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Social Stigma and Suffering: Perceptions, Practices and Impacts around COVID-19 in Bangladesh

Bulbul Siddiqi and Nur Newaz Khan

Abstract

The novel coronavirus (COVID-19) has become a global concern due to the unprecedented catastrophe it has brought about. Social stigma around COVID-19 has become another concern in many areas. This study employs a qualitative approach in analyzing and discussing cultural perceptions and experiences of social stigma and suffering around COVID-19 in Bangladesh. This paper argues that socio-cultural and religious practices and various new metaphors in day-to-day linguistic usage around COVID-19 created and shaped social stigma with social suffering for the suspected, infected, associated, and even recovered individuals and groups. The findings show that stigmatization around COVID-19 takes place due to fear of infection, perceived loss of social status, discrimination in social life, and exclusion from standard health services, all of which need to be addressed in health and related policies in the future.

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Background

1The novel coronavirus (COVID-19), which is also known as SARS-Cov-2 (Severe Acute Respiratory Syndrome Coronavirus 2), has reached unprecedented levels and appears to be a global catastrophe (Manderson and Levine 2020). It has become a global challenge since the beginning of 2020. Fear, panic, and stockpiling of groceries and medicines have been common in many countries during this time. Besides, there was an obvious labelling and stigmatizing COVID-19 patients, which acted as a barrier in accessing various health services (Abdelhafiz and Alorabi 2020a; Ren, Gao, and Chen 2020). The situation in Bangladesh was no different in the initial days of COVID-19. Historical evidence and studies suggest that people witnessed fear and stigmatization during the major pandemics and epidemics worldwide (Buchillet 2007). It is extremely common to stigmatize infectious diseases (Williams, Gonzalez-Medina, and Le 2011).

2Social science researchers, along with others, have attempted to understand the nature and impact of various seasonal outbreaks (Manderson and Levine 2020). Social stigma and suffering have become a growing area of attention for social science scholars during any illness outbreak, even though a more significant portion of available research and studies on stigma and health are focused on HIV/AIDS (Hyde 2007; Littleton, Park, and Bryder 2014). Scholars have also focused on pandemics and epidemics. For instance, many academics and researchers have attempted to analyze various cultural-economic determinants and impacts of outbreaks like Ebola, the SARS virus, Swine flu, Avian influenza and the Zika virus in the past (Benton 2017; Gray and Mishtal 2019; Høg et al. 2019; Leach and Tadros 2014; Mason 2012; Moran 2017). One such example is the cases of H1N1 virus in China (Mason 2015). The SARS epidemic induced racism even in the USA among the Chinese population in Chinatown (AsiaSource 2003 cited in Mason 2015). This case shows how ethnic identity is being stigmatized globally. Similarly, Briggs and Mantini-Briggs (2003) shows how Venezuelan people in many places faced stigma and social isolation due to cholera. Similarly, the ongoing COVID-19 pandemic has generated unanticipated scales of fear, stigma, marginalization and discrimination, subjugating millions of people to social suffering in many of the least developed countries (Loayza and Pennings 2020; Mamun and Ullah 2020). Bangladesh is no exception. So far, the country has experienced 29,427 deaths due to COVID-19 with a total number of 2,036,166 infections as of November 14, 20221 and created tremendous social and economic suffering. Stigmatization and marginalization due to this viral infection act as the major barriers for accessing basic healthcare and livelihoods for many people. Among others, a more effective explanation of stigma in health and disease, which has been adopted by many anthropologists and social analysts, comes from sociologist Erving Goffman (Castro and Farmer 2005).

3Goffman analyzed stigma as a product of social construction in various settings (Goffman 2009; Shortt et al. 2005). According to Goffman, stigma is the phenomenon where an individual with specific attributes (physical, behavioral, or social traits) is disgraced by the shared group ideology of the society. Goffman identified stigma as the distance between virtual social identity and actual social identity deriving from the constructed social settings. Such identity construction is formed on the basis of transforming anticipated behaviors into standard and justifiable expectations (Goffman 2009). Social stigma significantly spoils the identity of an individual (Goffman 2009; VanLandingham et al. 1995). Besides, stigmatization and marginalization can cause social suffering during and post-outbreak (Han 2008; Kleinman and Lee 2006; Venables 2017). The elements of social suffering affect everyday life and are embedded as accepted in socio-cultural practices (e.g. unequal access to resources, political power, access to health and legal rights), which “appear almost invisible” (Farmer et al. 2006) and “seem to defy explanation” (Bourdieu 1977).

