Gita Sen, director and distinguished professor, Ramalingaswami Centre on Equity & Social Determinants of Health (RCESDH), Public Health Foundation of India, spoke to The Hindu about how the stigma attached to COVID-19 is much like what was seen with HIV/AIDS and how it is a result of poor knowledge.
In this time of stress associated with COVID-19, why is a small group of people being stigmatised? How is this different from other health crises we have faced?
Stigma and fear are the result of people’s poor knowledge about COVID-19 and how it spreads. This is compounded by the large amount of fake news and false information being generated today. Some groups face the additional element that discrimination against them is already there, and COVID-19 has become one more reason to stigmatise them. In terms of stigma, the closest we have come is with HIV/AIDS patients. But HIV-related stigma did not extend, in general, to health workers.
Which are the groups most vulnerable to stigma related to COVID-19?
Three sets of people are being stigmatised now:
- those in quarantine, whether they have tested positive or not – many state governments are violating medical ethics codes by publicising address details, marking doors of their homes with stickers and even large posters, stamping them with indelible ink – and stories are coming in of people being thrown out of their homes, shunned, etc
- health workers from doctors down to the frontline workers are facing stigma and discrimination including losing their homes because their landlords somehow think they will be contagious
- those who traditionally face discrimination like migrant workers, people from the northeast, victims of religious or other persecution.
What can we as government/community do to prevent this?
We have a long way to go because we haven’t even fully acknowledged the economic and health challenges of 80% of our people in what we have done so far. The main responses put forward thus far, needed as they may be, such as social distancing, handwashing and sanitising, nourishing food are out of reach for the large majority of people.
The most vulnerable groups to the virus are the poor in urban slums, migrant workers with no homes, people living in close proximity with little possibility of social distancing or even hand-washing. Very important among them are women who are the traditional providers of home-based health care, which is where many poor people get their health care. These same citizens of our country are undernourished and have few resources to combat non-communicable diseases even in ordinary times.
Think of a woman who has to feed her family, take care of sick people and is herself suffering from poor general health – that is the section that is going to be very vulnerable.
Preventing stigma requires a full-throated campaign of public information. How good it would be if the Union Health Minister were to give a daily briefing to let people know what is happening, together with creative social media campaigns about the virus itself that gets rid of the stigma? How valuable it would be if the Prime Minister were to speak against stigma, on behalf of health workers, on behalf of migrant workers and those suffering discrimination, in support of women?
We need clear, informative and fun messages of the kind that our social marketers surely know how to produce. Think how creative a series of Amul ads could be! People also need to understand that the same health worker that you stigmatise today may be the one who you may have to turn to tomorrow.
What effect would this have on the groups of people who are discriminated against?
It would have the effect of removing the fear that the COVID-19 information barrage is creating. And that is the most important need.
