Programmes and tools for reducing stigma and

discrimination, including human rights approaches

What Works For Reducing Stigma

and Discrimination:

Laura Nyblade, PhDJuly 27, 2012

Human Rights ApproachesKey Principals For S&D reduction

programmingExamples from the healthcare sector

Tools & Resources

Presentation Guide

2

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 non- discriminatory, 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

Develop & Strengthen networks Empowerment & Capacity Strengthening

Address self-stigmaIdentify & support health & other needs

Build Resiliency

Affected Groups at the Core to Lead Response

Engage a range of groupsOpinion Leaders

– Policymakers– Service Providers – Religious Leaders– Youth– Media

General CommunityFamily

“Contact strategies”: Foster interaction between groups experiencing stigma & those perpetrating it.

Model desirable behavior

Hold up & reward role models

Create Alliances and Form New Partnerships for Influence and Expanded Reach

Participatory learningCommunity meetingsCultural MediumsWritten Materials Media ChannelsAdvocacy Campaigns

Employ a Range & Combination of Approaches

Stigma & Discrimination-Reduction in Health

ServicesSome Examples

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Building partnerships with Hospital gatekeepersBaseline dataHospital steering committeeParticipatory Training:

For all hospital staff Refreshers (monitoring visits)

Joint development of “Safe and Friendly” hospital policies

Structural changes supporting universal precautionsEducational materialsEndline data

S&D Hospital Reduction Intervention PackageHorizons, ISDS & ICRW

Training

3 to 4 half-days½ day basic HIV knowledge1 day on Universal Precautions½ day on social stigma (Arm 2 only) co-facilitated by PLHIV Naming stigma through pictures What is the meaning of stigma Naming stigma in hospitals—forms & Causes How it feels to be stigmatized

Each trained group developed their own policy & presented it in plenary to hospital

Steering committee took all comments & combined for final hospital policyAccess to services by PLHIVHIV counseling and testingConfidentialityUniversal PrecautionsTraining on HIV and AIDSDissemination of policy

Posters of policy posted throughout hospitals

Hospital Policy Development

Ashodaya-Samithi, Mysore, IndiaTrained 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

campaignsRose Campaign

Opened space for dialogue

Medical student rotation

Building Alliances & Advocating for Stigma-Free Health Services

Tools & Resources

General Tools• Challenging & Addressing

Stigma towards– 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)

People Living with HIV Stigma IndexGlobal Stigma and Discrimination Indicator working

groupGlobal working group on S&D measurement for

health facilities

Measures: Three Global Efforts

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www.stigmaactionnetwork.com– From working in isolation to collective action

• Share and learn from each other• Speak with collective voice• Raise external awareness about existing best practices• Coordinate efforts for efficiency & effectiveness

www.healthpolicyproject.com

Thank You!

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).