Transcript What is Being Done? - International AIDS Society
Current Gaps and Priorities in Advocacy to fight HIV Stigma
Ron MacInnis International AIDS Society
Examining the Issue
In order to identify the gaps in advocacy, let’s first take a look at what is being done today
What is Being Done?
1. Knowledge & Empowerment Toolkit
ICRW/Change Project Understanding and Challenging HIV Stigma: Toolkit for Action* • Help trainers plan and organize educational sessions to raise awareness and promote practical actions to reduce HIV/AIDS stigma and discrimination IPPF with UNAIDS,GNP+, and ICW- The People Living • with HIV Stigma Index** Enhance global understanding of HIV stigma and build an evidence base to inform policy and practice
Index
*International Center for Research on Women. (2008). How to Reduce the Stigma of AIDS. Retrieved November, 2008, from http://www.icrw.org/html/projects/stigma.html.
**The People Living with HIV Stigma Index. (nd). Retrieved November, 2008, from http://www.stigmaindex.org.
What is Being Done?
2. Development of Model Programs Framework
NGO Code of Good Practice Self-Assessment Checklist: • Stigma and Discrimination* Putting into practice the key principles of the code for successful responses AED-COACH HIV/AIDS Anti-Stigma • Initiative** A framework for addressing HIV/AIDS-related stigma, through models and community projects
Checklist
*International Federation of Red Cross and Red Crescent Societies. (nd). Code of Good Practice for NGOs Responding to HIV/AIDS . Retrieved November, 2008, from http://www.ifrc.org/what/health/hivaids/code/index.asp.
**Academy for Educational Development Center on AIDS & Community Health. (2007). The Initiative. Retrieved November, 2008, from http://www.hivaidsstigma.org.
What is Being Done?
3. Social and Attitudinal Change Campaigns
IAS and AIDES ‘If I were HIV positive’ campaign* National Red Cross and Red Crescent Societies ‘The truth about AIDS. Pass it on…’- The stamps campaign** *International AIDS Society. (nd). Campaign Against Stigma and Discrimination. Retrieved November, 2008, from http://www.iasociety.org/Default.aspx?pageId=236.
** International Federation of Red Cross and Red Crescent Societies. (nd). The Truth about AIDS. Pass it on... Retrieved November, 2008, from http://www.ifrc.org/what/health/hivaids/antistigma/stamps/index.asp.
What is Being Done?
4. Initiatives on Laws and Policies Guidelines
The World Bank- Legal Aspects of HIV/AIDS: A Guide for Policy and • Law Reform** A guide to help governments identify and address any gaps or problematic aspects of their legislation and regulatory systems UNAIDS- Reducing HIV Stigma and Discrimination: a critical part of national AIDS • programmes* Outlines strategies and programmes for overcoming stigma and discrimination *UNAIDS. (2008). Publications. Retrieved November, 2008, from http://www.unaids.org/en/KnowledgeCentre/Resources/Publications/default.asp.
** The World Bank Group. (2008). Publications. Retrieved November, 2008, from http://web.worldbank.org.
Yet Stigma is Still a Problem…
Where Does Stigma Come From?
The Roots Individual
Values Attitudes Beliefs
Structural
Culture Gender Laws/Policies Ideology Sexuality Socioeconomic
The Symptoms What HIV Does
Fear Shame Judgment Values Blame Gossiped about Avoided Isolated
Consequences of Stigma
Self Isolation Disclosure Decline to use services Support/care denied Institutional discrimination
Activities to Fight Stigma
Toolkits Campaigns Indexes
HIV stigma impacts human rights, HIV prevention, care and treatment Are the activities targeting HIV stigma addressing the roots or the symptoms?
Are the activities targeting HIV stigma protecting vulnerable communities and people living with HIV from the impacts and consequences of stigma?
