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Social stigma and discrimination faced by COVID-19 patients in an industrial unit: Findings of survey from rural Maharashtra
Sumeet Singh, Kunal Koundinya, Saurabh Bobdey, Prabhakar Teli, Arun K Yadav, Sushil Kumar Kaushik
Department of Community Medicine, AFMC, Pune, Maharashtra, India
|Date of Submission||10-Apr-2022|
|Date of Acceptance||25-Jul-2022|
|Date of Web Publication||04-Jan-2023|
Department of Community Medicine, AFMC, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Uncertain situation of the coronavirus disease 2019 (COVID-19) pandemic has led to fear, stigma, and discrimination across all strata of society in varying proportions. Stigmatization increases the suffering of people or those who are at risk of getting the disease and make it harder for public health authorities to control the disease. Material and Methods: The present study is a questionnaire-based cross-sectional survey conducted over a period of four weeks in the month of July 2021 in a food industry in rural region of western Maharashtra among COVID-19 positive patients. A total of 152 participants were included in the study. The data was analyzed using SPSS software (version 20). Descriptive statistics were used which included frequencies and percentages. Results: 64.5% of the participants were males and 35.5% were females. Approx. 85% of the participants were in age group 15-58 years. 100% of them reported to have faced fear on being tested COVID-19 positive. However, only approx. 2-5% individuals hid their illness from family and friends and 7.9% of them were afraid of getting hospitalized. Conclusion: It was found that fear was prevalent among all survivors but stigma was found to be minimal which is likely due to widespread awareness through media, IEC campaigns, and active involvement of administration in implementing policies.
Keywords: COVID-19, discrimination, social stigma
|How to cite this URL:|
Singh S, Koundinya K, Bobdey S, Teli P, Yadav AK, Kaushik SK. Social stigma and discrimination faced by COVID-19 patients in an industrial unit: Findings of survey from rural Maharashtra. Ind Psychiatry J [Epub ahead of print] [cited 2023 Jan 27]. Available from: https://www.industrialpsychiatry.org/preprintarticle.asp?id=367031
WHO declared the novel coronavirus disease 2019 (COVID-19) as a global pandemic on Mar 11, 2020. As there is no definitive treatment for COVID-19, prevention of spread of disease is the only strategy which has been implemented in various ways in form of social distancing, masks, lockdowns, and recently through vaccination coverage. The mainstay of preventive strategy includes information, education and communication (IEC) activities to raise awareness in general public about the transmission of disease and how to protect themselves.
The uncertain situation of the COVID-19 pandemic carries in its shadows a parallel pandemic of fear, stigma, discrimination, stereotypes, prejudice and fixed attitudes and beliefs. Also, in the present age of social media news spreads rapidly beyond geographic boundaries creating panic and fear swaying the focus away from the scientific approach. Being a contagion and its associated uncertainty, the disease flares up the stigma, fear, discrimination and subtle emotions leading to distortion of social structure, political decisions, and mental health. At the dawn of COVID-19 the media/social media infodemic of misinformation had created so much paranoia that locals were refusing last rites of dead body for fear of transmission. In an attempt to reduce the stigma and to prevail the scientific knowledge, International Health Organizations like WHO released guidelines for safe management of COVID-19 dead bodies and various other aspects regarding disease transmission and prevention.
Stigma is a mark of disgrace that separates a person from his/her peer. Social stigma which leads to discrimination, fear, and devaluation by others has a number of negative consequences such as retardation of recovery, shame, and the "why try" phenomenon. Stigma and discrimination tend to persist in the long term, even after isolation period has ended and the disease has been contained/cured. Since time immemorial, stigma had been often associated with infectious diseases and patients have faced discrimination which has had deleterious consequences on the patient, family and the society. Stigmatization increase the suffering of people or those who are at risk of getting the disease and make it harder for public health authorities to control the disease. Like other factors affecting social aspects of health, stigma is also unevenly distributed among various population groups, namely, literate and illiterate, rural and urban, young and old, male and female, lower and upper socioeconomic status, and so on. Another factor associated with society in modern days is the prejudice associated COVID-19 and the patient or the family members are labelled as "plague spreaders".
Though fear is a primary emotion which is crucial for survival and self-protection but it is in this fear lies the roots of stigma when it is irrational and unjustified. Although Govt uses different means of communication to educate the public about the COVID, however, preoccupation, superstitious beliefs, rigid thought process, and poor access to authentic knowledge becomes huge barrier in raising awareness among the general public. Though most people understand that the COVID pandemic carries the threat to life and one way or other everyone thrive on scientific knowledge and it is through this knowledge varying levels of awareness has been achieved in the different strata of society but rational and irrational fear still persist in the society.
