Community and Structural-level Interventions to Reduce HIV-related Stigma:

The Missing Components for Effective Biomedical Prevention

Dr. Madhumita DasICRW

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. 2012. 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 gamesCreated platforms for discussions between key populations, PLHIV and PanchayatMisperceptions 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

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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 BangaloreEmpowered 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 membersNumber of HIV+ FSW seeking HIV services (from 497-794)Enrolment in govt. ART centers (from 30% to 60%)

Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-100

100

200

300

400

500

600

700

197 203167

247265 255

438

574

Testing for HIV

Months

Num

ber T

este

d fo

r HIV

Source: Stangl, A. et al. Tackling HIV-related stigma and discrimination in South Asia. 2010. 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 projectsGlobal framework adapted to Indian contextImplementation guidelines developed

Source: ICRW, UNDP, STRIVE. 2013.

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 PrEPUnderstand 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! www.icrw.orghttp://strive.lshtm.ac.uk/www.stigmaactionnetwork.com