What Works F or R educing S tigma and Discrimination:

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

2. Presentation Guide • Human Rights Approaches • Key Principals For S&D reduction programming • Examples from the healthcare sector • Tools & Resources

3. Human Rights Approaches

4. 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

5. 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

6. Key Principals For Stigma Reduction Programming

7. 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

8. Affected Groups at the Core to Lead Response • Develop & Strengthen networks • Empowerment & Capacity Strengthening • Address self-stigma • Identify & support health & other needs • Build Resiliency

9. Create Alliances and Form New Partnerships for Influence and Expanded Reach • “Contact strategies”: Foster interaction between groups experiencing stigma & those perpetrating it. • Model desirable behavior • Hold up & reward role models Engage a range of groups • Opinion Leaders • Policymakers • Service Providers • Religious Leaders • Youth • Media • General Community • Family

10. Employ a Range & Combination of Approaches • Participatory learning • Community meetings • Cultural Mediums • Written Materials • Media Channels • Advocacy Campaigns

11. Stigma & Discrimination-Reduction in Health ServicesSome Examples

12. S&D Hospital Reduction Intervention PackageHorizons, 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

13. Training 3 to 4 half-days ½ day basic HIV knowledge 1 day on Universal Precautions ½ 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

14. 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

15. Building Alliances & Advocating for Stigma-Free Health Services SwathiMahilaSangha & partners, Bangalore, India • Capacity Strengthening • Designed advocacy campaigns • Rose Campaign • Opened space for dialogue • Medical student rotation 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

16. Tools & Resources

17. General Tools 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) • Challenging & Addressing Stigma towards • People living with HIV • Men who have sex with men • Sex workers • People who use drugs • Guidance Documents • UNAIDS, DfiD

18. 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

19. 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

20. 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).