dr. madhumita das icrw
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Community and Structural-level Interventions to Reduce HIV-related Stigma: The Missing Components for Effective Biomedical Prevention. Dr. Madhumita Das ICRW . Engaging key populations is critical to the effectiveness of biomedical prevention. - PowerPoint PPT PresentationTRANSCRIPT
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
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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