What do donor’s think? Opportunities and challenges for stigma reduction programs and research

1. What do donor’s think? Opportunities and challenges for stigma reduction programs and research R. Cameron Wolf, PhD Senior HIV/AIDS Advisor for Key Populations USAID, Office of HIV/AIDS, Washington, DC

2. Pervasive Stigma and Discrimination at All Levels • Self stigmas (multi-faceted) • Within-group stigma • Health facility providers (medical + administrative) • Community stigma - public positions by opinion leaders / stakeholders / religious leaders • Institutionalized societal stigma/discrimination - laws, policies and legal frameworks directed towards KPs / PLHIV

3. Competing Discourses • Vulnerable groups vs. key populations (or most-at-risk populations) who have higher-risk behaviors with attached legal and social marginalization • Criminalization vs. public health approach • Priorities within public sector vs. community vs. private sector vs. religious institutions • Confusion between gender identity and sexuality and terminology • Increased attention for KPs in planning documents - BUT this does not always translate to funding on the ground to communities or services • Generalized vs. concentrated epidemics • Service delivery vs. structural interventions / enabling environment • Prevention vs. care and treatment • International (or Western) vs. indigenous • Coverage vs. quality vs. development

4. No One Left Behind We, the signatories and endorsers of this Declaration, affirm that non-discrimination is fundamental to an evidence-based, rights-based and gender transformative response to HIV and effective public health programmes… - from the Melbourne Declaration, 2014

5. Making strategic, scientifically sound investments to rapidly scale-up core HIV prevention, treatment and care interventions and maximize impact Work with our partners to effectively mobilize, coordinate and efficiently use resources to save more lives sooner Focus on women and girls to increase gender equality End stigma and discrimination against people living with HIV and key populations Set benchmarks that are regularly assessed to assure goals are being met Main Principles

7. A Sampling of Donor Questions • How do we best measure (and cost) structural interventions designed to reduce stigma or build resiliency  uptake and retention of testing, care and treatment services? • How to build stronger partnership with corporate philanthropy programs in this area? • How to build enhanced linkages between faith-based organizations and KP community groups  non-discriminatory outreach, condom/lubricant distribution, peer navigation services • How to catalyze new communication technologies with KP and PLHIV for HIV service delivery promotion, monitoring of stigma and violence and quality assurance processes?

8. Key Considerations and Principles • Evidenced-based programming and scale up of services must be balanced with ethical considerations, data safety and security protections – Do No Harm • Many CBOs (and governments) addressing KPs have limited organizational capacity – all activities should include local community empowerment and capacity development • Providers at all levels must be engaged (community-based, private, public sector and donors need sensitization and appropriate training) • Addressing HIV among stigmatized populations requires crises response systems which respond to violence and human rights abuses

9. Ways Forward • Standard definitions for Key Populations and indicators, tools and methods for monitoring stigma and discrimination must be harmonized and utilized • Risk assessment and contingency planning is needed proactively in increasingly hostile environments • Systems for monitoring non-discriminatory services with KP / PLHIV leadership from contracts to services, with input from and engagement with civil society, must be implemented • The “combination prevention” paradigm (considering biomedical/ behavioral and structural factors) is now informing acomprehensive continuum of prevention, care and treatment. We must better demonstrate impact.

10. Thank you