the same conditions]” (Yang, 2014). It was also mentioned in the interview that the students at Pabe’s school were in fear of playing sports with him, due to the fear that he might pass on EVD. 

Beyond societal stigma and the influence it has on notorious diseases such as HIV/AIDS, COVID-19, and EVD being misconstrued by the public, the globalization of these shared ideologies further accelerated the rapid spread of these diseases on a much broader scale, especially and specifically among marginalized populations and the groups that were (and are) targeted by the misinformed claims made towards these demographics (i.e. gay men, Chinese, and African individuals, respectively). In 2023, a Stigma and Discrimination policy paper on HIV Care, published by Board-Certified Pharmacists Kevin Astle and Tam Phan, noted that: “the fear of [rejection] by others often leads individuals to avoid getting tested or seeking medical care, resulting in delayed diagnosis and an increased risk for transmission”. This is a common example seen across the other frequently stigmatized diseases referenced in this paper, COVID-19 and EVD.

In commonality, if a disease is stigmatized and/or ostracized by society, it’s only practical that there will be individuals who don’t feel comfortable and represented enough to speak out on their condition and/or diagnoses, and seek the treatment they need. Globalized stigma spread like wildfire amongst individuals carrying any one (or, in rare cases, more) of the three diseases mentioned in this paper, making it incredibly easier for pathogenic viruses to spread, as those affected had no one to turn to, and were left to deal with their conditions in private, isolated practice, in fear of criticism. The continued propagation of negatively shared ideologies of diseases will only continue harming individuals from comfortably seeking treatment, thereby actively aiding in its spread, rather than helping to minimize it. 

This begs the question: in what other ways does societal stigma reinforce boundaries to progressive treatment and management of infectious diseases among carriers, besides propagated propaganda accelerated with positive feedback via globalization? Well, we must also consider the impact of socioeconomic hindrances for demographics targeted by the disease, as these hindrances affect their ability and viability to afford medication/treatment to manage symptoms of HIV/AIDS, COVID-19, and EVD. Tackling this issue from an intersectional lens, overlapping barriers of race, gender, and low-income status intersect to form a unique, individualized perspective into the struggles of what it means/meant to be an individual who carried any of the aforementioned three diseases. If you carried HIV/AIDS, and happened to be gay, low-income, and black, the problem of this particular individual carrying a certain disease, HIV/AIDS, would no longer be the overarching, limiting trait to their identity. As an intersectional being facing overlapping discrimination from each identity trait they inhabit, they are now navigating a different experience and perspective: a unique, individualized experience. 

So, what does it mean to be intersectional? Intersectionality, or an intersectional framework, examines how systems of oppression interact to create unique forms of disadvantage for different identities of people. With an intersectional framework, we can better understand how racial inequality and structural barriers overlap to impact the socioeconomic inequalities of affected disease carriers in society (HIV/AIDS, COVID-19, and Ebola), and how individual navigation of life is dissimilar across the board. However, in doing so, we must also acknowledge that intersectionality is not limited to theory: “simply identifying particular intersections as undertheorized or unacknowledged is only the first step in a larger theoretical and political project, which intersectionality has yet to articulate with specific”.

It is certain that intersectionality presents critical understandings of how certain individuals are privileged in some ways, yet severely marginalized in others (such as being gay, low-income, black, and HIV/AIDS positive), and interprets the interspace of crossover between this breadth; yet, there is a much bigger conversation to be had about how we can use this theory of intersectionality to critique policy and advance social change and mobility, and not merely stop at this identification. We must emphasize the fact that there is so much more we can pull from intersectionality than what we do in theory, and in doing so, we allow for policies, movements, and better practices to be implemented, producing equitable change targeted at combating these systemic inequities, such as dismantling systems of power that reinforce societal stigma, which proliferate harm among individuals affected with stigmatized diseases. 

When considering the intersectional socioeconomic impact of being gay, low-income, black, and HIV/AIDS positive, and the systems in power that destroy this particular type of individual’s ability to navigate through their experiences, we must look toward relevant gaps in stigmatized spaces such as healthcare and policy. To reiterate, the aforementioned type of individual faces both racialized discrimination and stigmatized discrimination of their disease, along with homophobia in societal contexts. In healthcare settings that are not designed with inclusivity in mind and heart, understanding individual perspectives becomes essential. According to a 2005 study on Discriminatory Attitudes of Health Workers against People Living with HIV published by Gobopamang Letamo, the results suggested that “health-care professionals discriminate against and stigmatise PLWA [people living with AIDS]. For instance, 9% of professionals reported refusing to care for a patient with HIV/AIDS, and 9% reported that they refused a patient [of a particular demographic] with HIV/AIDS admission to [the] hospital”.

Nine percent might not seem like a large percentage, but in the context of each individual coming from a marginalized background who also has to deal with the added struggle of living with HIV/AIDS, each person denied equitable access to healthcare is a person who deserves justice. Many individuals who felt as though they had no one to turn to, especially a healthcare provider, when symptoms became too difficult to manage, only discouraged their trust in the healthcare system, leading these individuals to believe that there are extremely few resources available for them in support of their necessary accommodations. 