Stigma
Not a stand alone issue
Pre-dates HIV
HIV builds on pre-existing layers of stigma -
Homosexuality
Gender
Poverty
Chronic disease
Ethnic minority groups
Case 1: Travel Restrictions
74 countries deny the entry, stay or residence of HIV-positive people* Pre-existing stigma =
Chronic disease - Drain on the economy
Spread of disease
Ethnic and sexual minorities
Economic status/class
*UNAIDS. (2008). HIV-related travel restrictions. Retrieved November, 2008, from http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2008/20080304_HIVrelated_travel_restrictions.asp.
Case 2: Criminalization and Social Exclusion
86 UN member states still criminalize consensual same sex sexual relations* Pre-existing laws = social exclusion
Homophobia
Injecting Drug Use
Sex work
Migrants
*UNAIDS. (2008). International Day against homophobia. Retrieved November, 2008, from http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2008/20080516_homophobia_international_day.asp.
Digging Deeper… Are the roots being addressed?
What is Being Done?
Symptom advocacy link Individual
Values Attitudes Beliefs
Structural
Culture Denial of Rights Gender Laws/Policies Ideology Sexuality Socioeconomic
What HIV Does
Fear Shame Judgment Values Blame Gossiped about Avoided Isolated Violence
Consequences of Stigma
Self Isolation Social exclusion Denial of services Inequity Support/care denied Institutional discrimination Lack of allocation of resources or access to Services \ Response
Activities to Fight Stigma
Toolkits Campaigns Indexes
The Gap Individual
Values Attitudes Beliefs
Structural
Culture Denial of Rights Gender Laws/Policies Ideology Sexuality Socioeconomic
The Missing Link What HIV Does
Fear Shame Judgment Values Blame Gossiped about Avoided Isolated Violence
No Targets or Concept of Scale Consequences of Stigma
Self Isolation Social exclusion Denial of services Inequity Support/care denied Institutional discrimination Lack of allocation of resources & access Services \ Response
Why is Stigma Still a Problem?
Current advocacy does not adequately address or link to underlying stigma such as stigma associated with gender or consequences including violence 70 60 50 40 30 20 10 0 63.1
49.6
Women Men Experienced Stigma in the Last Year (n=218, p=.044)
*Understanding HIV Stigma & Discrimination, Laura Nyblade, ICRW
What Works in Other HIV Advocacy?
Leadership & Voice of Affected Accountability Adequate Funding Rights-based & Watch Dog Raise Awareness National Programs & Targets Linkages to roots
Learning by Example
What has worked in other HIV advocacy in the past three decades?
Develop a clear advocacy statement based on an agreed statement: “Globally agreed Universal Access targets (by 2010) will not be achieved because of the pervasive, largely ignored, and growing stigma associated with HIV.”
Advocacy for the Future
Advocate for…
Removal of legal and institutional barriers to equal access and equal treatment e.g. gender-based violence, travel restrictions; resource allocn.
Decriminalization: homosexuality; HIV transmission; etc
Removal of legal and institutional barriers to evidence based HIV interventions e.g. opiod substitution therapy
Accountability: link funding to legislative environment
Laws \Policies to protect against impacts & consequences ex - Denial of services; ethical practice; HCW & standard of care
Evidence based research and knowledge (politics vs. science) “What do we know and how are we packaging it?”
Advocacy for the future
Fund Advocacy – fund it long term Advocate for the correct usage of language on HIV scourge”) – with policy makers, media, etc. (i.e. “vicitims”, “AIDS Build awareness of harmful HIV policies, laws, practices that enable HIV stigma Advocacy with religious leaders – many people develop their normative views on culture, sex, disease, tolerance from their faith leaders Advocacy for scaling up program beyond projects
We need to: Increase advocacy around the structural, policy and legislative roots of underlying stigma
Summary
Gaps
People do not address the underlying layers of HIV stigma Advocacy does not target the connection between the roots and symptoms of stigma Key elements of other successful HIV advocacy are not being considered
Priorities
Reach out to other areas of social injustice, where these roots lie Link advocacy targeting symptoms with advocacy targeting roots e.g. Violence against MSM, Women, etc .
Incorporate funding, leadership, accountability, and human rights into the HIV stigma advocacy field Set targets and monitor progress linked to the Universal Access agenda