ABSTRACT

For nearly two decades, as countries all over the world have struggled to respond to the HIV/ AIDS epidemic, issues of stigma, discrimination and denial have been poorly understood and often marginalized within national and international programmes and responses. In some ways this is paradoxical, since concern about the deleterious effects of HIV-and AIDSrelated stigma has been voiced since the mid-1980s. In 1987, for example, Jonathan Mann, the founding Director of the World Health Organization’s former Global Programme on AIDS, addressed the United Nations General Assembly. In what would soon become a widely accepted conceptualization, he distinguished between three phases of the AIDS epidemic in any community. The first of these phases was the epidemic of HIV infection – an epidemic that typically enters every community silently and unnoticed, and often develops over many years without being widely perceived or understood. The second phase was the epidemic of AIDS itself – the syndrome of infectious diseases that can occur because of HIV infection, but typically only after a delay of a number of years. Finally, he described the third epidemic, potentially the most explosive – the epidemic of social, cultural, economic and political responses to AIDS. This was characterized, above all, by exceptionally high levels of stigma, discrimination and, at times, collective denial that, to use Mann’s words, ‘are as central to the global AIDS challenge as the disease itself’ (Mann, 1987).