Stigma is a strong feeling of being shamed or disgraced. It can come not only from strangers but also from families, friends and peers. When people are stigmatized, other people’s words and actions cause them to feel ashamed. These words and actions can be violent or discriminatory. When people are stigmatized because of how they identify themselves—by race, ethnicity, gender identification or sexual behavior—that shame can cause significant health problems.
A lot of stigma comes from attitudes about people’s gender identities or sexual behaviors. People who are lesbian, gay, bisexual or transgender (LGBT) report experiencing high levels of stigma and discrimination.
“We know from research that stigma adds to negative health effects in many communities, including communities of color, LGBT communities and people with disabilities,” says Sarah Krier, PhD, MPH, research specialist with the University of Pittsburgh Graduate School of Public Health’s HIV Prevention and Care Project. “It keeps people feeling isolated within the larger community. It prevents people from getting information, seeking support and getting medical care.”
“Stigma and discrimination can include rejection by loved ones, bullying or violence,” says Mackey R. Friedman, PhD, MPH, assistant professor of infectious diseases and microbiology at Pitt Public Health. “If people have these negative experiences early in life, they are more likely to have depression, stress, drug or alcohol use and other poor health outcomes in adolescence.”
Stigma and discrimination not only affect health directly but also the decisions that have the potential to negatively affect health.
Dr. Friedman says, “Research shows that people who experience stigma and discrimination early in life tend to have low self-esteem. This can lead to higher sexual-risk behavior (using drugs or alcohol and having sex, not using condoms or birth control, etc.) when they get older. And risky sexual behaviors can lead to higher rates of HIV [human immunodeficiency virus, which can lead to acquired immunodeficiency syndrome, or AIDS].”
Fear of stigma can lead to secrecy, which can also contribute to poor health. For instance, people may not want to tell their health care providers about their sexual behaviors for fear of being judged. A person feeling judged can lead to him/her not seeking resources like getting tested for sexually transmitted diseases or infections (STD or STI). Men who have sex with men may not identify themselves as gay or bisexual because they fear stigma and, therefore, feel they cannot openly discuss behaviors that may affect their health or the health of other partners.
According to the Centers for Disease Control and Prevention, 1.2 million people are living with HIV in the United States. Nearly one in seven of those do not know they are infected with the virus. But the disparities in infection among racial and ethnic groups are striking. African Americans bear the most severe burden of HIV and AIDS. African Americans account for 44 percent of new infections in the United States each year. Approximately one in 20 Black men will be diagnosed with HIV, as will one in 48 Black women at some point in their lives. The HIV incidence rate for African American women is 20 times higher than that of white women.
Health care providers recommend that sexually active adults get tested for STIs once a year. If people are afraid of people knowing they are getting tested, many sites, including the Pittsburgh AIDS Task Force, Allegheny County Health Department and Project Silk, offer free and anonymous STI/HIV testing. When people get tested, they can keep themselves and their partners healthy.
Remember that social and family supports are keys to health too. For people experiencing stigma or discrimination because of their gender identification or sexual behaviors, “You are not alone,” says Dr. Krier. “There are social support and health care services in the community that can help.”
Acceptance Journeys Pittsburgh
Started and run by Drs. Krier and Friedman, Acceptance Journeys (https://acceptancejourneyspgh.projectsilk.org/) is a social marketing campaign (on a website, printed cards and billboards) to share stories of love and acceptance between people who are not LGBT and their loved ones who identify as LGBT.
“We talk to young LGBT people in Pittsburgh who are experiencing stigma and discrimination from families and peers. Reducing shame and prejudice about people who are LGBT are health care and community issues. It’s why we started Acceptance Journeys,” says Dr. Friedman.
“With Acceptance Journeys, we’re trying to counter the negative health effects of stigma against people who are LGBT by showing their loved ones have accepted them,” says Dr. Krier.
Quotes from stories in the project include, “Who my son loves doesn’t change my love for him,” “I’ll let God do the judging,” and “If you love someone, labels shouldn’t matter.”
“Acceptance Journeys is a channel for the stories of real people in Pittsburgh who have LGBT loved ones,” says Dr. Friedman. “People who have come to us to share their stories are role models.”
Dr. Friedman says these people are role models because some of them have also faced stigma. “People say that they’re afraid that their friends or community will judge them because their loved one is LGBT,” he says. “We know young people who get kicked out of the house for being gay or transgender. We’re showing families who have been able to deal with LGBT kids in a beautiful and loving way. This doesn’t have to mean a broken family; there can be a path to wholeness.”
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