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A Global Framework for Action Translating Theory into Practice Anne Stangl, PhD, MPH Senior Behavioral Scientist, ICRW July 26, 2012 Background • ICRW stakeholder consultation, November 2008 • Lack of consistency in how stigma is measured globally – Question wording – Response categories – Domains assessed • Lack of M&E Guidance related to S&D • Limits ability to: – – – – Evaluate stigma-reduction programming Improve programs Compare data across contexts Use evidence to advocate for scale-up Background (2) • Initial Technical Consultation, Nov 2009 • Development of Framework by 16 member GSDIWG Impacts Stigma Outcomes Stigma Manifestations Key areas for intervention development, scale-up & measurement Stigma “Marking” HIV Stigma Intersecting Stigmas Other Stigmas Actionable Drivers & Facilitators General Population Family & Peers PLHIV & key Populations Institutions & Structures Adapted from: Stangl, A. V.Go, C. Zelaya, L. Brady, L. Nyblade, L. Stackpool-Moore, J. Hows, L. Sprague, L. Nykanen, B. DeZalduondo. Poster presented at IAS 2010; Vienna. Actionable & Facilitators Drivers Lack of Awareness Social Judgment Fear of HIV Infection Fear of Social Ramifications Fear of Economic Ramifications Prejudice & stereotypes regarding: •HIV status •Drug use • Sexual behavior • Sex work • Gender • Age Laws, Policies & Policy Environments Cultural • Gender culture • • • Individual & Community • Power • Social support • Social assertiveness • Resilience General Population Family & Peers PLHIV & key Populations Institutions & Structures Sexual culture Health beliefs Ethics & morality Stigma “Marking” HIV Status Intersecting Stigmas Gender Sexuality Profession Drug Use Caste Actionable Drivers & Facilitators General Population Family & Peers PLHIV & key Populations Institutions & Structures Stigma Manifestations Resilience Anticipated Stigma Perceived Stigma Internalized Stigma Experienced Stigma (outside legal purview) Discrimination (inside legal purview) Stigma “Marking” HIV Stigma Intersecting Stigmas Other Stigmas Actionable Drivers & Facilitators General Population Family & Peers PLHIV & key Populations Institutions & Structures Stigma Outcomes Behaviors Uptake of HIV Services Uptake of Support Services Stigma Manifestations Stigma “Marking” HIV Stigma Intersecting Stigmas Other Stigmas Actionable Drivers & Facilitators General Population Family & Peers PLHIV & key Populations Institutions & Structures Stigma Impacts Quality of Life HIV Incidence & Prevalence Morbidity & Mortality Stigma Outcomes Stigma Manifestations Stigma “Marking” HIV Stigma Intersecting Stigmas Other Stigmas Actionable Drivers & Facilitators General Population Family & Peers PLHIV & key Populations Institutions & Structures General Population Measures: How Far have We Come? Measures Piloted in Rwanda: 5 Domains • Cognitive Interviews of 18 questions in Rwanda (n=24) • Selection and piloting of 8 questions in Rwanda DHS Pilot • N=4669 • 9 questions found to be valid and reliable General Population Measures General Population Measures (2) Next Steps • Validate the measures in more countries • Assess whether the measures predict key HIV-related behaviors and outcomes (i.e. HIV testing, condom use, etc.) Thank You!