It is well known that "no industry runs in isolation" so is the health of people working there as community exists as a continuum in terms of health, society, culture, trade, and so on. Extensive review of literature revealed that previous studies have been conducted in urban and hospital settings, however, fewer studies have been conducted in rural settings and no study in an industrial setting. Our present study provided us with the unique opportunity to conduct research in industrial setting in a rural community. Keeping this in view, the present study with pragmatic approach was undertaken to assess the stigma and discrimination in the industrial workers based upon their workplace as well as personal experiences.
| Material and Methods|| |
A questionnaire-based cross-sectional survey was conducted among COVID-19 recovered patients who were employed in a food industry with free living facility for outstation workers, operational since 1965 in rural area of western Maharashtra. The factory has around 512 workers. The study was conducted over a period of four weeks in the month of July 2021. A total of 120 COVID-19 cases occurred in the industry and all were included in the study. Employees who required hospitalization were covered under health insurance scheme and had zero out of pocket expenditure. The workers of the industry were residing in nearby villages and also in residential complex of the industry. Data for workers residing in the village was collected from village Gram Panchayat office. A total of 32 post-recovery patients of Bastis of the villages which formed continuum with industry in terms of workers and domestic trade were included. A total of 152 participants were included in the study. The study participants were informed about the details of the study objectives and confidentiality at the beginning of the survey. A written informed consent was obtained from each participant and they were assured that their identity would be kept confidential and the results would be used only for research purposes. A draft questionnaire was devised after the literature review. The questionnaire was prepared in the English language and then translated into Hindi and Marathi. The first part of the questionnaire consisted of section on sociodemographic and second part consisted of questions related to consequences of fear and anxiety, stigma faced by individual (at family level and at community level), and stigma faced by the family of the COVID patient in community. The questionnaire was pilot tested among 10 individuals of the author's institute. The finding of the pilot testing was excluded from the final analysis. The questionnaire was administered by face-to-face interview and responses were fed on the spot in Goggle form designed by investigator and for ease of communication the team also included two Marathi translators. The participants were instructed to select one option from the list of responses (Yes/No/Not Applicable). Ethical clearance was obtained from the Institutional Ethical Committee. The data was collated in MS Excel. The data was analyzed using SPSS software (version 20). A P value < 0.05 was considered significant.
| Results|| |
A total of 152 COVID survivors participated in the study, 64.5% were males and 35.5% were females. Approx. 85% of the participants were in age group 15-58 years. The mean age of participants was 37.05 (SD ± 16.25) years. 57.3% of the subjects had studied high school and above whereas 21.1% were illiterate [Table 1]. Of all the cases interviewed, 100% of them reported to have faced fear on being tested COVID-19 positive. However, only approx. 2-5% individuals hid their illness from family and friends and 7.9% of them were afraid of getting hospitalized [Table 2]. On assessing the stigma faced by individual at family level, it was found that only 5.9% of the participants were treated unfairly by family on knowing their diagnosis [Table 3]. However, at community level 6.6% of them were treated unfairly and 15.8% reported that their neighbors avoided to be in contact with them even after complete recovery [Table 3]. On analyzing social stigma faced at family level, 5.3% reported that their families were asked to show negative report for COVID-19 and 2% felt that their families were rejected in the community after their return from COVID care center/hospital [Table 4].
| Discussion|| |
This study was conducted to analyze the stigma and discrimination faced by COVID survivors and their families both from the community as well as within the family. In this study, we found that though fear was prevalent among all survivors but stigma was found to be minimal. Only one (0.7%) individual felt rejected from family after recovery whereas no individual was rejected for treatment in hospital or COVID care center. It is likely due to widespread awareness through media, global spread of disease, active involvement of administration in implementing policies/IEC activities, and most importantly the IEC activities conducted by the healthcare workers (HCWs) especially Grass Root Level workers like accredited social health activist, village health guide, multipurpose workers in the community at large.
A study conducted in Indonesia among HCWs across 12 hospitals reported that about 21.9% of the participants had faced stigma associated with COVID-19. Also, the same study reported that doctors were more likely to have no stigma associated with COVID-19 compared with nurses and other HCWs. Another study from China reported higher stigma among COVID survivors in community as compared to their healthy controls (p <.05). Another study conducted among male government employee in India observed that 21.3% of COVID survivors noted the change in behavior of family members.
As is evident that the stigma level shows a zig-zag pattern not only across various countries, communities and cultures but also it varies with the education, occupation, and social security. There exists a large variation within the country and between the countries owing to a huge gap in data related to stigma and discrimination.
The pandemic has affected everyone irrespective of their geographical location, occupation, socio-economic status, education level and belief, hence high level of general awareness among the public has led to low level of stigma compared to non-COVID illnesses like human immunodeficiency virus (HIV), leprosy, tuberculosis (TB) wherein individual apart from becoming a focus of stigma but also becomes a victim of mental health issues. Another characteristic which differentiates COVID stigma from other illnesses is COVID being an acute illness requires short (~10 days) treatment; specific anti-viral treatment not needed in most cases (~80%); supportive treatment helpful in most cases (e.g., paracetamol, maintenance of hydration, and oxygen saturation) it subsides after a specific interval in contrast to HIV, leprosy, and TB which require lifelong/prolonged treatment to keep infection and opportunistic infections under control.
COVID-19 pandemic has received an aggressive response globally. IEC activities, awareness campaigns, social media, TV, and other public communication sources has played a vital role in reducing the stigma but still there exists a gap in data of COVID stigma especially to uncover the variations which exist within the country due to varied culture, beliefs and domestic practices and the variations of stigma between the countries. Another evident fact which requires further research is how stigma varies when the COVID wave is at its peak and when the number of cases have decreased or decreasing in the community.
| Conclusion|| |
This study suggested that fear and stigma can have discordant relationship which means stigma can be reduced despite the existence of fear. The present study had a unique distinction of reporting that in rural setting though fear was prevalent among all survivors but stigma due to COVID-19 was minimal. The high awareness regarding COVID-19 is likely to be due to widespread awareness through media, IEC campaigns, and active involvement of administration in implementing policies.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]