4Stigmatization and discrimination around COVID-19 and their suffering created mental health consequences after recovery (Abdelhafiz and Alorabi 2020b; Kumar and Nayar 2020; Yau et al. 2020), which also acted as negative tagging or exclusion from entitled services (Bhattacharya, Banerjee, and Rao 2020a; Das 2020). For example, COVID-19 survivors were tagged as “super spreaders” in India (Ram Theja 2020), and health personnel who worked in COVID-19 settings were denied public transport (Bagcchi 2020). In the context of illnesses and diseases, fear and stigma instigate social suffering by exclusion and marginalization. Besides untreatable infectious diseases and their asymptomatic conditions, often, fear of infection induce discrimination (Bohle 2013). Contagious diseases can isolate an infected person from normal life, restricting everyday activities, leading to self-stigmatization (Bohle 2013). Isolating or quarantining infected persons from society to maintain a secured distance is a technique used by health professionals to decrease infection rates (Phelan and Magnusson 2018). However, if it becomes a tool for treating someone who is in quarantine negatively, it would undoubtedly have an unexpected and damaging impact on them, such as, feeling ignored and excluded by the community and society (Kleinman 1988).

5It is also a known fact that stigmatization is seen as one of the barriers to accessing health services in many other cases (Williams et al. 2011). Contextual religious scripting and interpretations influence masses in society in explaining the virus and viral infection with a specific attitude towards health guidelines. While referring to the spread of smallpox among the native Americans, it was conveyed by many Christians that the virus was a punishment by God for committing crimes against nature (Buchillet 2007). There also has been a rise in hate crime and bullying among Asian and Asian Americans in the USA (Turner-Musa, Ajayi, and Kemp 2020). Under such a backdrop, this paper looks at the Bangladesh context and analyses how the social stigma around COVID-19 impacts health, social identity, and individual and group life.

6Published research-based literature on the stigmatization and related marginalization around COVID-19 in Bangladesh are scarce. Much of the available literature is based on secondary sources such as the news and medical reporting that identifies social stigma as a challenge in combatting COVID-19 virus infection and related health needs (Mahmud and Islam 2020). A few surveys and statistical analyses identified COVID-19 related mental health consequences, fear and induced suicide (Bodrud-Doza et al. 2020a; Khan et al. 2020; Mamun, Bodrud-Doza, and Griffiths 2020; Sakib et al. 2020). However, qualitative research on the lived experience of COVID-19 related stigma and suffering is rare, except for evidence reported in various news and social media. Using Goffman’s concept of stigma (Goffman 2009) and theorization of social suffering (Kleinman et al. 1997) this paper argues that the existence of stigma causes a sense of fear, generating suffering for infected or perceived infection towards further mental stress and loss of social status, which subsequently marginalizes COVID-19 patients.

Research Methods

7We have applied a mixed-method approach with a major focus on qualitative data collection. As field in research can be dynamic (Faubion and Marcus 2009; Gupta and Ferguson 1997), we did not limit data collection to a particular place; instead, self-administered surveys, telephone interviews, case studies from an informal discussion were conducted from different areas. Interviews from different regions provided us with the diversity in understanding the process and construction of stigmatization. First, we planned to collect responses through an online survey with open-ended questions to receive descriptive responses using Google forms and screen interesting cases for qualitative interviews. However, we received many incomplete and vague answers from the online form. This also reminded us about the methodological limitations of online surveys (Andrade 2020; Teitcher et al. 2015). Hence, we sorted those responses through careful reading and out of 53, we finalized 32 individual completed forms. Among them, 10 were female, and 21 were male. One participant did not disclose his/her gender identity. 40% of participants were students from different universities, and the rest of them worked in various private sectors. Among them, 5 participants shared their experiences of social stigma and suffering as a patient of COVID-19. As it was completely anonymous, participants wrote their experiences of social stigma around COVID-19.

8Then we convened 10 in-depth interviews to understand the experiences and perceptions of the participants on social stigma around COVID-19. Participants were primarily from economically better-off families in urban areas of Dhaka city. Among them, 5 were females and 5 males. We also conducted follow-up interviews with some of them to get their latest situations. To get a class perspective on social stigma, we convened 5 informal discussions among the people from a low-income area in the capital city in the middle of 2021. Participants from this low-income area mainly work as day laborers and housemaids.

9In addition, both authors’ observations from personal and family levels enriched the paper with a qualitative understanding of the phenomenon. As part of the reflexive ethnographic process, insights from our personal and relatives’ experiences were valuable. During this process, we have had informal conversations with 10 participants over the phone and in person. Data collection was carried out between May 2020 to August 2020 and August 2021, mainly, in Dhaka city. Some cases outside Dhaka were also investigated using the telephone interviews process. These cases were selected from the social network (offline) of both authors. Both authors carried out in-depth interviews and transcribed these for the thematic analysis.

