Community and Structural-level Interventions to Reduce HIV-related Stigma: The Missing Components for Effective Biomedical Prevention Dr. Madhumita Das ICRW

Engaging key populations in HIV prevention efforts is a critical challenge Engaging key populations is critical to the effectiveness of biomedical prevention

Stigma must be addressed at: – Multiple levels – Multiple target pops Most interventions: – Attempt to shift individual attitudes e.g. students, teachers, health care workers – Few seek community or societal-level norm shifts Source: Stangl, A., K. Fritz; L. Brady. Technical Brief: Measuring HIV stigma and discrimination STRIVE

Two examples of community-level stigma- reduction interventions in India

PANCHAYAT-LED HIV RELATED STIGMA REDUCTION PROGRAM A Unique Model Developed in Nandi, Karnataka Nandi Grama Panchayat

Program Highlights Action against stigma and discrimination part of Panchayat Agenda Panchayat members and community leaders = ‘Stigma Busters’ Messages against stigma through games Created platforms for discussions between key populations, PLHIV and Panchayat Misperceptions of PLHIV reduced from 64% to 19% Awareness of HIV increased from 30% to 94% DAPCU and District Administration to replicate model 6

Key Lessons Importance of PRIs in stigma reduction efforts: – Panchayat members have great influence in the community and can be excellent role models – Pride, visibility and real role can be key drivers for leaders to commit to stigma reduction program. – Stigma activities can be mainstreamed within the regular GP activities (Grama Sabha, VHSC, Primary Health Center) Lessons for working with PRIs: – Implementing organizations should be neutral; should not intervene in PRI internal affairs. – Take all stakeholders into consideration with patience and positive approach 7 Source: Stigma Busters: Empowering and Enabling Local Governance to Work towards Stigma-free Gram Panchyat. Swasti Health Resource Centre and ICRW, 2013.

Sex worker-led advocacy campaign in Bangalore Led by 3 networks of sex workers covering entirety of Bangalore Empowered WSW to challenge S&D via targeted advocacy – General population – Key stakeholders (e.g. police and HCWs) 221 events aimed to sensitize about issues faced by WSW and PLHIV

Sex worker led advocacy campaign in Bangalore led to increases in: HIV testing among network members Number of HIV+ FSW seeking HIV services (from ) Enrolment in govt. ART centers (from 30% to 60%) Source: Stangl, A. et al. Tackling HIV-related stigma and discrimination in South Asia The World Bank.

An example of a structural–level intervention in India

Indian government to integrate stigma-reduction framework into NACP-IV UNDP supported 5 pilot projects Global framework adapted to Indian context Implementation guidelines developed Source: ICRW, UNDP, STRIVE

Rigorous research needed to… Assess the efficacy and effectiveness of community-level stigma reduction interventions – Particularly in the context of biomedical prevention approaches such as UTT, MMC, and PrEP Understand the influence of national-level policies to reduce stigma and discrimination – How best to implement? – How best to scale-up multi-level stigma-reduction interventions?

Thank you!