Is Combination Stigma, Worse Than Stigma?

[Donte]

At some point in our lives we may have bad experiences by people who display negative attitudes, thoughts, beliefs and behaviours that influence us and others around us, altering the way we see things, injecting fear, prejudice, rejection, avoidance that leads to discrimination and marginalisation, simply based on our mental health. Even though, this is a common experience that transcends ethnicity, this stigma is often much greater for people of culturally and linguistically diverse backgrounds, especially if they do not 'fit' into their ethnic origins' prescribed stereotypes and if not being accepted by their own cultural or religious community.

Think of cultural and religious minorities who already confront prejudice and discrimination because of their group affiliation, and suffer double or triple or multiple stigma simultaneously, inside and outside of their communities.

For instance, consider a HIV+ married muslim or jewish man who has sex with other men but is not openly 'out' in his community, doesn't speak good English, lives in a remote or rural area, is facing family breakdown, isolation and possible homelessness, unemployment, has drug dependency and suffers from mental illness. The potency of the stigma in this scenario may lead this individual to not seek help inside their community and also not seek or adequately participate in treatment. So, I'm taking about the combination stigma and how it can impede treatment and well-being, creating otherwise preventable and treatable mortalities and morbidities.

Stereotyping various groups only adds to the stigma. I have heard people inside and outside the muslim and the jewish community for example, saying that muslims or Jews don't have alcohol or substance abuse problems, or that there are no gay muslims or jewish gays! Such stereotypes could serve as a deterrent to mental health care for the above-mentioned individuals, and place extreme ambivalence at the centre of their need to seek help.

What are your thoughts on combination stigma? Have you experienced it? Do you know of others who do? How would you effectively deal with this if you are in this situation or you want to help someone in this predicament?

[Donte]

Hi Hayfa,

You have summarised this very well.

Thank you

[white knight]

Hi all, thankyou for your replies. This discussion is fruitful.

Perhaps I am a good example. Although a 5-6th generation Australian from British extraction (Scot, Wales and English...my family moved from Tasmania to Melbournes western Suburbs in 1962 for health reasons. When I started Technical school all other of the 30 students in my grade were either born in Europe or their parents were (no Asians then). The German kids spoke to each other in German, the Italians, Yugoslavs, Poles, Greeks etc kept amongst themselves and avoided English unless in class. I was very much ostracised. I was different.

Add to that severe emotional issues diagnosed around 42 years later as bipolar, depression, anxiety and dysthymia. Add to that an overweight body and what might seem minor, but thick hair. In the 1960's long hair of the Beatles and hippy era was fashionable...the longer I grew my hair the more I was teased. Oddly enough had I been in USA I would be ok Afro hair was "in".

So I suffered "combination stigma" in my own way. Imagine joining the RAAF at 4 days past my 17th birthday and I was elated for many reasons one of which was that I would fit in with mandatory short hair!! But alas, I was the youngest and notoriously immature emotionally. Another stack of stigmas replaced those in school..

Personally due to the above I dont feel multicultural background/experiences/cultural gaps are any worse than what Ive gone through. As I've mentioned, some families have strong ties, religious support and beliefs which helps. Some dont. If an Italian boy was the only migrant child in a class of 5th generation Aussies might he feel as I did? Yet he/she would be receiving extra focussed attention with the multicultural theme of support.

So I dont feel there is equal regard to reverse multicultural issues, those that also suffered by NOT being of ethnic background. Similar to how the indigenous were deprived compared to white Australians.

Imo all people are equal and these "combination stigmas" are everywhere and should be approached for all people and crafted for the individual. I feel a bias towards migrant families and dont agree with that.

We have support for LGBTIQ people. Imagine if we left out the transexuals in that ? Hence the best approach that covets all. Perhaps organisations are trying too hard to help various groups and in the meantime they miss some that slip through the net.

To avoid bias we should just help all individually as equals.

Tony WK

[Donte]

Thanks White Knight,

Person-centred care is the best approach.When I am in need, I don't want people to respond to me as a Greek person, or as a gay person, but rather as a person. The questions we should always ask, according to my view, are:

'how is this person like all others?' (Universal issue)

'how is this person like some others?' (Cultural issue)

'how is this person like no other? (Individual issue)

These three questions combined could lead us to appropriate responses for the needs of a particular person.

[quirkywords]

Donate,

What a real discussion.

I like the idea of eyeing someone as a person not their race, religion, or mental illness.

We are all different and have needs.

I have had people say very hurtful things to me because of my religion. I sometimes challenge people and find they have never met someone of my religion but base their stigma on something they have heard or read.

This is why I am open about my religious back ground and my bipolar as I feel the more honest I am, I can at least break down a few stereotypes.

I think avoiding generalisations and stereotypes is one way of reducing stigma.

Quirky

[Donte]

I agree Quirkywords,

Generalisations and stereotypes can evaporate once you get to know the actual person! There are so many people who have said to me (after getting to know me), that I'm not like other Greeks or like other gays etc. Some ask 'what type of Greek are you?', to which I reply: 'the type that is me!'. Or 'Are you sure you're gay?', well yes, the last time I checked!

[Donte]

I have an Egyptian neighbor with whom we have become friends.

The other day while enjoying our coffee we started discussing about how terrible it is in their country in regards to stigma if you are HIV+.

I told them that there is a global decline of HIV infections. Stigma is the last frontier when it comes to living with HIV particularly in certain countries where discrimination is legal and citizens are not protected even if they are victims of violence.

In Egypt, HIV has actually been spreading at an alarming rate contrary to global trends of decline.

Apart from the lack of funding and access to medications, social stigma hinders all efforts for prevention and treatment.

(This is not only unique to Egypt by no means.)

Majority of population doesn’t get tested for HIV on a regular basis as the assumption is that only homosexuals, prostitutes and drug addicts get the virus.

The reality is that many HIV+ people have families — husbands, wives and children — who if infected are forced to live with this disease for the rest of their lives in a society that heavily discriminates against anybody living with HIV.

To have HIV and live in Egypt is a tragedy due to discrimination from family and friends, as well as losing your job and sometimes being obliged to move around because of aggressive neighbors. Dentists can refuse treating you, people can by law refuse service and ask you to leave.

UN figures show that Egypt ranks behind only Iran, Sudan and Somalia for the rate at which the epidemic is spreading. Treating people could cost thousands of dollars per person, and there is no budget allocated to prevention and treating the virus.

The best way to reach Egyptians, my neighbor claims, is through religious leaders, due to the cultural importance Egyptians place in religion and God. The responsibility of sheikhs and priests should be not only to raise awareness, but to teach tolerance and acceptance towards those who have HIV and not exclude but rather accept one other.

This made me think that we, here in Australia, need to actively work together within the various communities and consolidate all initiatives and efforts by ethnic NGOs, civil societies and the government in order to control the epidemic within our CALD communities and change conceptions and stigmas of HIV by raising awareness at a local level.

Perhaps then, people from these communities can also offer support to loved ones and people in their homelands.