10Informed consent was obtained before conducting in-depth interviews with participants who volunteered to participate. Since not all in-depth interviews were conducted face-to-face, verbal permission was obtained for telephone interviews. Privacy and confidentiality were maintained with utmost priority. In addition, information and news on social stigma from social media (i.e., Facebook) and news media helped us acquaint ourselves with various social stigma cases along with primary data.

Findings

11The findings are organized based on thematic categories derived from the interviews and observations. The section discusses the perception of social stigma and practices around COVID-19. Fear of lockdown, which subsequently contributes to the increasing nature of shame and loss of social status, will be discussed under social stigma and othering COVID-19 patients and their families.

Perceptions of Social Stigma

12People have a diverse set of perceptions about COVID-19. Study findings show that participants were more interested in talking about its cure and their experience of suffering as COVID-19 patients than the perception of social stigma around COVID-19. Most informants discussed their views of COVID-19 in relation to religion, reliance on home remedies with herbal treatments, and cultural practices of many unproven treatments (often seen as prejudices). Thus, the findings on perceptions of COVID-19 can be seen from two broader categories. First, the socio-cultural understanding of social stigma and, second, the contextual interpretation of religion.

13Most informants did not have much idea about “stigma” and needed to have it explained further during the interviews. Despite such barriers, some informants defined stigma as a social concept that indicates treating someone negatively, discriminating in the social context, harassing and abandoning sick persons because of the infection. Some also referred to the example of HIV and mentioned that such stigmatization of disease is not new. A similar approach to seeing COVID-19 patients from a negative perspective was also frequently seen among many people in Bangladesh, although the illness of COVID-19 is different from HIV aids. As one of the informants mentioned,

“If it is about Bangladesh, then we had seen before how others treated HIV patients. Though COVID-19 is not similar to HIV still, infectious diseases are taboo in this country. Yes, COVID-19 patients hide it from others because they are scared to be bullied.” A 24-year-old student

14Fear is also reported to be a cause behind such stigmatization in many cases of COVID-19. As another informant stated,

“Unfortunately, COVID-19 survivors are facing some sort of stigma in many forms. I saw people are hiding patients if they are COVID-19 positive. My perception regarding this stigma is the outcome of ignorance and fear.” A 45-year-old teacher, female

15Stigmatization begins with different wording and phrasing relating to COVID-19 infection that is used as slang or to label, tease and tag individuals to humiliate and harass them socially. Other informants gave examples of general tagging, for example, “tui ekta corona” (you are a coronavirus) or “hey see, there is a corona passing by!” to identify COVID-19 survivors.

16According to many informants, the phrase “positive,” referring to COVID-19 positive, is also seen as a terrifying matter, which made many people suffer in public spaces. One of the informants said,

“I was advised to be positive [metaphor] in my whole life, but now for the first time, I see people are fearing and afraid of being positive [Covid-19 positive]. Because of coronavirus testing, and if you are positive, you are out of the mainstream! You cannot go and mix with people like before, even if you recover from the disease, because people would fear you or you would be marked as a COVID-19 patient!” A 31-year-old bank employee, male, Dhaka

17However, the perception of being negative can be a confusing term too. For example, a bank employee reported his COVID-19 positive status at his workplace in early June and recovered from the disease in the middle of June. He had to get tested again to confirm that he did not have the infection anymore. After getting the report of COVID-19 negative status, he showed it to his workplace. His manager then told him come back to work. He tried to explain that he was still very weak and needed to rest as his doctor advised. The manager said that he was immune to the coronavirus, and he could come back to work as he was negative. The manager also invited him to participate in Eid prayer with him. Since many cases were reported to have the virus even after they tested negative, such reactions by his manager generated stress, as he mentioned. Besides, many people hid the information of COVID-19 related sickness from their workplace due to the fear of termination from their job; instead, they took a long day off.

