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

2. 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)

3. 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

4. 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

5. 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

6. Community-led Stigma Reduction In Vietnam An Example Illustrating Principles & Promising Approaches from the Global Experience

7. 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)

8. Gate Keepers & Multiple Change Agents Understanding & Ownership

9. Range and Combination of Approaches
Participatory learning
Community educators
Community meetings

10. Range and Combination of Approaches
Billboards
Factsheets
Slogans

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

12. 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

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

14. Thank You!

15. 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.