HIV Stigma Reduction: Evidence and Tools for Action Anne Stangl World Bank Africa Regional Videoconference April 2, 2009

Stigma is a Dynamic Process with 4 steps Distinguish & label differences Associate negative attributes to perceived differences Separation of ‘us’ from ‘them’ Status loss & discrimination (Link and Phelan 2001)

HIV-related Stigma & Discrimination “…a ‘process of devaluation’ of people either living with or associated with HIV and AIDS…Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status.” - UNAIDS, 2003

What We Know: HIV Stigma is Universal & Prevalent Barrier to Universal Access Differentially experienced by women and men; vulnerable groups Common at its core while contextually specific Causes Forms Consequences Actionable & Measurable Promising program models & practical tools available for scale-up Base of validated & tested measures

Immediate Actionable Causes Lack of awareness Fear of casual contact Values linking HIV with immoral behavior Individual Address attitudes and behaviors Environmental Meet needs for information, training, and supplies Structural Policies, laws, and systems

Community-led Stigma Reduction In Vietnam An Example Illustrating Principles & Promising Approaches from the Global Experience http://www.icrw.org/docs/2009/Communities-Confront-HIV-Stigma-in-Vietnam.pdf

Partners Communities of Cai Khe and Cam Dong Communist Party, Vietnam Institute for Social Development Studies (ISDS), Hanoi International Center for Research on Women, Washington, DC PACT US Government (USAID/PEPFAR)

Gate Keepers & Multiple Change Agents Understanding & Ownership

Range and Combination of Approaches Participatory learning Community educators Community meetings

Range and Combination of Approaches Billboards Factsheets Slogans

Additionally Central role for People Living with HIV Address internalized stigma Skills building Delivering programs Address the Multiple Layers of Stigma Start at ‘home’

It’s Time to Scale-up We know what works: Understand stigma and know how to address Tools and strategies are available: Communities Health care settings Validated measures exist

What is Lacking? International will and resources HIV stigma a critical barrier to universal access To maximize investments, must reduce stigma

Thank You!

Resources Ogden, J., & Nyblade, L. (2005). Common at Its Core: HIV-Related Stigma Across Contexts. Washington, DC: International Center for Research on Women. Nyblade, L., Pande, R., Mathur, S., MacQuarrie, K., Kidd, R., Banteyerga, H., et al. (2003). Disentangling HIV and AIDS Stigma in Ethiopia, Tanzania and Zambia. Washington, D.C.: ICRW. Kidd, R., & Clay, S. (2004). Understanding and Challenging HIV Stigma: Toolkit for Action. Washington, DC: CHANGE Project/AED, ICRW. Tanzania stigma-indicators field testing group. (2005). Measuring HIV Stigma: Results of a Field Test in Tanzania (Working Report). Washington, DC: Synergy, ICRW.