Stigma-Reduction S cale U p: It Can Be Done Building on Practice-Based Evidence

1. Stigma-Reduction Scale Up: It Can Be DoneBuilding on Practice-Based Evidence Laura Nyblade, PhD July 22, 2012

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

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

5. Create Alliances and Form New Partnerships for Influence and Expanded Reach • Break down the ‘us’ vs ‘them’: Foster interaction between groups experiencing stigma & those perpetrating it. • Model desirable behavior • Hold up & reward role models Engage a range of groups • Opinion Leaders • Policymakers • Service Providers • Religious Leaders • Youth • Media • General Community • Family

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

7. Stigma & Discrimination-Reduction in Health ServicesSome Examples

8. 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. 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 • SwathiMahilaSangha & partners, Bangalore, India • Capacity Strengthening • Designed advocacy campaigns • Rose Campaign • Opened space for dialogue • Medical Student Rotation

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

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

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

13. 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 Coverage Stigma reduction intervention • Provision of health care • Palliative care • Family support • Community support • Testing • PMTCT • Disclosure • Risk Behaviors • Timely uptake • Adherence Prevention Treatment Care & Support

14. We Know Enough to ACTWhat will you do? You are part of the solution