Reframing applied disease stigma research: a multilevel analysis of diabetes stigma in Ghana

Research suggests that rural and urban Ghanaians living with uncontrolled diabetes—typified by extreme weight loss—experience HIV/AIDS-related stigma. This paper reports a multilevel analysis of this stigma within the broader context of diabetes handicap in two rural communities. Two key findings emerge. First, the content of stigma constitutes social representations of HIV/AIDS, and to internalized and projected collective attributions of protracted illness to witchcraft or sorcery. Thus the stigma experienced by people with uncontrolled diabetes is not specific to the disease category ‘diabetes’ and distant others affected by it. Second, extreme biophysical disruption, which precipitates misperceptions, stigma and/or discrimination, is both cause and consequence of financial destitution and psychosocial neglect. Both forms of handicap have deeper pre-stigma roots in poverty and the socio-psychological and cultural impact of long-term illness. Thus the actuality or threat of diabetes stigma has to be understood in terms of diabetes handicap, which in turn has to be understood as a product of shared responses to long-term illness in communities constantly negotiating financial, health and psychological insecurities. The scope for multifaceted/multilevel intervention is considered taking into account the biophysical and psychological impact of illness and the sociopsychological and structural realities of diabetes care in Ghana.