Confronting pandemic fears

Tackling the Covid-19 stigma

16 October 2020 | Health

Windhoek • [email protected]

With the normalisation of Covid-19 over the past year, stigmatisation has waned but experts caution that confronting fear-based discrimination must remain a priority and requires precise messaging.
“Stigma is a mark of disgrace associated with particular circumstances,” chief social worker at the coast, Audrey Gaes, said during a presentation last month.
The Erongo region and its residents became a prime target of Covid-19 stigmatisation when Walvis Bay became the first epicentre of the pandemic earlier this year.
It was labelled as a “source of the coronavirus".
“We had colleagues who refused to take in patients from Walvis Bay, irrespective of their Covid status,” Dr Kwasi Yeboah, a Walvis Bay surgeon, said.
Within the community itself, stigmatisation of the sick or those in close contact with them erupted.
“In our hospital, the patients who recovered and went home sometimes experienced problems where friends and relatives avoided them afterwards,” Yeboah said.
Stigmatisation arises from both fear and worry about the long-term effects, including the economic repercussions for businesses who might come into contact with Covid-19 positive persons.
Gaes warned that stigmatisation can lead to a variety of negative ripple effects. “Stigma hurts everyone by creating more fear and anger, instead of focusing on the disease that causes the problems. Stigma can make people hide symptoms.”
A brief by the United States Agency for International Development (USAID) warns that “stigma has the power to destabilise communities and isolate groups of people.” This reduces testing and seeking medical help when needed, and can in turn increase infection and death rates.

Among those most at risk of being stigmatised are frontline workers, whose occupation increases their risk of infection. These include health workers and long-distance truck drivers and others who are key to ensuring that basic goods remain on the shelves and that people have access to reliable healthcare.
At the start of September, Amnesty International announced that at least 7 000 health workers have died around the world after contracting Covid-19.
On 7 October, it was reported that in Africa, the number of health worker infections continues to increase gradually, with 43 868 infections reported in 43 countries since the beginning of the outbreak.
Yeboah explained that stigmatisation amidst a new disease outbreak is not unique to Covid-19. “It’s normal. If we look back at history, it’s always like that. People discriminate. It’s not new to Covid.”
Stigma is no stranger to coastal journalist Ester Mbathera, who wrote poignantly of the impact on her family when a close family member contracted full-blown Aids twenty years ago. “When it came to stigma, the ignorance of the community really hurt. You are rejected by your own community for something you didn’t do. Even in church you could sense it; in a place that is supposed to be a refuge.”
She says twenty years later, she still feels the impact of the shunning she experienced. “It didn’t just end there. I still feel the after-effects today,” she recounted. “I became a loner. I sensed that the warmth and openness I was used to, wasn’t there anymore.”

A brief issued by the International Labour Organisation (ILO) underlined that in addressing Covid-19 stigma, the response to HIV and Aids provides key lessons. “HIV-related discrimination was caused by fear, misinformation and because people saw it through a moralistic lens. Calling Covid-19 a foreign virus and accusing certain groups of being responsible for spreading it, can be detrimental.”
The ILO warned that a key lesson from the HIV response “is that exclusion and punitive laws don’t work. People did not seek testing and treatment as they feared facing stigma and discrimination.”
The ILO stressed that protecting human rights is a pillar as important as prevention and treatment in a public health response.

Words matter
“Stigma arises from how information is disseminated. If we put out information on a contagious or life-threatening disease, it has to be done carefully,” Mbathera said.
She was concerned however that communication strategies around the pandemic response were not always well considered to manage panic and fear. “What we went through was a crisis. And I realised that as a country we lack crisis management strategies. It all boils down to crisis communication preparedness.”
Mbathera cautioned further that prolific mis- and dis-information “fuels stigma”.
Yeboah added that at the start, a lot of unverified and untrue information swirled amongst the community. “People were talking about things they didn’t understand, and that can mislead people. If information is not accurate, people become unsure.”
Mbathera said her on-the-ground experience during the pandemic as a journalist highlighted the lack of cohesive information sharing, with information either withheld or shared in a haphazard and ad-hoc manner that fuelled uncertainty, fear and lack of knowledge.
“It was reactive information sharing.”

Since the pandemic struck, facts on the virus have led to a steady decrease in stigma and discrimination, Yeboah said. “We have all learned from it and we have all grown from it.”
He added there was generally a change in perceptions. “It’s not a trend that has stayed the same. A lot has happened in the last few months, and people are much more informed.”
He explained that following the first wave at the coast, there was a decrease in fear, and thus in discrimination and stigmatisation.
From her experience of being shunned as a family member of an HIV-positive relative, Mbathera says going forward it is crucial that people learn to become more emphatic towards each other in a time of crisis.
“We have to learn to deal with issues without stigmatising. Just because it hasn’t reached you, it does not mean it never will. Stigma comes in many forms. Today it’s the pandemic, tomorrow it could be something else and it could be you that needs support.”

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