Stigma and discrimination reduction programmes work to reduce stigma and discrimination towards people living with or affected by HIV, TB and malaria, and other key populations. They are an equally vital part of reducing human rights and gender-related barriers and creating strengthened frameworks, and are based on an understanding that law and policy review alone cannot reduce human rights violations, harmful gender norms and gender-based violence.
Stigma and discrimination reduction programmes may include:
People living with HIV and other key populations in El Salvador report stigma, discrimination and even violence in accessing basic health services, education and employment. The police and healthcare workers are said to be particular offenders. Discrimination is linked to high levels of violence against lesbian, gay, bisexual, transgender and intersex communities. Atlacatl (an organization of people living with HIV representing HIV and human rights issues for key populations in El Salvador) took various actions to reduce HIV-related stigma and discrimination. They held workshops with partner organizations representing sex workers, transgender women, women living with HIV, gay men and men who have sex with men to identify the nature and extent of stigma and discrimination; to discover which service providers discriminated; and to find out what key populations wanted to do about it. They ran stigma and discrimination workshops with key populations, service providers, law enforcers and the broader community, to reduce stigma and discrimination in service delivery, and to build the capacity of key populations to participate in decision-making and advocate for change.
The project worked to improve relationships between key populations and service providers and to improve services. It also supported organizations to gain the experience, visibility and confidence to participate in policymaking bodies and advocate for the rights of key populations.AIDS Alliance & ARASA HIV and Human Rights Good Practice Guide
AUA, the ARV Users Association, is one of a few community-based HIV organizations in Cambodia whose staff work directly alongside health-care providers. While the organization provides a range of services, such as counselling on treatment adherence and HIV prevention, it places a particular focus on preventing stigma and discrimination in the hospitals in which it works.
Eighty-five per cent of AUA’s 40 staff members are people living with HIV and so they know first-hand how discrimination can lead to social isolation and negatively affect a person’s health and well-being. The group facilitates connections between clients and health-care providers and holds regular meetings with hospital staff to provide feedback.
In 2015, AUA was trained by Asia Catalyst to document human rights violations in health-care settings. The cooperation was part of a study that Asia Catalyst conducted in four countries in Asia, which found discrimination evident in many areas, from denial of services and segregation to arbitrary additional fees for health services. When AUA receives a discrimination case, it acts as a mediator, trying to find a solution that is acceptable to both health-care workers and clients.
AUA also holds counselling sessions with clients that aim to give them accurate information, as well as empower them to advocate for their rights and negotiate with health-care providers.
In Nigeria – as in many countries - religious and cultural values that associate HIV infection with poor moral behaviour are believed to contribute to the high levels of discrimination and stigmatising public perceptions of people living with HIV.
In 2016, NINERELA+, an association of religious leaders living with HIV in Nigeria, brought religious leaders and religious scholars from different faiths together, to talk about how they could support initiatives to reduce HIV-related stigma and discrimination. Together, they developed an innovative way to incorporate legal and religious norms and principles into messages of acceptance and support for people living with HIV.
The group took Nigeria’s 2014 HIV anti-discrimination law and developed a simplified version of the Act, integrating teachings from various religious texts to support the legal protections of equality and non-discrimination afforded to all people. More than 10 000 posters and pamphlets of the simplified law were distributed across the country.
NINERELA+ also trained 150 religious leaders as HIV stigma mitigation champions. These leaders enlightened their worshippers on the mutually supportive legal and religious principles that promoted acceptance of and protected people living with HIV, and encouraged tolerance towards all those affected.
The combined legal and religious document has been hailed as an important tool in reducing stigma and discrimination. Though the long-term impact is yet to be documented there are many examples of how the initiative has led to reduced stigma and greater acceptance of people living with HIV. For example, some churches have renounced their policy of requiring compulsory HIV testing as a prerequisite for a church wedding.
A religious leader who was involved in the process says that, “This simplified version of the law is more appealing to the conscience, as it calls for collective responsibility and projects the failures to adhere to the laws as violating divine injunction. In a society as religious as Nigeria, the approach is far more effective”.