The study also suggested that “a significant number of health-care professionals engage in discriminatory and unethical behaviour, [with] some professionals giving confidential information to other people (family members and unrelated individuals) without the patient’s consent, [highlighting how] myths and misconceptions about HIV transmission play a role in promoting discrimination”.Not only do we see providers breaking patient-client confidentiality, but also doing so in a manner driven by stigma and highly discriminatory towards different groups of people, all trying to manage the same viral condition. In a holistic effort to account not just for those battling HIV/AIDS, but for all stigmatized diseases, especially COVID-19 and EVD, an intersectional framework of identities must be applied to reaffirm why malpractice in healthcare must be approached from multiple, intersecting angles. By addressing overlapping dimensions of race, class, gender, and identity, healthcare settings become better at providing solid foundations for intersectional beings to feel comfortable, heard, and seen when society negligibly draws the line.

As we look toward future societal implications of the spread of misinformation among disease epidemics, we gradually discern how targeting/attacking specific demographics of people, instead of centralizing on conducting more research into the root causes of conduct and providing better patient-centered care to affected persons, objectively harms the mental health of individuals living with these diseases/conditions. Centering on the COVID-19 outbreak at its peak across the globe, regarding collective racism, a 2023 study found that “both health-related and media Sinophobia [Anti-Chinese sentiment]…[, and]…Chinese American parents’ fears and worries about being targeted and having more difficult lives due to the Trump administration’s racist responses to the COVID-19 pandemic were more strongly associated with their poorer psychological well-being in 2021 compared to 2020”.

The longer society decides it is okay to attack certain demographics of individuals based on preconceived opinions, especially political powers like President Trump, who held major significance in tackling the spread of stigma and health misinformation when the U.S. public eye was just starting to understand the disease in its broader extent, the longer we invalidate the experiences of these individuals who are battling with these diseases, all while struggling to manage their own psychological hardships due to targeted discrimination, as denoted in the findings earlier. 

Misinformation surrounding the EVD virus at its peak, and the targeting of African individuals, instead of focusing on conducting further research into the root causes of the disease, only aided psychological harm to this demographic and individuals with this disease who struggle to manage symptoms. A paper written by freelance writer Dawn Fuller on The Ebola Scare, and how it stigmatized African Americans, reads: “In the early stages of [EVD] in West Africa, we found a fear linked with African immigrants around spreading the disease in the U.S. Some of these populations felt they had to hide their ethnicity in an effort to avoid the stigma”.

It is evident that psychological distress becomes present when society begins to attack a particular demographic and “name-blame,” an entire group of people solely based on biased and untrue perceptions. This distress might not manifest itself at first; however, with prolonged exposure to societal hatred for one’s own demographic, and news and media outlets spreading propaganda, over time, we will likely see greater and greater distress being built up emotionally and physically. It is impossible to fully understand what someone is going through, especially an individual who feels the need to isolate themselves and hide their ethnicity, their identity, who they are, to avoid stigma and criticism. 

Fuller also added that researchers’ understanding of this stigma faced by African communities in the U.S. “could help improve health promotion programs targeting immigrants, [emphasizing] that the outbreak highlights a need for research on infectious disease that’s relatively unknown in the U.S. and the Western world” (qtd. in Fuller, 2015). This shows that the more we make an effort to dismantle societally constructed systems in power that allow for criticism and stigma to perpetuate, the closer we become towards emphasizing the need for further research efforts that must be taken beyond measure to ensure that every individual impacted by stigmatized diseases is properly accounted for, both physically and medically. 

Together, findings from each study necessitate the implication that vicarious experiences with discrimination in society, along with racism, hurt an individual’s mental health, especially if you’re an affected person with the stigmatized disease or condition, along with being an individual who identifies with the targeted demographic. With intersectionality at play, we must consider all possible levels of harm to one’s identity being affected, and how we as a society can support intersectional individuals to the greatest extent.

In summary, societal stigma objectively plays a major role in how an individual seeks treatment for a disease, how they are impacted socioeconomically, and how society diminishes their intersectional perspectives, all factors being proponents that sustain the spread of these diseases globally, especially if the disease is notorious and ostracized, such as HIV/AIDS, COVID-19, and Ebola Virus Disease (EVD). When investigating derogatory opinions on underrepresented demographics with an ostracized disease, misinformed and propagated social views and stigmas were present, aiding in the proliferation of psychological harm to affected demographics with said disease. Derogatory monikers for researched diseases like “gay disease,” “China disease,” and “African disease,” were propelled widely with globalization, through sociocultural norms and in society through the rapid exchange of ideas, behaviors, beliefs, and people, all of which are aspects that helped globalization act as a positive feedback mechanism for the amplification of widespread propaganda of stigmatized diseases in and throughout societies around the world. 

To prevent a repeat of history, we must ensure that, as a society, “blame” for the origin and spread of all diseases is not administered to a specific area, demographic, racial group, or intersectional being. With the inevitable introduction and spread of new diseases bound to take place eventually, it becomes even more necessary to challenge societal constructs and hold individuals accountable who have no problem with spreading misinformation, hate speech, xenophobia, sinophobia, propaganda, derogatory comments, or any form of misunderstanding that could potentially become widespread and further harm more individuals.

Once challenged, we are better able to cultivate truth and strike down hatred of all forms that actively use present societal stigma to target vulnerable, impacted demographics hatefully—only if done together, and not apart.

Photo Credit: Associated Press