18As many informants described, the perception of infectious diseases, coronavirus, and hygiene behavior is heavily influenced by religious interpretations. According to them, there were numerous religious explanations regarding COVID-19 all over the country. Many of them were misleading and ultimately misinterpretations of religion; for example, at the earlier stage of COVID-19 in March 2020, the most common idea held was that COVID-19 would not infect Muslims. This has changed after a larger number of COVID-19 patients and subsequent deaths. Many people even started to believe that this deadly virus infects only sinners as an expression of punishment. Such beliefs were found to be a typical pattern among many who claimed to be religious. One of the authors of this paper had a conversation with a three-wheeler driver while he was travelling. In response to the question of why there were no or relatively lower deaths among the low-income areas, the driver explained that

“Corona only kills sinners; honest and good people did not die due to this virus. You see, many wealthy and corrupt people died …. I found one of my neighbors died who was a rich man. Once I saw him disrespecting his father, who was a poor man from the village. He treated his father as his servant in front of others. His father raised him by selling ropes in the village, but he did not show any respect; thus, he died. It is the curse, and corona took him.” A 27-year-old CNG driver, Dhaka

19Such perceptions around COVID-19 generated fear, which was the cause of suffering for many infected people, where othering COVID-19 infected persons was the most common example.

Othering COVID-19 Patients

20The fear around COVID-19 was so intense during the beginning of the pandemic in Bangladesh in March 2020 that people started to single out COVID-19 patients and kept them in isolation by locking down the entire family. The most common incidents that people began to experience was being othered as COVID-19 patients by being left in a remote and disconnected place, cut off from communications by the neighbors, harassed in public space after recovery, and denied treatment by many health service providers. Besides generalized labelling, treating COVID-19 patients and survivors from a negative perspective triggered stigmatization and suffering. Informants talked about their experience of how they were treated after being found to be infected with or suspected of having COVID-19. The most common experiences reported are: avoiding or socially boycotting, refusing a proper burial, de-valuing, isolating and blaming a COVID-19 patient. Informants viewed these phrasings and wordings as the social stigma that triggered harassment for many people. Almost all informants described that the outcomes of such behavior and social stigma are pathetic and unfortunate.

21Fear and boycotting is the most common form of othering COVID-19 patients that many informants view as a process of stigmatization. For example, an informant expressed his experience of how he was avoided and feared by his neighbors from the same building, even though he was isolated in his room. Many other patients like him reported that they felt socially excluded when people started to avoid, ignore and kept a distance from them in public spaces. They were avoided even after their recovery from the disease. One of them expressed his frustration that,

“I got my report on 30 June, and I did not know that the news spread immediately in the compound I live. Now I heard from my sister, who lives in the same building, that some of our neighbors strictly instructed our security guard not to visit my house. Seriously! I locked myself in my room …. These people are educated; it is actually about the mentality, you know! Even though I recovered and got my test report negative twice, people kept distance and avoided me in public spaces. I feel socially excluded by such behavior.” A 41-year-old bank employee

22In a different context, a survivor explained how she was questioned by people in her village when she went to her village with a COVID-19 infection. As she stated,

“In the beginning, the people of our village said many bad words. They started to question and criticize me by asking why I returned to my village. Even people from my home started to treat me differently.” A 30-year-old housewife

  • 2 A ward commissioner is an elected representative at the lower administrative level in a city corpor (...)

23People from marginal and lower-income settings reported being more victimized than others. For example, a poor health worker was forced to live in a small hut beside a pond by a ward commissioner2 in Narayanganj (district adjacent to the capital city Dhaka) after being diagnosed with COVID-19. Another informant mentioned that many other villagers isolated a farmer from a village in his own house. People were afraid to talk to him even after his recovery. The family was outcaste by other villagers and suffered a lot to manage medicine and even food during his sickness. In the urban context, we have observed that the infection rate is relatively lower among slum dwellers. However, day laborers, housemaids, garment workers who live in slums and lower-income settings are treated as dirty, ignorant, reluctant to follow COVID-19 health instructions and spreaders of COVID-19 by the people from the well-off classes. It was found that many housemaids were in a situation where they were asked to shower before starting their work in a house, which the housemaids found disrespectful and which demotivated them to work under such conditions. In addition, there was a sense of unwillingness to follow the COVID-19 health instructions, particularly the habit of wearing masks was relatively unfollowed among many urban slum dwellers.

24Stigma has a similar effect on other economic classes as well. One of the informants from the middle and upper-middle-class from urban area shared his experience in this context that

  • 3 The Prime Minister started to send food and medicines to poor COVID-19 infected people during the b (...)

