Stigma and Community

Community Participation of Former Leprosy Patients, Former Mental Patients and HIV Positive Patients

Abstract

 In 2008, the Basic Act for Former Leprosy Patients was established in Japan, which calls for opening the door of the leprosarium to the neighborhood community and promoting the community residents’ access to health care provided by the leprosarium, which could be expected to lead the maintenance of the health care level of the leprosarium and overcome the stigma attached to the former leprosy patients through the everyday interaction with the community residents. However it is strongly feared that this promotion could cause the further discrimination against them. This paper seeks pathways to overcome the possible discrimination through investigating two cases of the former mental patients and HIV positive patients who both have already achieved the community participation.

 Goffman’s （1963） definition of the concept of stigma would help us consider the possible discrimination. He warns us against taking stigma as an independent entity, but he defines stigma as enacted through the interaction between the stigmatizer and the stigmatized. It follows that the enactment of stigma depends on the kinds of relationship made between them. We conducted a fieldwork research on the NPO Heart-in Heart Nangun Market in Ehime Prefecture and had made intensive interviews to the HIV positive patients. The research results reveal that the stigma would not be enacted as long as the community residents would be well educated about the mental illness and have good encounters with the mental patients. The Ehime NPO has made efforts to educate residents with the more familiar mental illness such as the aged person’s dementia and has provided a lot of amusing events where they could both enjoy the opportunities of the encounter.

 In the case of HIV positive patients, they are found to be involved in the passing （Goffman） which is one type of strategy to manage their identity through conveying limited information about them to conceal the possible stigma of HIV infection. This passing could have devastating effect of individualizing and isolate them against them; the result of the Foulcaudian power effects. However, they are not totally defeated by the fear of disclosure, to the contrary, they could control the self-information with great craft avoiding the attachment of stigma and sometimes succeeding in the establishment of firm friendship and partnership where they can open up the HIV infection to their ‘buddy’. Also, we should take note the role of peer group to empower the HIV positive patients.

 We can draw lessons from these two cases in order to make pathways to overcome the possible discrimination against former leprosy patients; the need to educate the community residents with the understanding of the life-world of the residents, the establishment of the relationship which could avoid the enactment of stigma and the active strategy of conveying self-information on the side of the possible stigmatized who should be supported by peer group.