History repeating

When prejudice spreads faster than disease

An image of a lonely man sitting with his head in his hands.

Image: Srdjan / Adobe Stock

Image: Srdjan / Adobe Stock

By Camille Brandon

On 23 July 2022, the World Health Organization (WHO) declared the monkeypox outbreak a Public Health Emergency of International Concern (PHEIC). Three days later, Australia’s Chief Medical Officer declared it a Communicable Disease Incident of National Significance.

The virus can affect anyone; however, the latest outbreak has largely affected men who have male sexual partners. This has created a stigma around gay and bisexual men.

Unfortunately, the blame game and stigmatisation of certain groups is not specific to monkeypox.

Throughout history, many illnesses have been stigmatised – from bubonic plague to Human Immunodeficiency Virus (HIV)/AIDS and COVID-19, and now monkeypox.

Contact asked experts from across UQ about why certain diseases attract stigma, what impact this stigma has on various communities, and what we can do to stop it?

Image: Ying Ge / Unsplash.com

Image: Ying Ge / Unsplash.com

Professor Jolanda Jetten

ARC Laureate Fellow
School of Psychology and Professor of Social Psychology

From an evolutionary perspective, it makes good sense to stay at a physical distance from those showing signs of being infected with a contagious virus.

Unfortunately, however, we may not always look in the right place when assessing the risk of contagion, resulting in minority groups often being singled out as suspected sources of pathogen threat. This happens even when there is no actual evidence suggesting the minority in question poses a risk.  

Indeed, prejudice and hostility towards minorities, such as ethnic or sexual minorities, often spreads faster than the virus itself.

Consider the extent to which stereotypes reigned free during the COVID-19 pandemic and coloured our perceptions of specific ethnicities, triggering new forms of bigotry, and exacerbating and legitimising some old forms of prejudice and stereotyping.

A case in point is India. In the context of long-standing conflict between Hindus and Muslims, the COVID-19 pandemic was used to legitimise hostility and attacks on minorities.

Historically too, concerns about contagion have enhanced xenophobia towards foreigners and minorities. For example, in 14th century Europe, Jews were falsely held responsible for the spread of the plague and their persecution continued long after the pandemic ended. These are not inevitable processes though.

Leaders have an important role to play in preventing the emergence of such 'us' versus 'them' dynamics in situations where citizens fear the spread of a virus. More specifically, leaders can arouse or attenuate fear for minorities during pandemics.

For example, while former US President Donald Trump fuelled stereotyping of American-Asians by calling COVID-19 the 'Chinese virus', other world leaders discredited such prejudice against groups and called instead for unity and inclusion in the fight against the virus (e.g. New Zealand Prime Minister Jacinda Ardern).

This is particularly important because stigma and discrimination inevitably takes its toll. Being a target of prejudice is reliably associated with a heightened stress response, both physical and psychological. Importantly too, if left unchecked, prejudice and intergroup hostility will ultimately polarise society and undermine its social fabric. 

It is therefore important to avoid repeating past mistakes now that the monkeypox virus poses a new collective challenge.

Brief virus and disease timeline

Historic 'plague doctor' with beak-style mask.

Bubonic plague
1347–1351

The second bubonic plague pandemic, penned the Black Death, reached Europe in 1348 and killed 200 million people. During the Black Death, Jews in Europe were falsely accused of having caused the spread of the disease by poisoning the wells from which the entire population drank. Consequently, many were executed for their alleged role in spreading the plague.

HIV, the AIDS virus (yellow), infecting a human cell.

HIV / AIDS
1981–present

Although HIV/AIDS had been recorded before the 1980s, it wasn't until that decade that cases began to spread, leading to an epidemic in the United States. Stigma and discrimination against certain groups arose due to lack of knowledge and misinformation surrounding HIV and AIDS. In 1987, the United States introduced a travel ban on people living with HIV. The ban was lifted in 2010, allowing HIV-positive people to enter the country without completing a waiver.

