The basis of ethical perspectives including utilitarianism, universal human rights, contractualism, and communitarianism outline not only moral theories but also moral dilemmas. However, in practice, these dilemmas go further than pure theory, having real-world impacts on communities. For example, within the sphere of public health, stigma resulting from health issues or created in order to discourage certain lifestyles cause certain communities to be ostracized and left without proper health resources. We see this not only in the United States’ cultural bias against those with sexually transmitted infections but also with non-sexually transmitted infections caused by various viruses. Rather than further fuel these hateful flames, which do nothing to solve the underlying issues and only make it more challenging for oppressed populations, by approaching these problems through a social justice lens, distributive and recognitional justice interpretations support an argument against creating and reinforcing stigma.
Erika Blacksher, affiliate associate professor in the Department of Bioethics and Humanities at the University of Washington and fourth John B. Francis Chair in Bioethics, asserts that the goals of public health require public health to counteract existing stigma and not use stigmatized measures in its public approach. Elements of stigma might include individuals with socioeconomic and political power identifying and labeling a difference, linking this difference and those labeled as such with negative stereotypes, creating an “us” versus “them” framework, and discriminating against “them” in order to cause a loss of “their” socioeconomic or political status. This ensures the familiar power structures are kept intact in alignment with the patriarchal hierarchy, while health disparities widen between the upper and lower classes. However, when applied to public health, this stigma can have life-threatening consequences. In fact, from a communitarian theorist’s view, Blacksher explains stigma can drive health disparities by putting the blame on individuals or certain communities, as well as lowering the self-worth of those with stigmatized health issues.
Sexually transmitted infections have been categorized as an epidemic in America, and within heterosexual intimate relationships, there are a couple of reasons that women are more likely to be affected by this epidemic and not given proper care. One reason for this is that sexually transmitted infections are biologically more transmittable to women from men than vice versa. In addition, these infections are often more dangerous for women than men— -- HPV can cause penile cancer at only one- hundredth the rate of women who get cervical cancer from an HPV infection. Another reason sexually transmitted infections are worse for women is because of the implicit biases of health care providers. Medical professionals might discriminate against women with sexually transmitted infections because of the cultural perception that these women are sexually promiscuous. This would be another form of misrecognition, including denying one’s shared humanity with these individuals in order to assert some sort of power over them or hold onto their psychological need to be an individual.
Historically, this type of isolation and persecution has also occurred with the HIV/AIDS crisis of the 1980’s. We can compare stigma surrounding sexually transmitted infections to more specific health issues that “target” certain populations, such as HIV/AIDS affecting LGBTQ+ populations the most. There is little to no research to support that these populations engage in any behavior that is out of the ordinary sexual experience to develop these health issues. Therefore, it would be unfair to blame these communities for the potentially fatal health issues they face. This form of misrecognition within the recognitional justice framework could be categorized as neglect or denial of a difference which would only exacerbate the harm to this population through ostracization and oppression. Furthermore, the guilt this blame would put on these communities might negatively affect their mental health, potentially leading to other, compounding health issues. This is especially troublesome given that LGBTQ+ populations often have more serious mental health issues than their cis-het counterparts.
We’re now seeing similar fearmongering tactics feeding into societal stigma with the more recent Monkeypox health crisis. Though discovered in 1958 and first recorded in humans in 1970, a recent outbreak has caused social hysteria around causes and contagion sources. While many believe this virus constitutes a sexually transmitted infection, the CDC has not classified it as such. Instead, Monkeypox can be spread through close contact including touching objects or fabrics, in addition to intimate contact with partner(s) of any gender. The primary reason for the misconceptions surrounding the classification and contagion statistics lies in the fear and resulting stigma associated with infections and the communities most at risk for those infections.
Without challenging these typical narratives, at-risk populations will not be able to heal effectively and wholly. Regardless, experts such as Blacksher agree that one of the first steps to dismantling stigmas should be for stigmatized populations to release their guilt. This does not override the need for the public health field to counteract this institutional stigma, but it is a helpful reminder for these morally oppressed individuals and their activist, caring communities at large.
By Emily Carriere