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AIDS 2010 Combination HIV Prevention Evaluation 22 July 2010 Laurel Sprague, GNP+

AIDS 2010 Combination HIV Prevention Evaluation 22 July 2010 Laurel Sprague, GNP+ Wayne State University. PLHIV Doing It For Themselves Lessons from the PLHIV Stigma Index. 22 July 2010 Combination HIV Prevention Evaluation. 2. PLHIV Stigma Index. Joint initiative of:

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AIDS 2010 Combination HIV Prevention Evaluation 22 July 2010 Laurel Sprague, GNP+

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  1. AIDS 2010 Combination HIV Prevention Evaluation 22 July 2010 Laurel Sprague, GNP+ Wayne State University

  2. PLHIV Doing It For Themselves Lessons from the PLHIV Stigma Index 22 July 2010 Combination HIV Prevention Evaluation 2

  3. PLHIV Stigma Index Joint initiative of: International Community of Women Living with HIV (ICW) International Planned Parenthood Federation (IPPF) Joint Programme on HIV/AIDS (UNAIDS) Global Network of People Living with HIV (GNP+) Measures PLHIV experiences with stigma, discrimination, and human rights violations Participative research based in GIPA principle and human rights 22 July 2010 Combination HIV Prevention Evaluation 3

  4. HIV-Related Stigma Stigma = Social devaluing Devaluing occurs when one: Tests positive Accesses prevention, testing, or treatment Discloses one's positive status Becomes visibly ill Associates with vulnerable communities Incentives not to know or tell 22 July 2010 Combination HIV Prevention Evaluation 4

  5. What's Stigma Got To Do With It? 22 July 2010 Combination HIV Prevention Evaluation 5

  6. Measurement Challenges Identifying newly emerging and locally specific concerns Interpreting results from general population studies Reaching “hard to reach” populations Drawing linkages between individual, social and structural level interventions and effects 22 July 2010 Combination HIV Prevention Evaluation 6

  7. Country and Sample Size Asia Pacific Bangladesh (238) China (2096) Myanmar (324) Philippines (80) Europe UK (867) Africa Kenya (1086) Rwanda (1530) Zambia (854) Latin America Dominican Republic (1000) Paraguay (256) 22 July 2010 Combination HIV Prevention Evaluation 7

  8. Identifying Newly Emerging and Locally Specific Concerns 22 July 2010 Combination HIV Prevention Evaluation

  9. Testing Barriers in Zambia 22 July 2010 Combination HIV Prevention Evaluation

  10. Interpreting Results from General Population Studies 22 July 2010 Combination HIV Prevention Evaluation

  11. Family Exclusion in China Excluded from family life/activities: 5% of sample Response to HIV infection was supportive or very supportive 69% of spouses/partners 62% of other adult family members 80% of children Percent who disclosed to close family members Fewer than 2 out of 3 (50-61%) 22 July 2010 Combination HIV Prevention Evaluation

  12. Discrimination by Health Care Workers Denied health services in the last 12 months because of HIV status: Philippines – 8% China – 12% Paraguay – 17% UK – 17% 22 July 2010 Combination HIV Prevention Evaluation 12

  13. Reaching “Hard to Reach” Populations 22 July 2010 Combination HIV Prevention Evaluation

  14. Key Populations in Myanmar Sample 22 July 2010 Combination HIV Prevention Evaluation

  15. Drawing Linkages Between Individual, Social, and Structural Level Interventions and Effects 22 July 2010 Combination HIV Prevention Evaluation

  16. Voluntary Counseling and Testing Tested under coercion or without consent: Philippines – 44% Paraguay – 24% Received no pre- or post-test counseling: China – 35% Myanmar – 16% Philippines – 31% UK – 32% Dominican Republic – 27% 22 July 2010 Combination HIV Prevention Evaluation 16

  17. Human Rights Violations in the Philippines 23% experienced at least 1 human right abuse in the last 12 months 17% of them tried to get legal redress for this violation Main reasons for not attempting redress: Intimidated or scared Insufficient financial resources No or little confidence of success 22 July 2010 Combination HIV Prevention Evaluation 17

  18. Effecting Change in Kenya 22 July 2010 Combination HIV Prevention Evaluation 18

  19. Concluding Thoughts Stigma creates a significant barrier to prevention efforts and must be taken into account in prevention programs. The PLHIV Stigma Index can help to handle measurement challenges with stigma and prevention evaluation – Identifying new and local concerns Translating general surveys into useful information Reaching, hearing, and protecting “hard to reach” populations Linking individual, social, and structural effects – Particularly in combination with other evaluation tools 22 July 2010 Combination HIV Prevention Evaluation 19

  20. Concluding Questions What opportunities exist for collaboration with other research tools? How can we build in funding and time for capacity- building and technical assistance for both PLHIV networks and academic researchers to support collaboration? 22 July 2010 Combination HIV Prevention Evaluation 20

  21. This research has been made possible by the people living with HIV who participated, in Bangladesh, China, the Dominican Republic,Kenya, Myanmar, Paraguay, the Philippines, Rwanda, the UK, and Zambia For more information please contact lsprague@wayne.edu jhows@gnpplus.net Or visit www.gnpplus.net 21

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