Text reading 'COVID-19'.

COVID-19
2019–present

In 2019, a new coronavirus (SARS-CoV-2, commonly referred to as COVID-19) was found in China. By 2020, a pandemic was declared by the World Health Organization (WHO). Confusion, anxiety and fear, heightened by the level of unknowns associated with virus, led to a new level of stigma. Phrases like 'Asian Virus' began to emerge and stigma and racist remarks began to form.

A test tube with a sample of blood infected with monkeypox, close-up.

Monkeypox
1970–present

Monkeypox was first identified in humans in 1970. Recently, cases of monkeypox were found in several 'non-endemic countries'. The outbreak in 2022 has led to harmful stereotypes regarding gay and bisexual men. Messaging and communication about the virus has been challenging for public health authorities, as they try to raise awareness and ensure people at risk are adequately informed, without stigmatising gay and bisexual men or letting others become complacent.

Dr Karin Sellberg

Lecturer in Humanities, School of Historical and Philosophical Inquiry

Infectious disease is never simply a matter of science, but in its very definition emerges from shared environments and social settings, in the meetings and connections between people. As such, it often produces social prejudice and stigma.

Few diseases have attracted more stigma in modern times than AIDS and HIV. When first identified and acknowledged in the early 1980s, it was initially thought to be a disease solely associated with homosexual men and users of intravenous drugs. Despite the production of ample conflicting evidence, this view has persisted.

Right-wing social commentators and politicians went as far as to claim that it was a form of divine retribution against sin and iniquity, and there was a concerted effort required to convince the general public that anyone could catch HIV, including the infamous 1987 Australian ‘Grim Reaper’ advert, featuring women and children falling like bowling pins.

What emerged was a careful curation of the narrative surrounding HIV/AIDS, both from the Christian right-wing politicians, and opposing radical activist movements. The HIV/AIDS epidemic was devastating both physically and socially for the LGBTQIA community of the 1980s and 1990s, yet most historians of sexuality agree that it also became a catalyst for the foundation of a shared social and political platform and voice – through grassroots activism, and the development of AIDS performance and arts movements.

The LGBTQIA community became visible, and through the lens of art and theatre, the suffering and resilience of the victims of the HIV/AIDS epidemic evoked sympathy as well as stigma. The story of AIDS became a means of community healing.

Image: Ehimetalor Akhere Unuabona / Unsplash.com

Image: Ehimetalor Akhere Unuabona / Unsplash.com

Associate Professor Lisa Fitzgerald,
Associate Professor Allyson Mutch,
Chris Howard

School of Public Health and Queensland Positive People

Certain diseases attract social stigma. Diseases perceived to be contagious, terminal, and visible have moral connotations, while those seen as the responsibility of the individual are often the most stigmatised.

In the case of HIV-related stigma, the prejudice, discrediting, labelling, stereotyping, and discrimination directed at people living with HIV has been a persistent feature of the HIV epidemic for the last 4 decades.

HIV stigma is caused by fear and moral judgement, and is based on outdated knowledge, incorrect information, and a general lack of awareness, understanding and empathy. The impacts of HIV-related stigma are not only felt by those living with HIV, but also partners, families, and key social groups.

Stigma impacts people’s lives – their psychosocial, physical, and mental health, constraining access to resources and opportunities, driving inequalities, marginalisation and reducing quality of life.

In our longitudinal qualitative research with people living with HIV long term, we have witnessed the cumulative impact of stigma on people’s lives, and how it insidiously intersects with other forms of stigma, such as homophobia, ageism, racism and sexism.

Stopping HIV-related stigma requires multiple approaches. Practical strategies for people who experience stigma, as well as community-wide efforts to improve understanding of what it means to live with HIV are needed to directly challenge stigmatising attitudes, outdated myths and stereotypes, and to ensure non-discriminatory legislation.

We all have a role to play in reducing HIV-related stigma by educating ourselves, calling out stigmatising actions and attitudes, and correcting misinformation to help others learn.