Transcript What Works For Reducing Stigma and Discrimination: Programmes and tools for reducing stigma and discrimination, including human rights approaches Laura Nyblade, PhD July 27, 2012

What Works For
Reducing Stigma
and Discrimination:
Programmes and tools for
reducing stigma and
discrimination, including
human rights approaches
Laura Nyblade, PhD
July 27, 2012
Presentation Guide
Human Rights Approaches
Key Principals For S&D reduction
programming
Examples from the healthcare sector
Tools & Resources
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Human Rights
Approaches
A Rights-Based Approach to HIV
 Supports govts to realize rights
 Supports people to take up/demand rights
 Ensures that HIV response addresses
vulnerabilities/needs of most affected
 Ensures that HIV response is nondiscriminatory, inclusive, participatory, and
accountable (human rights principles)
 Empowers individuals and communities
Promote Programmes That Empower
 Know your rights/laws campaigns (“legal literacy”)
 Programmes to reduce stigma and discrimination
 Human rights education for key service providers (health
care workers, police, judges): nondiscrimination,
confidentiality, informed consent, ethical partner
notification
 Programmes to change harmful gender norms, violence
against women
 Provision of legal aid, community paralegals, working with
traditional leaders
 Economic empowerment
Key Principals For
Stigma Reduction
Programming
Address Immediately Actionable
Drivers
 Raise Awareness:
Close the Intention-Action Gap
• Foster understanding and motivation for stigma reduction
 Address Transmission Fears and
Misconceptions
• How it is and is not transmitted
• Respond to specific fears related to daily living context
 Discuss and Challenge the Shame and Blame
•
The values and beliefs that underlie stigma and
discrimination:
•
Where they come from
•
What they do
Affected Groups at the Core to
Lead Response
Develop & Strengthen networks
Empowerment & Capacity
Strengthening
Address self-stigma
Identify & support health & other
needs
Build Resiliency
Create Alliances and Form New
Partnerships for Influence and
Expanded Reach
Engage a range of
groups
Opinion Leaders
– Policymakers
–
–
–
–
Service Providers
Religious Leaders
Youth
Media
General Community
Family
“Contact strategies”:
Foster interaction
between groups
experiencing stigma &
those perpetrating it.
 Model desirable
behavior
Hold up & reward role
models
Employ a Range & Combination of
Approaches
Participatory learning
Community meetings
Cultural Mediums
Written Materials
Media Channels
Advocacy Campaigns
Stigma & DiscriminationReduction in Health Services
Some Examples
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S&D Hospital Reduction Intervention
Package
Horizons, ISDS & ICRW
 Building partnerships with
Hospital gatekeepers
 Baseline data
 Hospital steering committee
 Participatory Training:
 For all hospital staff
 Refreshers (monitoring visits)
 Joint development of “Safe and Friendly”
hospital policies
 Structural changes supporting universal
precautions
 Educational materials
 Endline data
Training
3 to 4 half-days
½ day basic HIV knowledge
1 day on Universal Precautions
½ day on social stigma (Arm 2 only) cofacilitated by PLHIV
 Naming stigma through pictures
 What is the meaning of stigma
 Naming stigma in hospitals—forms & Causes
 How it feels to be stigmatized
Hospital Policy Development
Each trained group developed their own
policy & presented it in plenary to hospital
Steering committee took all comments &
combined for final hospital policy
 Access to services by PLHIV
 HIV counseling and testing
 Confidentiality
 Universal Precautions
 Training on HIV and AIDS
 Dissemination of policy
Posters of policy posted throughout hospitals
Building Alliances & Advocating for
Stigma-Free Health Services
Ashodaya-Samithi,
Mysore, India
 Trained Peer Patient
Advocates, placed in
public hospitals
 Opportunity for
increased contact and
understanding
 Sex workers found
easier to access
services
Swathi Mahila Sangha
& partners, Bangalore,
India
 Capacity
Strengthening
 Designed advocacy
campaigns
 Rose Campaign
 Opened space for
dialogue
 Medical student
rotation
Tools & Resources
General Tools
• Challenging & Addressing
Stigma towards
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–
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People living with HIV
Men who have sex with men
Sex workers
People who use drugs
• Guidance Documents
– UNAIDS, DfiD
Health Care Specific
• Safe & Friendly Health Facility
Trainers Guide
(ISDS/ICRW/Horizons tools, Vietnam)
• Reducing Stigma and
Discrimination Related to HIV
and AIDS: Training for Health
Care Workers (Engender Health)
• Reducing HIV Stigma &
Gender Based Violence:
Toolkit for Health Care
Providers in India
(ICRW/BPWT/Levi Strauss Foundation)
• Global Stigma-Reduction
toolkit for health care settings
(Draft)
Measures: Three Global Efforts
 People Living with HIV Stigma Index
 Global Stigma and Discrimination Indicator working
group
 Global working group on S&D measurement for
health facilities
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www.stigmaactionnetwork.com
– From working in isolation to collective action
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Share and learn from each other
Speak with collective voice
Raise external awareness about existing best practices
Coordinate efforts for efficiency & effectiveness
Thank You!
www.healthpolicyproject.com
The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International
Development (USAID) under Cooperative Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is
implemented by Futures Group, the Centre for Development and Population Activities (CEDPA), Futures Institute,
Partners in Population and Development Africa Regional Office (PPD ARO), Population Reference Bureau (PRB),
Research Triangle Institute (RTI) International, and the White Ribbon Alliance for Safe Motherhood (WRA).