Dynamic and game theory of infectious disease stigmas

Stigmas are a primal phenomena, ubiquitous in human societies past and present. Some evolutionary anthropologists have argued that stigmatization in response to disease is an adaptive behavior because stigmatization may help people and communities reduce the risks they face from infectious diseases and increase reproductive success. On the other hand, some cultural anthropologists and social critics argue that stigmatization has strong negative impacts on community health. One recent analysis resolved this conflict by hypothesizing that stigmas had individual and group-evolutionary benefits in the past but are now maladaptive because of intervening societal transitions. Here, we present a quantitative theory of infectious disease stigmatization. Using a four-compartment model of stigmatization against a chronic disease, we show a stigma ratio, being the ratio of net transmissions by stigmatized people to net transmissions by unstigmatized people, predicts the impact of stigmatization on lifetime infection risk. When stigmatized people are segregated from the rest of the population and there are no alternative interventions that reduce transmission, stigmatization can reduce prevalence and infection risk. When stigmas do not lead to segregation but do discourage behavior change and reduce access to medical interventions, stigmatization acts to increases the lifetime risk of infection in the community. We further show that fear of stigmas can create policy resistance to healthcare access. The societal consequences of fear are worse when effective medical treatment is available. We conclude that stigma's can be adaptive, but good healthcare and leaky ostracism can make stigmas against chronic infectious disease maladaptive, and that the deprecation of stigmas is a natural transition in the modern urban societies.