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One of the most perplexing and elusive phenomena in the HIV epidemic is the concept of internalized stigma. The phenomenon of stigma is well understood and lavishly described in the AIDS literature. Internal stigma is the individual's internal appropriation of the fear, rejection, and condemnation with which many react to AIDS. The non-description, or mis-description, of internalized stigma in the literature of AIDS is the more puzzling because the phenomenon is well-known in other settings. The "self-hating Jew" and the "self-loathing gay man" are readily recognizable constructs of the psychological and other literature. In South Africa's vile past of racial hatred, Steven Bantu Biko recognized that the stigma of racial subordination had an internal impact that had to be eradicated first, if notions of white superiority and black subordination were to be effectively overcome. Internalized stigma is deadly because it incapacitates health-seeking choices.
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