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