According to the author of this 33-page study, it is a "micro-analysis perspective of the problem of stigmatization..., [of] conversational strategies used by HIV/AIDS-infected patients conversing with their physicians during consultations in a public hospital in Montevideo [Uruguay]....It is argued that in conversations with their physicians, patients use self-effacing arguments and conversational strategies with the communicative intention of redressing their human images, and as a way of resisting the stigma.... It is observed that the patients’ arguments and strategies used to resist stigmatization might, paradoxically, perpetuate the HIV/AIDS-related stigma."


The author first examines current definitions of stigma and the ways in which they are specific to HIV/AIDS, including: the association with other stigmatised behaviours such as injection drug use, prostitution, and homosexuality; their use as a social control mechanism; the problem of the categorical application of self-attribution and responsibility; HIV/AIDS -related stigma in the health care system; and the distinction of felt and enacted stigma. She then applies the "sick role model" theory to the perception of HIV/AIDS patients in Uruguay, stating that, "People who are HIV/AIDS-infected are not guaranteed to enter the sick role since they are more likely to be held responsible for their perceived deviations: deviance and even criminality are ascribed to them." Thus, as stated here, in a patient-physician conversation, a strategic verbal behaviour of the seropositive patient is adopted in the medical interviews in order to preserve "face" - "the positive social value a person effectively claims for himself by the line others assume he has taken during a particular contact" and to discursively represent himself as "normal".

The patient speech patterns demonstrated in the data collected from patient conversations with physicians include self-effacing statements about how the virus was contracted, about how the patient is behaving since the diagnosis, and about reasons for the patient response to treatment or compliance/non-compliance with the treatment schedule, such as the following:

1. Self-effacing strategies by blaming others or life circumstances
2. Self-effacing strategies by withdrawing information
3. Self-effacing strategies by assuming responsibility
4. Self-effacing strategies by fulfilling job requests (for testing)

The author concludes that self-effacing strategies are used by patients as strategies of resistance against stigmatisation. Not only are they attempting to assert identities prescribed by social norms, i.e., as obedient and responsible patients, in part because they are receiving publicly funded treatment, but also they are using "self-effacing strategies for resisting a felt stigma and repairing a human identity." The author also suggests that "the patients’ strategies used to resist stigmatization are reproducing those very dominant frames of the Uruguayan culture and society, which constitute the source of creation for stereotypes and stigmatization."


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