Stigma of HIV and AIDS—Psychiatric Aspects

Since 1981, when previously healthy young adults were first stricken with a mysterious illness that was eventually described as “a new acquired cellular immunodeficiency” (Gottlieb et al., 1981), understanding of HIV and AIDS, both the in the medical community and general society, has come a long way. There remains, however, an unfortunate degree of stigma that persists since its development in the early days of the illness (Cohen and Weisman, 1986; Cohen, 1987, 1992; Cohen and Alfonso, 1998;Cohen, 2008). Early in the course of this epidemic, as it became evident that the immune deficiency had an infectious etiology and could lead to rapidly fatal complications, many became fearful of the possibility of contagion. An “epidemic of fear” (Hunter, 1990) thus began to develop along with the AIDS epidemic. During the first decade, even many physicians surveyed had negative attitudes toward persons with HIV and AIDS (Kelly et al., 1987; Thompson, 1987; Wormser and Joline, 1989). At the beginning of the HIV epidemic some persons hospitalized with AIDS experienced difficulty receiving even minimally adequate care, including getting their rooms cleaned, obtaining water or food, and receiving proper medical attention. Psychiatric consultations for AIDS patients with depression, withdrawal, and treatment refusal often revealed the heightened feelings of isolation and depression experienced by the patients, in part as a result of the reactions of staff members to their illness, including the palpable fear of contagion. Holtz and coauthors (1983) were the first to describe the profound withdrawal from human contact as the “sheet sign,” observed when persons with AIDS hid under their sheets and completely covered their faces. Thus, since the beginning of the AIDS epidemic, people with AIDS have been stigmatized. They have felt shunned and ostracized by not only medical caregivers but also the general community and even by their own families and friends. In some areas of the world, persons with AIDS have been quarantined because of the irrational fears, discrimination, and stigma associated with this pandemic. In the United States, persons with AIDS have lost their homes and jobs, and some children and adolescents have been excluded from classrooms.