A/HRC/21/42 18. Understanding how stigma relates to social power, marginalization and exclusion also reveals the drivers of stigma, which lie in the individual, social, cultural and institutional spheres. Individuals across society contribute to the creation and continuation of stigma. Often, prejudices and stereotypes persist across generations, and are combined with irrational fears—of contagion, ―impurity‖ or ―otherness‖. This is frequently exacerbated by a lack of access to accurate information, for example on the transmission of diseases. In many instances, people are not aware that they are stigmatizing certain groups, since their stereotypes are widely prevalent in society, considered ―normal‖ and ―acceptable‖. 19. Stigma can also be felt as personal shame, guilt and embarrassment, referred to as internalized stigma. It manifests itself in self-exclusion from services or opportunities, low self-esteem, negative self-perceptions, social withdrawal, and fear of disclosure of one‘s stigmatized status. 20. Stigma also has its drivers at the societal level with, for instance, the media contributing to spreading prejudices and stereotypes. It is also driven by deeply entrenched cultural beliefs relating, for instance, to gender, sexuality, health and descent. Caste systems are striking examples of systems that lead to the stigmatization of large parts of the population, potentially amounting to violations of human rights. 21. These drivers of stigma in the individual, social and cultural spheres find their reflection at the institutional, structural and policy levels. Politicians often win votes by proposing populist policies reflecting public attitudes. Instead of combating stigma, legislative, policy and institutional frameworks may reflect stigmatizing attitudes, further entrenching stigma by institutionalizing, formalizing and legitimizing it. III. Stigma and its links to water, sanitation and hygiene 22. Stigmatization often results in lack of access to water and sanitation and poor hygiene standards. The lack of access to essential services is a symptom, while the root causes lie in stigmatization. Only through an understanding of these causes will it be possible to implement effective measures to improve access to services. Stigma is often closely linked to perceptions of uncleanliness, untouchability and contagion. In many instances, stigmatized people are perceived as ―dirty‖, ―filthy‖ and ―smelly‖, affecting for instance homeless populations, menstruating women and girls, Roma communities, Dalits or women suffering from obstetric fistula. 7 Individuals who find themselves stigmatized because of the perception that they are ―dirty‖ or ―contagious‖ may be socially ostracized and be denied access to water, sanitation and hygiene services, hence reinforcing the stereotype of uncleanliness and prolonging a vicious circle. It is not their inherent condition to live in filthy and poor conditions; it is a position imposed by society that uses stigma as a tool to create, perpetuate and justify marginalization and inequality. IV. Manifestations of stigma 23. Stigma manifests itself in different ways, combining ostracism, abandonment, shunning, rejection, isolation, exclusion, bullying, discrediting, blaming, harassment, 7 6 Obstetric fistula is a medical term which refers to a hole which develops either between a woman‘s rectum and vagina, or between a woman‘s vagina and bladder (or both), as a result of obstructed labour, resulting in constant urinary and/or faecal incontinence. See World Health Organization (WHO), ―10 facts on obstetric fistula‖ (2010).