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

 Human Rights Approaches  Key Principals For S&D reduction programming  Examples 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-stigma  Identify & support health & other needs  Build Resiliency Affected Groups at the Core to Lead Response

Engage a range of groups  Opinion Leaders –Policymakers –Service Providers –Religious Leaders –Youth –Media  General Community  Family  “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 learning  Community meetings  Cultural Mediums  Written Materials  Media Channels  Advocacy Campaigns Employ a Range & Combination of Approaches

Stigma & Discrimination- Reduction in Health Services Some Examples 11

 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 S&D Hospital Reduction Intervention Package Horizons, ISDS & ICRW

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

 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 Hospital Policy Development

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 Swathi Mahila Sangha & partners, Bangalore, India  Capacity Strengthening  Designed advocacy campaigns  Rose 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 Index  Global Stigma and Discrimination Indicator working group  Global working group on S&D measurement for health facilities Measures: Three Global Efforts 18

–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

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 , beginning September 30, 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).