Disease-related stigma, the social construction of target groups, and South Africa's programs for AIDS & TB

While there are many studies evaluating the impact of specific intervention strategies on target populations, there is a limited assessment of the political factors that shape how these intervention strategies become policies. Disease-related stigma may be one of these important political factors. Using over 500 government policy documents, speeches, and statements, as well as approximately 25 interviews with policymakers, non-governmental organization leaders, scholars, and researchers, I analyze the role of stigma in AIDS and tuberculosis (TB) policy in South Africa from 1994 until present. AIDS and TB are chosen specifically for this study because they have important similarities and differences that aid in the analysis of stigma.  For example, they affect similar population groups but vary according to symbolic (harsh moral judgment) and instrumental (fear-based) stigma. South Africa was chosen because it is the country with the largest number of people living with HIV and the third largest number of people with TB. Results suggest that even though AIDS and TB affect largely the same population groups in South Africa (70% of TB patients are HIV positive), the government was more aggressive in addressing TB because of two primary factors: perceived differences in the responsibility for infection (TB patients are seen as more vulnerable and innocent than HIV/AIDS patients – evidence of symbolic stigma), and the burden of treatment on health systems (the curability of TB and cost-effectiveness of TB treatment compared to the incurability of AIDS and the expense of AIDS treatment).