“I kept it secret [when he was diagnosed as COVID-19 positive] within our close family members for a couple of reasons. The first reason is a sense of shame. As accidentally, the local leaders came to know about my condition, and he sent me a gift from the Prime Minister.3 I could not accept it due to a fear of being exposed to the neighborhood; thus, I distributed it among two of my caretakers. I also thought that my tenant might leave the house if they came to know about my sickness.” A 40-year-old man

25In another context, an expatriate professor from the USA came for a short visit to Bangladesh, and he was a suspected case of COVID-19. He went to a leading private hospital to get admitted, but he was denied treatment; then he decided to stay home and consulted a family doctor. He did not disclose it to anyone other than his close family members. His concern was that his landlord might force him to leave the house. It was also evident from the research that many people refused to participate in the burial of a person who had died from COVID-19, even family members. Such fear-induced stigmatization made the family members victims. It created unbearable social stigma due to such behavior from the community.

26News of many such incidents, relating that close family members reportedly left a corona patient’s dead body, was published in newspapers and later made its way into social media (i.e., Facebook). Among many others, one of the cases drew much attention on social and news media: a person died in his isolated room, and no one even came when he asked for help. His body was left on the stairs for hours, and family members refused to take care of it. The local ward commissioner took care of the body and completed the funeral (Saha 2020). Several cases of abandonment of dead bodies by family members due to COVID-19 were reported in the media. For instance, in one case, police rescued a man from a hospital gate in Dhaka who was abandoned by his son, suspecting his father was COVID-19 positive (Haque 2020). Similar evidence was found across the country. For example, two sons put their father in a sack and left him at their village in Pabna. Local administration confirmed after his death that he was not infected by COVID-19, but suffered instead from asthma (The Business Standard 2020). Although the situation of people from different classes is not the same, the idea of social stigma existed across all of these cases and the nature of suffering by othering COVID-19 patients existed almost in all cases regardless of their social and economic position.

Fear of Lockdown, Isolation and the Loss of Social Status

27The fear of lockdown and loss of social status were key reasons for many to hide the fact of COVID-19 infection. We also experienced situations where we could not even ask the suspected COVID-19-positive person if he or she was diagnosed to avoid discomfort during the interview. It was also found that many people shared the information on social media once they recovered from COVID-19. Many informants spoke about their fear of forced lockdown by community members or local authorities; thus, they kept it secret from the people outside their close circle of relatives. Another informant mentioned that he had a fear that his tenant might leave his house if they came to know about his infection. Thus, he deliberately hid his COVID-19 status. In addition, most informants pointed out that in many cases, community members were overly enthusiastic to lock up a house where COVID-19 patients lived and blocked the roads creating a bamboo fence. People started to mark those houses by hanging a red flag or writing a notice like “this is a corona house.” Thus, people from those marked houses were restricted from going out even to buy food and other daily necessities, which created shame, frustration and mounting mental stress.

28One of our informants shared that her maternal uncle was found to be COVID-19 positive. He was hiding his infection, and when he was found to be asymptomatic, the family refused to go to the hospital for testing. They were in fear that if the police came to know about their situation, they might be locked inside their house, which may destroy their goodwill and status in society. However, they got a phone call from the local police station saying that their home would be locked and the family was instructed by the police station to test all family members for COVID-19. The entire family panicked and refused to do so, but they were compelled, and in the end, the whole family (6 members) tested COVID-19 positive. They thought that this damaged their social status, and they feared stigma afterwards.

29In another case, a landlord in Dhaka reacted to the death of his security guard, which had occurred suddenly. The person had a heart condition, but as he was not tested for COVID-19, his dead body was left abandoned for long hours. Local police came and wanted to lock down the house, but the landlord begged them not to do so as it might diminish his status if the local people saw his house as a “corona locked-down house,” and they would be stigmatized and outcaste.

30Fear of losing social status was also evident when a wedding was postponed and eventually cancelled when the entire family of the girl tested COVID-19 positive. The girl’s family thinks this damaged their social status, and the whole family was traumatized by the experience. The mother stated that

“The boy’s family made a terrible judgment about my daughter, but she has recovered now! She is no more infected and she is healthy, but still, they denied it! This is shameful! Now we cannot show our face [an expression of shame] to our relatives as our daughter’s marriage has been broken. Moreover, one more recent proposal was refused when the boy’s matchmaker heard about this corona history. Now you tell me how I could make anyone understand that the girl is not affected now. We are now tensed how long would this corona be attached to our fame.” A 50-year-old housewife

31While exploring the reasons for such practices, informants referred to lack of knowledge, education, superstitions around viral diseases, anxiety and fear of COVID-19, inability to raise appropriate awareness by the Government, fake news and rumors in social media, and behavior patterns as creating the most common problems in generating social stigma. Among these various reasons, fear and anxiety around COVID-19 were frequently referred to as the key reasons as many people have a perception that it will kill everyone. Thus, people started to discriminate against COVID-19 infected patients, which created social stigma for many. An informant mentioned that he even avoided his brother when he was infected. As he related,

