Blog by Dr. Thurka Sangaramoorthy
Thurka Sangaramoorthy is an associate professor of anthropology at the University of Maryland, College Park, and an expert on issues of infectious disease outbreaks, health equity, and social justice. She is the author of Treating AIDS: Politics of Difference, Paradox of Prevention (Rutgers University, 2014) and Rapid Ethnographic Assessments: A Practical Approach and Toolkit For Collaborative Community Research (Routledge, 2020).
As the COVID-19 pandemic continues to sweep across the globe, social distancing interventions—school closures, event cancellations, telework, home isolation, and physical separation—are becoming commonplace. Social distancing is a vital public health intervention because it is often the only measure available to slow the rate of infection and reduce mortality in the early phases of a pandemic when treatment is unavailable or in low supply. Many countries, as a result, have embedded social distancing measures within their pandemic preparedness plans. But social distancing can also have deep social impacts, particularly for people who are already marginalized and stigmatized.
A few days before quarantine and social distancing measures fully went into effect in response to COVID-19, I participated in a public event that brought together Black women to talk about gender and sexual health. I had been asked to discuss a project I had been working on for a number of years—an oral history initiative documenting the lives of older Black women living and aging with HIV. Many of the HIV-positive women that I worked with were in attendance, and proceeded to hug and kiss me upon my arrival as they had done countless times before. I was surprised at their intimate gesture given that we had all been encouraged to practice social distancing to help flatten the curve. When I asked women why they were so willing to touch others despite public health warnings, I was gently reminded that for people who live with HIV (PLWH), especially Black women, the practice of social distancing invokes painful memories and opens up historical wounds of stigma and isolation.
Researchers have extensively studied the relationship between stigma, social distancing, and HIV. Findings suggest that stigma, fear, discrimination, othering, stereotypes, and deliberate and unconscious social distancing attempts by HIV negative people have resulted in social isolation, societal alienation, and a decreased quality of life among PLWH. My own work in Washington DC and Prince Georges County, Maryland has shown that social distancing related to HIV stigma is a central feature in the lives of older Black women living and aging with HIV. Many women continue to experience indifference and hostile rejection from family members, friends, co-workers, and intimate partners, who sometimes refuse to accept women’s HIV-diagnosis or blame them for their condition. Women often discussed how social distancing practices such as physical and social shunning left them feeling polluted, impure, and contagious. Many studies have shown that stigma and social isolation can have serious negative health and psychological effects for PLWH.
Ethically encumbered pandemic planning decisions such as those we face currently should involve more public engagement to improve public trust and public health outcomes. Understanding public perceptions about social distancing measures likely to be implemented during a pandemic can help prevent additional social and physical harm to those already experiencing multiple forms of stigma and isolation, including those that are disease-related. Social distancing measures may be challenging to implement and maintain due to a number of social considerations such as strains on family resources and lack of trust in government. Increasing opportunities for public input and education can greatly help us reach important public health prevention goals while positively shifting social norms and reducing negative stereotyping and discrimination faced by those who are medically fragile and socially vulnerable.