Breaking down HIV stigma: a global challenge
To mark World AIDS Day on December 1, Palladium staff and projects around the world are engaged in a number of events, programs, and campaigns. One of the widely embraced themes for World AIDS Day this year is the UK National AIDS Trust’s campaign to promote awareness of HIV stigma. With the theme “HIV Stigma: Not Retro, Just Wrong”, we are reminded that fears, myths, and outright discrimination are still a barrier to achieving impact and progress. In our World AIDS Day blog, Palladium health specialist Ron MacInnis outlines the adverse effects of HIV stigma and five ways we are tackling this issue on the ground.
The negative impact of HIV stigma
Not only does stigma negatively impact individuals in need of HIV services, but it impacts uptake of free HIV services, prevents people from being tested for HIV, and inhibits honest dialogue between people living with HIV and their care providers. In many countries where we work, specific groups such as gender and sexual minorities face outright discrimination, rooted in policy, politics and social norms.
As part of Palladium’s work on the ground, we have been heavily involved in monitoring, measuring and developing solutions to mitigate HIV-related stigma and discrimination. More recently, we have worked to support the US Office of the Global AIDS Coordinator - sharing and strategizing on how the US Government’s multi-billion dollar HIV Program ‘PEPFAR’ can scale up and replicate programs and activities to mitigate HIV-related stigma and discrimination.
Practical action: five key approaches
In tackling HIV stigma and discrimination, there are a number of tools, approaches, programs and solutions that can be used – and that we are implementing through our projects around the world. This includes work completed on our USAID- and PEPFAR-funded Health Policy Project (HPP) and its follow on project called Health Policy Plus.
1. ‘Positive Health Dignity and Prevention’ for those living with HIV
Working with the Jamaican Network of Seropositives and Jamaican Ministry of Health’s National HIV/STI Program, the HPP helped create a capacity-building curriculum led by people living with HIV. The curriculum aims to implement and advocate for Positive Health, Dignity, and Prevention (PHDP) and promote community leadership at the country level. PHDP – a global policy framework authored in 2011 by the Global Network of People Living with HIV and UNAIDS – advances a holistic framework for people living with HIV to manage their health, advocate for high-quality HIV services, and prevent onward HIV transmission. PHDP also provides a concrete framework that is especially relevant to meeting current global and national care and treatment goals for HIV—and to making ‘combination prevention’ a reality.
The Jamaican curriculum can be adapted across countries and provides an easy-to-use set of resources (combining structure and flexibility) that allow HIV affected people to adapt PHDP to specific communities and stakeholders.
2. Clinical Competency Training
Transgender persons are disproportionately affected by HIV. Moreover, high levels of stigma and discrimination create significant barriers and make it difficult for them to access the health care services they need. Most clinicians in this area do not receive any training on transgender health or broader issues of sexuality and diversity, further limiting the availability of transgender-friendly services.
To better improve clinical competency training, we have developed key tools for Latin America and the Caribbean, and the Asia Pacific. The training tool for Latin America and the Caribbean is helping service providers better understand and meet the needs of transgender people, including specific risk factors for transgender women. In the Asia Pacific region, the Blueprint for the provision of comprehensive care to trans people and trans communities frames key areas of need to meet the health care needs of transgender persons.
3. Ghana HIV-related stigma and discrimination reporting and redress system
In Ghana, HPP has done much to develop effective ways to report HIV stigma and discrimination. After researching Ghanaian legal codes and systems, and conducting extensive consultations with key health stakeholders, a tailored approach to monitoring discrimination was implemented. This system was in the form of internet and text message based platforms for reporting HIV-related discrimination to the Commission on Human Rights and Administrative Justice. The mechanism allowed civil society organizations to report cases to the Commission, track case progress, and use data on stigma and discrimination to guide future advocacy on HIV- and other related policies in Ghana.
4. Health facility stigma and discrimination-reduction programming
In health facilities, people associated with HIV often experience negative attitudes and harmful actions that deter them from accessing services, disclosing information to providers, and adhering to treatment. The HPP stigma-reduction package for health facilities is based on a globally validated measurement tool and a ‘best of’ set of participatory training materials based on experiences in nine countries in Africa, the Caribbean and South and South-East Asia. This total facility approach for reducing stigma and discrimination in health facilities covers all staff - from support staff through to clinicians.
Developed under the HPP, the package brings together three key intervention elements: assessment, participatory training and a focus on facility policies and environment. It has been adapted for use in multiple countries in the Caribbean and is the basis for Thailand’s national roll-out of an HIV stigma and discrimination reduction program.
5. Understanding Gender and Sexual Diversity
In 2014–2015, our HPP team implemented a Gender and Sexual Diversity Training in 38 PEPFAR countries. We were pleasantly surprised by the overwhelming willingness by public health professionals to discuss sensitive topics. After the training in Rwanda, one participant remarked, ‘I had no idea that trainings like this exist. It’s great that someone was willing to start the conversation. Dialogue is always the beginning of change.’
A participant from Namibia shared, ‘Before the panel [discussion], I had never met someone within the gay community and had never met anyone from an organization representing the LGBT community.’
Health Policy Plus is currently developing an online version of the training, and supporting civil society organizations in Kenya and Jamaica to adapt the program to local context.
We’re proud of our staff and partners who have designed, led and documented a range of innovative solutions that tackle unfair HIV stigma and discrimination. Beyond World AIDS Day 2016, we will continue to advance effective and sustainable approaches that help break down HIV-related stigma - and urge the global community to do likewise.