Goldin C S
Office of Academic Planning & Institutional Research, Rutgers University, New Brunswick, NJ 08903.
Soc Sci Med. 1994 Nov;39(9):1359-66. doi: 10.1016/0277-9536(94)90366-2.
From Goffman's classic sociological work on stigma to Sontag's popular works on metaphors, stigma has captured academic and general public interest. The severity of the AIDS pandemic has transformed our lives profoundly, and the stigma experienced by persons with AIDS has grave consequences for public health efforts. Fears of the consequences of open discourse and self-identification have created a silence that threatens all of us. Using analyses of Western imagery and African ethnographic accounts, this paper explores the differences between AIDS in America and in Africa with respect to epidemiology, socio-economic and cultural illness patterns, and experiences of stigmatization. Several research questions are posed to stimulate discussion of future ethnographic work on illness and stigma in Africa. The paper concludes with a discussion of the impact on public health of four types of AIDS stigmatization: theologically-based blame, liberal concern for the health of those not afflicted, risk group problem and civil rights problem. From the point of view of enlightened management of public health, the civil rights issue poses the most serious threat. The tension between the rights of the individual, who is at risk of exposure and condemnation because of stigma, and the rights of the rest of society, interferes with the development of large-scale, effective public health programs.
从戈夫曼关于污名的经典社会学著作到桑塔格关于隐喻的通俗作品，污名一直吸引着学术界和普通大众的关注。艾滋病大流行的严重性深刻地改变了我们的生活，而艾滋病患者所遭受的污名给公共卫生工作带来了严重后果。对公开讨论和自我认同后果的恐惧导致了一种沉默，这对我们所有人都构成了威胁。本文通过对西方意象和非洲人种志描述的分析，探讨了美国和非洲在艾滋病的流行病学、社会经济和文化疾病模式以及污名化经历方面的差异。提出了几个研究问题，以激发对未来关于非洲疾病和污名的人种志研究的讨论。本文最后讨论了四种艾滋病污名化对公共卫生的影响：基于神学的指责、对未感染者健康的自由主义关注、风险群体问题和民权问题。从公共卫生开明管理的角度来看，民权问题构成了最严重的威胁。因污名而面临暴露和谴责风险的个人权利与社会其他成员的权利之间的紧张关系，干扰了大规模有效公共卫生项目的发展。
