When stigma sticks

11 May 2020

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The writer is a journalist.
The writer is a journalist.

HERE’S a funny story about syphilis: when this venereal disease came to Europe from the ‘New World’ along with Columbus’ sailors, it cut a swathe of death and disfigurement across the continent earning itself the title of the Great Pox. Since it quickly became evident that it spread through sexual contact, the stigma carried by this disease became all the greater and so did the desire to want to have absolutely nothing to do with it on a national level. The first written notes on syphilis come from an Italian doctor named Nicolò Squillaci who in 1495 wrote: “Nothing could be more serious than this curse, this barbarian poison.”

The use of ‘barbarian’ is interesting as it indicates a desire to remove one’s own country and people from the list of ‘immoral’ culprits, and in fact to ascribe such foul deviancy to others. Thus, in Italy, syphilis was referred to as the ‘French disease’, an appellation eagerly adopted by the British and Germans as well. The French were having none of this, and counter-named it the ‘Neapolitan disease’, implying that it came through Italian sailors. For the Portuguese, Danish and much of North Africa it was the ‘Spanish disease’.

The further east you went, the more age-old regional rivalries came into play, with the Polish calling it the ‘German disease’, the Russians calling it the ‘Polish disease’ and the Turks calling it the ‘Christian disease’. In this part of the world, Muslims called it the ‘Hindu disease’ while the Hindus naturally called it the ‘Muslim disease’… though both also agreed it was very much a European disease.

The point of this rather long story is that no one loves or wants to own a virulent and deadly disease, and that stigma of infection is such that we will go to great lengths to avoid any association, especially by name, when it comes to a disease that spreads like syphilis does.

Naming a disease in the ‘old’ manner almost always led to stigma.

There is a reason that Covid-19 has a far less evocative title than the plagues of the past, which usually contained the name of a place, an animal or even a community or subculture, and that is because of a conscious decision by the World Health Organisation to avoid “references to a specific geographical location, animal species or group of people”, when it comes to naming diseases.

There’s good reason for that, as naming a disease in the ‘old’ manner almost always led to stigma and discrimination. Swine flu, for example, led to fear-mongering about pork products and Middle East Respiratory Syndrome (MERS) also led to discrimination in some cases against people of Middle Eastern origin, as South Asian Respiratory Syndrome (SARS) did with South Asians.

The most egregious example of this is probably the Spanish flu pandemic of 1918, which claimed the lives of some 50 million people and is forever linked by name with Spain, which had absolutely nothing to do with it. The reason this name stuck is because Spain was one of the few European powers to have remained neutral in the First World War and thus its press was not under wartime censorship and was free to report on this growing pandemic without worrying about what it was doing to the morale of a nation at war.

The first reporting on this outbreak was in a Madrid paper in May 1918, and it only picked up pace after the Spanish King Alfonso XIII came down with it. Since other European countries only read about this disease in the Spanish media, it was dubbed the ‘Spanish flu’. The Spanish did try to rebrand it as the ‘French flu’ but it clearly did not take.

Beyond the name, the nature of the disease and the community it originally spreads in also become sources of stigma. Take acquired immunodeficiency syndrome (AIDS), which was originally termed ‘gay related immune deficiency’ (GRID) and was only revised when it became clear that a far wider population was at risk. Nevertheless, the stigma has stuck and remains to this day with many considering this affliction to be a purely sexually transmitted disease, and thus an ‘immoral’ one.

Other diseases, like tuberculosis, also carry the stigma of being the diseases of the underclass, and in this case, TB is also associated with factors that are in themselves sources of stigma: HIV, poverty, homelessness, etc.

Such stigma, in turn, leads to lower-quality care as those in the community and in some rare cases healthcare workers as well, shun the infected which leads to people trying to hide their infections until it is too late. Luckily, Covid-19 isn’t a disease with a great deal of inherent stigma, but we still have seen many cases of people avoiding tests and treatment out of fear that they and their families will be shunned by society. This is a natural fear, but one that we must constantly guard against by realising that concealing this disease only lowers your own chances of survival and that of those you are trying to protect.

The writer is a journalist.

Twitter: @zarrarkhuhro

Published in Dawn, May 11th, 2020