Disease Stigmatization and National Security

I spent my summer living in Eastern Uganda and working for a community-based AIDS prevention organization called The AIDS Support Organization (TASO). While at TASO, I observed the impact the stigmatization of HIV/AIDS has had on national unity and international relations- two variables that impact a state’s security. With a highly transmissible disease, like HIV, especially in a developing country non-reliant on western biomedicine, stigmatization plays a large role in citizen response. Disease stigmatization constitutes prejudice and rejection, often manifesting in forms of social exclusion and public shaming of victims of illnesses feared by the public. While sociologists like Erving Goffman argue that stigma is a binding agent within a society because it delineates social order and societal values, other authors argue that stigma is a “powerful discrediting [agent] and a tainting social label that radically changes the way groups view themselves and are viewed.” This final statement conveys the way stigma can impact a state on an international level, as it influences international relations by affecting trade relations and/or by creating or identifying state vulnerabilities. Stigmatization within a state’s populace also impacts internal cohesion, causing the breakdown of social support networks as fear drives people away from each other. As citizens become divided and are unable to get adequate support, and as international bodies isolate or act against the stigmatized state, that state’s security is jeopardized both internally and externally. Thus, the stigmatization of infectious diseases like HIV, or currently Ebola, must be mitigated within a nation-state in order for it to preserve its security.

Case-Study: Uganda
The HIV-prevalence rate in Uganda went from 0-1% in 1982, to 29% in 1986, indicating a massive spread of the virus among the Ugandan population. With such a rapid dissemination of HIV/AIDS can a tidal wave of stigmatization that covered every part of Ugandan society. The impact this stigma had on Uganda internally was the breakdown of the family structure, as fear of catching HIV caused neglect of family members, the expulsion of people from their family structures, and ultimately the inability of society to absorb the 1.1 million children left orphaned by the disease. With this huge number of uncared for children and youth, civil unrest is growing within Ugandan society, and many predictions have been made about what these unoccupied youth will do to the security of the country as they mature. Internationally, Uganda was impacted by stigmatization as the majority of international non-government organization (INGO) effort and foreign aid money went to fighting HIV/AIDS, rather than into other infrastructure/government transparency/human rights causes- impacting government functionality and priority. Disease stigmatization created conflict between Uganda and the Democratic Republic of the Congo in the mid 1990s-early 2000s, as the DRC accused Ugandan sex works of crossing the border and proactively spreading HIV within their population. This and other historic tensions created guerilla warfare across their shared border.

As a response to this stigma, the government, under Yoweri Museveni, created a comprehensive public health campaign promoting a three-point approach to HIV prevention: Abstinence, Be faithful, and use a Condom (ABC). Musevein worked with community, religious, and cultural leaders to spread HIV/AIDS education in rural areas, trained Ugandan community and health workers in HIV/AIDS education/treatment, and solicited donations from global partners. Museveni also spoke publically about HIV/AIDS to national and international media outlets- he was the one of the first African leaders to publically speak about such a socially taboo disease. Through this government run and INGO-supported campaign, Museveni was able to decrease social stigma of HIV/AIDS, as indicated by the now 7.2% HIV-prevalence rate among Ugandans.
While the community structure within Uganda has been severely impacted by HIV/AIDS, it is clear through huge community-based organizations like TASO, that stigmatization, especially within Uganda’s heavily populated urban areas, is decreasing, and that more people are coming for treatment without fear of social isolation or rejection. 26 years ago, TASO helped on average 100 people a year. Now, they have over 600,000 patients in every region of Uganda. Internationally, Museveni’s public mitigation of HIV/AIDS-based stigma and his successfully multifaceted approach has made Uganda today a leader in Sub-Saharan Africa, and has given them an advantageous position within their regional economy. Through the public commitment to decreasing the stigma surrounding HIV/AIDS within its population, Uganda was able to boost its national security, and stand as both a regional and international leader in the fight against infectious disease.

Works Cited:

http://news.ku.dk/all_news/2014/03/why-sanctions-do-not-always-work/Stigma_Management_in_International_Relations_-_IO_print.pdf

http://news.ku.dk/all_news/2014/03/why-sanctions-do-not-always-work/Stigma_Management_in_International_Relations_-_IO_print.pdf

http://www.avert.org/hiv-aids-uganda.htm

http://www.irinnews.org/report/96349/uganda-decades-later-hiv-stigma-lingers

http://www.afrik-news.com/article16489.html

On September 18th, 2014, the UN Security Council called an “emergency meeting,” to garner support for the “emergency UN mission” to combat Ebola. This is only the second time in UN history that a public health crisis has been deemed such a threat to the international system, second only to HIV. The UN has called on its member states to raise $1billion in aid money, and for states to resist isolation, and instead join together to curb the spread of this disease. A record number of 130 states signed this resolution, and the International Monetary Fund (IMF) has agreed to loan the three countries most affected- Sierra Leon, Liberia, and Guinea- $ 127 million to boost their health care infrastructure (ironic because of the austerity measures, no?). The US has also pledged to send troops into West Africa to help increase health care standards, and Congress is reviewing a bill for $500 million to fight Ebola. A solid basis of international governmental support has been established for a epidemic that has infected 5,000 people and killed 2,500 since March.

A problem with this American and UN response to containing Ebola is its lack of contextual understanding. Thus far, the most tangible security risk in regards to Ebola is that of the health care workers in the three states most affected by Ebola. Yesterday, 8 healthcare workers and journalists were killed and 21 injured in southeastern Guinea after attempted to educate a village about the spread of Ebola and how to avoid it. Within this region and many others, the culture of western biomedicine is not mainstream. Local variations on folk medicine tend to dominate. The difference between what is being proliferated by international health-based NGOs and government services versus what the local people know and believe to be true about infectious disease is vast, as if the same international healthcare approaches continue being pushed again and again on these communities of people, the containment of Ebola will not be a peaceful one. This is regardless of how much money is pushed into the hands of the international and government-based health care workers.

To exemplify current local attitudes toward Ebola, the BBC reports that some people in Guinea believe Ebola to be a tool white people are using to kill black people. There is great suspicion of the outsiders who come to take Ebola patients away, as many of these ‘outsiders’ have encouraged local people to abandon with their age-old traditions, as these are spreading the disease among villages. The lack of cultural context had lead to riots and increased hostility and resistance to aid workers, as reported by Doctors Without Borders. Health workers have begun fleeing their posts due to threats of violence as well as fear of contracting the disease, as the health care infrastructure is so poor in these West African countries. It has been argued that this distrust of the West will only increase when the US troops arrive, as they will bring with them connotations of further control or potential violence.

It is a deeper understanding of the cultural, social, and historical context surrounding medicine and disease-based beliefs in the different areas within Western Africa that is needed to reduce Ebola’s threat of becoming an international security issue. Thus far, the international community’s western-based response to this epidemic has increased resistance, hostility, and violence among the infected populations they are trying to reach. Practical measures such as better and quicker evaluations of NGO public health initiatives in foreign countries or greater transparency of funds and resources as the UN prepares to roll out its “emergency plan,” should be encouraged, rather than a flood of financial stimulus into countries with serious structural inequity.

http://www.bbc.com/news/world-africa-29262968

http://www.vox.com/2014/9/17/6334943/why-is-the-military-being-sent-to-attack-ebola-virus/in/5712456

http://touch.latimes.com/#section/-1/article/p2p-81406643/

http://touch.latimes.com/#section/-1/article/p2p-81384979/

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