“It can be seen as fear among the cross-sections of people, including those engaged in the treatment of COVID-19 patients. My brother, who lived in an apartment in a residential area, suffered from COVID-19, but we all avoided him only out of fear that we might get infected too. We sent him food through a messenger who delivered those with full protection.” A 70-year-old professor, male

32Another informant questioned the preparedness of the Government and raised a concern about rumors spreading on social media. As he stated,

“As COVID-19 is a new virus, nobody (including the Government) was prepared for it. In this age of information technology, news spreads with many misperceptions and rumors, and social stigma comes out of it. Moreover, the Government failed to make the people informed about the virus. News of death, harassment in the hospital and inadequate medical facilities in the country make the people panicked about the pandemic. Moreover, the lack of trust in government institutions might contribute to escalating fear among people.” A 40-year-old teacher male

33As reported by the informants, the COVID-19 pandemic and related anxiety, panic and stigmatization contributed towards increasing mental stress among many, as many people were forced to leave the neighborhood. In this context, a 22-year-old female COVID-19 survivor mentioned that “Attitudes from people in my surroundings caused a lot of stress for me. People from my building even told me to leave the house and move to another place. My family and I were victimized and had to leave the house eventually.” This female university student and the entire family had to experience a severe level of social stigma, which was a primary cause of their escalated mental health problems.

34Some informants also expressed their opinion on what to do during such a crisis. According to them, following health guidelines and assisting infected people would effectively combat and reduce stigma and fear around COVID-19. As one of the female informants mentioned, “We need to maintain social distancing with COVID-19 patients, but we also need compassion and care.”

35Another informant stressed the importance of medical advice and moral support rather than socially boycotting infected persons. As he stated,

“COVID-19 is not like other diseases. Vaccine for this has not been discovered yet. Patients who suffer from this disease should be treated according to the doctor’s advice, without socially boycotting or denigrating them. Due to the stigma, people segregate the unfortunate patient, and it may create immense psychological pressure to overcome the disease for the patient. We should support and give them courage. We should try to convince the patient that it is not a fatal disease. It is possible to get rid of this disease with proper treatment.” A 34 year-old-advocate, male.

36The findings show that COVID-19 shaped different types of social communication, which acted as a stigma and triggered suffering for the infected and suspected to be infected person in various ways. The following section will discuss the analysis of findings and see how the social stigma around COVID-19 increases suffering among individual and social groups compared to the existing body of literature and theoretical concepts.

Discussion

37The perspectives on COVID-19 in Bangladesh are the newest addition to the discussion of social stigma and contagious diseases. Forced isolation and boycotting, loss of status, fear, anxiety, panic and mental stresses were associated with the social stigma around COVID-19 in Bangladesh. Cultural understanding and defining social stigma were different as it was defined by many scholars (Ahmedani 2011; Goffman 1997; Tyler 2018). The wording and stigmatization process do not always follow the theoretical analogy, stages, or hierarchy (Ahmedani 2011; Tyler 2018), which is also evident in this study, as we have presented. Unlike chronic diseases with a more prolonged and life span of stigmatization and discrimination, infectious diseases have a temporal shape of the stigma that arrives with specific forms of emergence. For instance, previous cases of contagious diseases had situational differences in developing new terms and labelling tools shaping stigma in a different time and cases such as SARS (Kleinman and Lee 2006; Lee et al. 2005; Person et al. 2004), MERS (Dwinantoaji and Sumarni 2020), EBOLA (Cheung 2015; Venables 2017), HIV/AIDS in the global context (Parker and Aggleton 2003) and leprosy and HIV/AIDS in the South Asian region (Luka 2010; Tsutsumi et al. 2007; Ullah 2011). In this case, COVID-19 is similar to many of these examples of stigmatization. However, the stigma around COVID-19 can be slightly different from HIV/AIDS, as HIV/AIDS is seen as a product of not complying with sexual morality codes in many cases, as Das (2001) presented the example from North America.

38In contrast, COVID-19 is infectious, but the element of sexuality is not there. Despite such differences, the COVID-19 pandemic created “corona” as a new phrase and it has become a linguistic tool for labelling and shaping social stigma. Fear, stigmatization, and marginalization around COVID-19 in Bangladesh created the importance of understanding socio-cultural perspectives at the local level. For example, labelling tui corona (you are a corona), as we observed, acted as a triggering point of stigmatizing behavior from non-infected or “normal” members of society as we found the contextual phrases reported in studies like “coronized” in other cultures in studies among COVID-19 survivors (Bhattacharya, Banerjee, and Rao 2020b). In a similar context, S and Gogoi (2021) shows from an Indian village that people with COVID-19 have been excluded and avoided by the neighbor, which in turn created a situation of loss of status and shame.

