1. RTI International RTI International is a trade name of Research Triangle Institute. www.rti.org Stigma-Reduction Scale Up: It Can Be Done Building on Practice-Based Evidence Laura Nyblade, PhD July 22, 2012

2. RTI International Presentation Guide  Fundamentals for Stigma-Reduction Programing: What we’ve learned from the field  Health Care Setting Programmatic Examples  Scaling up: Foundation & Gaps

3. RTI International Address Immediately Actionable Drivers Interactively in Safe Spaces to:  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

4. RTI International  Develop & Strengthen networks  Empowerment & Capacity Strengthening  Address self-stigma  Identify & support health & other needs  Build Resiliency Affected Groups at the Core to Lead Response

5. RTI International Engage a range of groups  Opinion Leaders – Policymakers – Service Providers – Religious Leaders – Youth – Media  General Community  Family  Break down the ‘us’ vs ‘them’: 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

6. RTI International Employ a Range & Combination of Approaches  Participatory learning  Community meetings  Cultural mediums  Written materials  Media channels  Advocacy campaigns

7. RTI International RTI International is a trade name of Research Triangle Institute. www.rti.org Stigma & Discrimination-Reduction in Health Services Some Examples

8. RTI International S&D Hospital Reduction Intervention Package: Horizons, ISDS & ICRW  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

9. RTI International Building Alliances & Advocating for Stigma-Free Health Services Ashodaya-Samithi, Mysore, India  Trained Peer Patient Advocates, placed in public hospitals  Opportunity for increased contact and understanding  Improved access & utilization of health services  Swathi Mahila Sangha & partners, Bangalore, India  Capacity Strengthening  Designed advocacy campaigns  Rose Campaign  Opened space for dialogue  Medical Student Rotation

10. GOAL: SCALE UP STIGMA REDUCTION ESTABLISH A STRONGER CASE BUILD JOINT ACTION CREATE READINESS FOR SCALE CAPACITYSTRENGTHENING EVIDENCE BASE COMMUNICATION & ADVOCACY PROGRAMMING LAWS AND POLICY

11. RTI International Causes, manifestations & consequences Stigma impacts HIV and AIDS Programs How to measure stigma How to reduce stigma What works in different contexts WHAT WE HAVE SCALING UP S&D REDUCTION EVIDENCE BASE WHAT WE KNOW WHAT WE NEED  Inclusion of S&D in national strategies  Implementation  Program Evaluations  Costing and cost effectiveness data

12. RTI International  Standardize program guidance  Validate & global indicators  Institutionalize stigma- reduction  Incorporate stigma-reduction into prevention & treatment programs Stigma reduction tools IEC material Intervention models Measures Stigma Action Network SCALING UP STIGMA REDUCTION WHAT WE HAVE PROGRAMMING WHAT WE NEED

13. Coverage If you invest in stigma reduction… …the ripple effect will impact all HIV and AIDS programs and services, reaching more people in a single community Care & Support Provision of health care Palliative care Family support Community support Prevention Testing PMTCT Disclosure Risk Behaviors Treatment Timely uptake Adherence Stigma reduction intervention

14. RTI International RTI International is a trade name of Research Triangle Institute. www.rti.org We Know Enough to ACT What will you do? You are part of the solution