Forum on Stigma, Discrimination, and Health: Policies and Research Challenges. Introduction

This introduction outlines the Forum on stigma, discrimination, and health: policies and research challenges, including four articles and a final commentary. The first article reviews the development of international research on the relationship between discrimination and health. The second analyzes the recent Brazilian research output on AIDS, stigma, and discrimination. The third article addresses conceptual and methodological aspects of the relations between discrimination and health from an epidemiological perspective. The forth examines the process of affirming sexual rights in Brazil, involving the judiciary system, public policies, and the executive and legislative branches of government, among others. The fifth paper presents comments and questions on the contents discussed in the first four articles. The reflections aim to provide conceptual and meth-odological contributions for research and health policies on stigma and discrimination, given the gaps identified in the international and Brazilian literature. The relevance of stigma and different expressions of discrimination in the production of social and health inequalities has been discussed in the international literature, particularly in the United States. The studies show that stigmatiza-tion and discrimination can negatively impact living conditions and life expectancy among individuals and social groups, leading to harm to health and situations of social marginaliza-tion 1,2. The growing literature on the theme indicates that the concepts of discrimination, prejudice , and stigma applied to the field of health have been approached by different fields, in various ways, sometimes imprecisely. There is a prevalence of approaches centered on individual experiences, based on specific interpretations of the concept of stigma formulated by Goffman in his classic study 3. There are gaps in the research on the power relations involved in the expressions of stigma and discrimination and their implications for the expansion of life opportunities and guarantees for health conditions for persons and social groups 4,5. The assumption is that manifestations of stigma and discrimination result from interdependence between multiple factors associated both with the macro-social level, involving relations of power and domination, and with the individual and social group characteristics that shape social interactions. Thus, in order to understand the connections between health conditions, pro-FÓRUM FORUM

The relevance of stigma and different expressions of discrimination in the production of social and health inequalities has been discussed in the international literature, particularly in the United States.The studies show that stigmatization and discrimination can negatively impact living conditions and life expectancy among individuals and social groups, leading to harm to health and situations of social marginalization 1,2 .The growing literature on the theme indicates that the concepts of discrimination, prejudice, and stigma applied to the field of health have been approached by different fields, in various ways, sometimes imprecisely.There is a prevalence of approaches centered on individual experiences, based on specific interpretations of the concept of stigma formulated by Goffman in his classic study 3 .There are gaps in the research on the power relations involved in the expressions of stigma and discrimination and their implications for the expansion of life opportunities and guarantees for health conditions for persons and social groups 4,5 .
The assumption is that manifestations of stigma and discrimination result from interdependence between multiple factors associated both with the macro-social level, involving relations of power and domination, and with the individual and social group characteristics that shape social interactions.Thus, in order to understand the connections between health conditions, pro-cesses of stigmatization, and various forms of discrimination, beyond individual experiences, one must take into account the social axis of difference that historically produce inequalities between social groups, such as social class, gender, color/race/ethnicity, social diversity, and others.Such an approach can shed light on the social differences that account for the fact that certain social groups remain deprived of symbolic and material goods in contemporary societies.Consequently, the approach can also foster an understanding of the effects of gender stereotypes, homophobia, racism, and other forms of human rights violations and the lack of legal and social support that increases conditions of health vulnerability.
There is limited research in Brazil on the consequences of stigma and discrimination in terms of health problems.In addition, reflections on the implications of social hierarchies for the production of health disparities, influenced by the Brazilian public health tradition, tend to focus primarily on socioeconomic factors rather than other social axis such as gender, color/race/ethnicity, or sexual diversity.However, some authors have identified changes in this scenario, like the growing use of the gender category in the public health field 6,7 , recent incorporation of the ethnic/racial dimension in studies by public health researchers 8 , and the increase in studies on sexual diversity since the onset of the HIV/AIDS epidemic 9 .
This set of articles aims to encourage the development of research and policies in the field of public health in Brazil, focused on understanding and deconstructing stigma and discrimination in relation to health.The papers resulted from the meeting entitled Stigma and Discrimination: Challenges for Health Research and Policies, held on June 2, 2011, in Rio de Janeiro, with the support of the Rio de Janeiro State Research Foundation (FAPERJ) and the Oswaldo Cruz Institute of the Oswaldo Cruz Foundation (IOC/ Fiocruz), convening a group of experts from the fields of social sciences and health, belonging to public universities and research institutions in Rio de Janeiro: the Oswaldo Cruz Foundation (Fiocruz), State University of Rio de Janeiro (UERJ), and Federal University in Rio de Janeiro (UFRJ); from São Paulo: University of São Paulo (USP), Federal University in São Paulo (UNIFESP), and State University in Campinas (UNICAMP); from Porto Alegre: Federal University in Rio Grande do Sul (UFRGS); from Florianópolis: Federal University in Santa Catarina (UFSC); and New York, USA: Columbia University; as well as a nongovernmental organization from Rio de Janeiro: Brazilian Interdisciplinary AIDS Association (ABIA).The meeting was intended to promote dialogue and interaction between actors from different fields belonging to public health, namely the human and social sciences, epidemiology, policy, and planning.Such diversity has represented both the richness and one of the main challenges for public health in understanding and dealing with health inequalities.
The first article, by Richard Parker, reviews the trends in the international literature on the intersections between discrimination and health.His reflections highlight the contributions from the human rights and social justice perspective as a political and methodological device for linking the macro-and micro-social dimensions in the production and reproduction of stigma in the public health field.
The second article, by Simone Monteiro, Wilza Vieira Vilella, and Daniela Knauth, discusses the themes and theoretical and methodological approaches in recent Brazilian research on health, AIDS, stigma, and discrimination and points to similarities and specificities as compared to the international literature.
In the third paper, João Luiz Bastos and Eduardo Faerstein reflect on the conceptual and methodological aspects in the relations between interpersonal discrimination and health problems in epidemiological studies.The authors present the instruments that have been developed to measure discrimination and a proposal for their use in Brazilian epidemiological surveys.
In the fourth article, Sergio Carrara examines the process of affirmation of sexual rights, in particular those of lesbians, gays, bisexuals, and transgenders, known as "LGBT rights".The work is based on initiatives and tensions associated with sexual rights, present in public policies, the judiciary system, and in the legislative and executive branches of government, among others.
In the fifth study, Francisco I. Bastos offers comments and questions on the reflections raised in the first four articles, highlighting the gaps and challenges in the different disciplines in the analysis of the relations between stigma, discrimination, and health.
These reflections aim to make conceptual and methodological contributions to research and policies in the field of public health on the production of stigma and discrimination, given the gaps identified in studies on this theme in the Brazilian and international literature.

Contributors
The two authors participated equally in writing the article.