1. Removing Barriers: Creating better access to health services for people living with HIV,HCV and HBV
Brent Allan
Senior Coordinator
Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM)

2. Overview of the Project
Aim to reduce structural barriers, stigma and discrimination which impede access to the health service of people living with HBV, HCV or HIV, and people at risk of these conditions
Hepatitis B barriers
similar to culturally and linguistically diverse and indigenous populations
Hepatitis C barriers
associated with injection drug use
HIV barriers
vary by location
strong in non-HIV or gay community settings
self imposed/relate to perception as much as actual

3. Six key stigma-reduction principles and approaches
1. Education & information-based approaches
2. Skill building
3. Counselling approaches
4. Social contact-interaction
5. Structural approaches
6. Biomedical approaches
1. Education & information-based approaches:
Evidence-based, written information in a brochure and other media. These programs should engage in myth-busting through the provision of reliable evidence. Such programs should emphasise and demonstrate recovery from illness as a key part of its messaging
2. Skill building:
Exercises that entail tangible learning strategies to reduce negative attitudes. Such programs should focus on behaviour change by teaching skills that help health care professionals know what to say and what to do when engaging people with a stigmatised illness
3. Counselling approaches:
Such as attending support groups (particularly to address internalised stigma)
4. Social contact-interaction:
Including testimonials and interaction between people from the general population and from stigmatised groups; personal testimonies from trained speakers with lived experience of stigmatised illness; employ multiple forms of social contact (e.g., several first-voice speakers, a live speaker presentation and a video presentation)
5. Structural approaches:
Such as changing discriminatory workplace policies and laws, and increasing health professionals’ and health students’ structural competency (see Metzl & Hansen, 2014)
6. Biomedical approaches:
In the context of HIV infection, such as antiretroviral treatment and PrEP to reduce new HIV infections

4. Project Phases Planning Gathering research and community feedback
Baseline data collection in collaborating services
Trialling and Evaluating interventions
Implementation
Developing up interventions to be rolled out across health system
Supported by a range of establishment organisations

5. Health Services Data Sites exist in 6 of the 9 states
Do service users feel discriminated against or stigmatised?
Are patients staged appropriately?
Are patients key demographics entered?
Do staff have training in non- discriminatory practices?

6. Implementation Partners
9 collaborating health services
8 implementation partners
6 community partners
2 research and communication partners

7. Overview of the interventions
Intervention 1: Improved experience of patients in the waiting room.
Intervention 2: Stigma and discrimination competency for practice nurses.
Intervention 3: Stigma and discrimination are part of health service management educational and professional offerings.
Intervention 4: Stigma and discrimination is included in ethics sessions in undergraduate and CME programs.
Intervention 5: Improved completeness of data collected in health care services, to facilitate improved care and develop an evidence base.
Initiative 6: Development of a discussion paper on the cost of opiate substitution therapy (OST)
Initiative 7: Develop an awareness resource on injection drug use
Intervention 8: Advocate for a review of Practice Standards which prohibit people with a BBV from practicing
Intervention 9: increase the workplace safety and capacity of HCW living with HIV,HVC or HBV to challenge stigma and discrimination
Intervention 1: Improved experience of patients in the waiting room, approaching services, and optimising the front of house role in patient management and service delivery, through training
Intervention 2: Stigma and discrimination is a dimension of competency in the education and career path for practice nurses. Training is made available to demonstrate competency at all levels in this domain
Intervention 3: Issues of stigma and discrimination and structural barriers are recognised as important by the ACHSM and flow through to their various programs, educational and professional offerings.
Intervention 4: The importance of addressing stigma and discrimination included in Ethics sessions (undergraduate and RACGP/ACRRM) and CME programs.
Intervention 5: Improved completeness of data collected in health care services, to facilitate improved care, screening and access to opportunities for priority populations and increased participation in surveillance, monitoring, research and development of evidence base.
Initiative 6: The cost of OST in the community should not inhibit its use - Development of a discussion paper
Initiative 7: Redevelopment of AIVL/NUUA resource on injection drug use (this is currently a year 2 activity though some discussion have commenced)
Intervention 8: RACGP Practice Standards – Submission to review

8. What steps have been taken?
Comprehensive literature review of the stigma and discrimination in health care settings
Updated RACGP practice standards to include stigma and discrimination
Community submissions on systemic barriers in accessing health services. (n=9)
Policy and practice documents relating to other workforce domains including:
Geographic issues (eg. Malaysia)
Cost factors (eg. OST)
Specialist issues (eg. HIV nurse specialists)
Updating standards and accreditation
Master Health Service Management competency framework
Standards for Assessment and Accreditation of Primary Medical Programs by the Australian Medical Council

9. What activities are currently underway?
Online training packages which address stigma and discrimination
Front of house reception staff
nurses
Medical education students training modules utilizing people living with HIV,HCV and HBV
My Story - awareness videos on what it means to live with HIV,HCV and HBV and what barriers people face in health care settings
Responsiveness video which aims to enable HCW to appreciate and intervene with PWID

10. ASHM Priorities and Sustainability
All outputs are to be electronic/on-line
Establishment of a service directory
ASHM commissions
content development with implementing agencies
Policy production
Position ASHM as a clearinghouse on stigma and discrimination resources for the health services sector
Share footprint nationally and internationally