39Thus, as in many other COVID-19-affected cultures, a Bangladeshi contextual form of labelling and formation of stigma in action are evident around COVID-19. While, in different contexts, economic class, religion, ethnicity and race play roles in triggering COVID-19-related stigma, in Bangladesh, we have observed COVID-19 related labelling and stigma has a “classless” pattern. This means COVID-19 related labelling and stigmatization are the same for any suspected or infected or recovered individuals/groups regardless of their economic class. However, marginalization due to COVID-19 labelling and stigma make the low-income population suffer more.

40Historically, religion as a socio-cultural determinant of health has a pivotal role in guiding social behavior, forming an interpretation of illness, health, and shaping social stigma during the outbreak. Besides, epidemics and pandemics of infectious diseases are also seen as an expression of God’s punishment for wrongdoings in many areas (Buchillet 2007). The COVID-19 scenario has also revealed such traits in Bangladesh; as presented above, people have interpreted COVID-19 as a punishment of God and believed only sinners are suffering or facing death from coronavirus. In many countries, such perception instigated violence and hate crime (Turner-Musa et al. 2020). Scapegoating Muslims for spreading mass infection at the beginning of COVID-19 was observed in India (Yasir 2020). Such cultural perceptions and misapprehended interpretations of religious beliefs in justification of stigmatization were also evident in many societies (Buchillet 2007; Robertson 2020). Scholars suggested engaging religious leaders in sensitization campaigns and awareness programs might educate the masses about adversity (Bhattacharya et al. 2020b). Even though we have not found any such evidence in this study, we observed media reporting misinformation spreading or bridging COVID-19 health guidelines based on the interpretation of infectious viruses in religious scripting emanating from many religious leaders in Bangladesh. This signifies the necessity of having a more inclusive health awareness program from the state and Government and a proactive role from the scientific community (Chopra and Arora 2020) in combating deadly viral infections like COVID-19.

41Labelling, tagging and subsequent perception of the loss of social status and identity were the ways of the social construction of stigma. Suffering induced by stigma acted as an effective tool of discrimination. As Briggs and Mantini-Briggs (2003) show, there was a similar perspective surrounding cholera whereby contracting it was seen as a mark that created stigma by labelling its sufferer as pre-modern and unhygienic. A similar situation was also evident in Bangladesh, where slum dwellers are seen as the spreaders of COVID-19; thus, they were being racialized and stigmatized. In this context, Goffman’s theory shows how stigma might create a situation where the victim starts feeling a sense of shame and guilt during this process of its formulation (Goffman 2009). For many COVID-19 cases in Bangladesh, the present situation resembles the same. As findings in this study also revealed, many people secretly abandoned individuals who had died of COVID-19 in hospitals, streets and homes because of the fear of being labelled and victimized. Thus, othering people is one of the common outcomes of stigmatization (Williams et al. 2011). According to Kleinman, in case of illness, “… a person so labeled is shunned, derided, disconfirmed, and degraded by those around her/him” and could only be accompanied by the closest family members who may not discriminate (Kleinman 1988:160) In the present study, we have seen a difference from Kleinman’s findings in the western context; in many COVID-19 cases, even the closest family members left patients alone in Bangladesh.

42As we observed in this study, the idea of isolation was incorrectly represented among the community members living in urban spaces, and people started interpreting isolation from a negative perspective. Forcibly living in isolation during the lockdown with the aim of personal protection already seems to be affecting mental health in many contexts (Burtscher, Burtscher, and Millet 2020). Furthermore, social stigma experiences are a key reason for hiding the COVID-19 infection in Bangladesh, as social stigma may further create substantial mental pressure and stress. In addition, isolation, lockdown and discrimination could seriously affect mental health and wellbeing that could lead to other illnesses, which is consistent with contemporary COVID-19 literature (Bodrud-Doza et al. 2020; Burtscher et al. 2020; Islam et al. 2020; Jung and Jun 2020; Khan et al. 2020; Kumar and Nayar 2020; Mamun and Ullah 2020). Even though we are unsure how long the attitudes and behavior linked to a social stigma will persist in the post-COVID-19 era, it is clear from this study that stigma around COVID-19 has an adverse impact among many people in society at present.

