Challenges and opportunities in examining and addressing intersectional stigma and health

Abstract

Background ‘Intersectional stigma’ is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. Discussion Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. Conclusions Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

“…There is no standard approach to measure intersectional stigma . Davis argues in the 2008 “Intersectionality as Buzzword” article that it may be in part due to its non‐prescriptive nature that the concept of intersectionality has been so widely taken up and applied across disciplines and methodological approaches.…”

“…Davis argues in the 2008 “Intersectionality as Buzzword” article that it may be in part due to its non‐prescriptive nature that the concept of intersectionality has been so widely taken up and applied across disciplines and methodological approaches. There are calls for innovation in quantitative intersectional stigma measurement , using strategies such as structural equation modelling (SEM) that has been applied in prior intersectional stigma research . SEM allows the assessment of correlations between variables, including multiple forms of stigma.…”

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

“…Individuals facing stigma may also internalize stigma [22,25,26]. Intersecting stigma occurs when individuals who have identities linked to multiple marginalized groups, for example based on socio‐economic status, race, sexual orientation, gender identity or health conditions face multiple intersecting stigmas [27,28]. Embedded within human rights imperatives, recognition of the necessity and urgency of responding to stigma and resulting discrimination is critical to achieving global targets for HIV testing, linkage to care and viral suppression.…”

Lessons learned from HIV can inform our approach to COVID‐19 stigma

“…race, sexual orientation) and practices (e.g., sex work, drug use) [15]. Instead, stigma is understood as intersectional, social ecological, and produced by drivers (e.g., misinformation) and facilitators (e.g., inequitable social norms) [15‐18]. Intersecting stigma – such as racism and poverty – interact with HIV‐related stigma to harm health engagement and outcomes [16,17] and may present analogous barriers to COVID‐19 testing and treatment [14].…”