43Besides, our findings show that social stigma around COVID-19 act as a barrier and trigger suffering while accessing health services, such as refusal or denial due to stigma or fear of infection. Lack of trust among the various governmental institutions that measurably failed to manage the COVID-19 situation in Bangladesh. This subsequently worsens the situation around the social stigma that affects people’s access to healthcare services and facilities. As Williams et al. (2011) also show, stigmatization can be a barrier to accessing health care services in many cases of infectious disease. Exclusion from standard health services for the COVID-19 patient was a huge problem in the initial days of the COVID-19 pandemic in Bangladesh. Thus, the findings also suggest policy inclusions for awareness for breaking the chain of social stigma in Bangladesh society to ensure necessary health services for all, which can also be useful in similar cultural contexts around the world. We reiterate with Briggs and Mantini-Briggs (2003) that interventions are needed to make institutions function more effectively for the people affected by social inequality, stigma, and disease.

Limitations of the Study

44The major limitation of the study was not conducting a face-to-face interview due to restricted physical mobility during the lockdown situation in Bangladesh. The telephone and online-based platforms were used to convene interviews. Besides, a formal ethical review process was not carried out before convening data collection. However, the authors strictly followed all ethical standards during and after data collection, where the anonymity and privacy of all participants were strictly maintained. In addition, it was ensured that the participants voluntarily attended the interview sessions.

Conclusion

45Like many other pandemic situations, COVID-19 generated social stigma of unprecedented nature in many societies worldwide. Likewise, many people in Bangladesh were stigmatized due to the COVID-19 infection, and they suffered a lot in the end. The stigma around COVID-19 raises several challenges in social settings and when it comes to getting treatment. People from different socio-economic classes from urban and rural areas were the victims of COVID-19 stigmatization, despite their class and educational status. In the end, extreme cases of stigmatization created anxiety, fear and mental stress for many people.

46In some cases, people may have to bear the impact of social stigma for a more extended period. Simultaneously, the broader literature on the formation of stigma suggests that it is a construction of a socio-cultural process where the fear of infectious diseases plays a vital role in stigmatization. The cases of COVID-19 about stigma in Bangladesh were not an exception. Additionally, lack of knowledge and education, superstitious belief, and long socio-cultural understanding and prejudice about infectious disease further aggravated the process of stigmatization. Besides, “social media” also influence many people through various rumors and fake news, making the situation worse.

47In contrast to this cynical view about social media, there have been numerous cases of stigmatization in social media found simultaneously, which can be used to create a robust platform for raising awareness as well. We also need to include useful materials in the curriculum of different education levels for children and adults to combat stigma and suffering. The lack of awareness material and the preparedness of the Government also contributed to the process of stigmatization. Thus, the Government should have more inclusive information about the harmful effects of stigma in the media. Finally, further larger investigations are needed and will be crucial in exploring the relationship between social stigma and COVID-19 to understand possible divergent determinants and associations. Nonetheless, in societies like Bangladesh and unstructured health settings, such evidence-based knowledge will also reduce social stigma as a social disease during any future pandemics. In addition, such knowledge could effectively be used in ensuring health services for all, including stigmatized people, for Bangladesh and beyond in an epidemic or pandemic situation. Since culture and religion, in many cases, define and propagate social stigma in a pandemic situation, which is the case for COVID-19 in Bangladesh, awareness of this issue will further reduce stigmatization in future episodes.

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Notes

1 See https://www.worldometers.info/coronavirus/country/bangladesh/ accessed on November 14, 2022.

2 A ward commissioner is an elected representative at the lower administrative level in a city corporation. As reported, the victim was rescued by police later. For more, visit: https://unb.com.bd/category/bangladesh/police-finally-rescue-woman-forced-to-live-in-isolation/50676

3 The Prime Minister started to send food and medicines to poor COVID-19 infected people during the beginning of the pandemic as a gesture of compassion, which was distributed through the local politicians.

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References

Electronic reference

Bulbul Siddiqi and Nur Newaz Khan, Social Stigma and Suffering: Perceptions, Practices and Impacts around COVID-19 in BangladeshSouth Asia Multidisciplinary Academic Journal [Online], 29 | 2022, Online since 27 October 2022, connection on 19 July 2024. URL: http://journals.openedition.org/samaj/8253; DOI: https://doi.org/10.4000/samaj.8253

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About the authors

Bulbul Siddiqi

Associate Professor in Anthropology and Sociology, Department of Political Science and Sociology, North South University, Bangladesh

Nur Newaz Khan

Lecturer, Department of Political Science and Sociology, North South University, Bangladesh and PhD researcher at Australian National University, Australia

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