Stigma and discrimination reduction programmes
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Stigma and discrimination reduction programmes reduce inequality and protect and promote access to health care services for vulnerable and key populations.
Stigma, discrimination, gender inequality and violence isolate and marginalize vulnerable and key populations from their families, communities and from services, often preventing people from accessing the necessary prevention, treatment, care and support they need to protect and promote their health. In this way, stigma and discrimination drive HIV, TB, malaria and poor health.
Stigma and discrimination reduction programmes work to reduce inequalities that affect vulnerable and key populations, to promote universal health coverage. These programmes are an important way to address critical enablers to enhance access to health. They are based on an understanding that law and policy review alone cannot reduce human rights violations, harmful gender norms and gender-based violence and that action is required to reduce inequalities and social exclusion that drive HIV and poor health.
Stigma and discrimination reduction programmes may include:
- education campaigns and use of media to promote non-stigmatizing messages towards vulnerable and key populations
- engagement with and sensitization of political, religious and community leaders
- inclusion of non-discrimination and education campaigns in workplaces, schools or other settings
- measuring stigma and discrimination against vulnerable and key populations, particularly in the context of access to health care
- peer mobilization, advocacy, education and support
Ipsos carried out surveys in 27 countries to assess global attitudes towards transgender people. They collected answers to questions such as whether transgender people should be protected from discrimination, allowed to serve in the military and adopt children. The findings show that transgender people still face many challenges in societies around the world, although there are positive signs of increased acceptance in a number of countries. The survey results provide useful information for developing stigma and discrimination reduction programmes to overcome stigmatizing attitudes towards transgender people and to protect and promote their rights, including health rights.
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 stigmatizing 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 describing the 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”.
Lesbian, gay, bisexual, transgender and intersex people in El Salvador report stigma, discrimination and even violence in accessing basic health services, education and employment. The police and health-care workers are said to be particular offenders. Discrimination is linked to high levels of violence against lesbian, gay, bisexual, transgender and intersex communities more generally.
Atlacatl (an organization of people living with HIV representing HIV and human rights issues for key populations in El Salvador) has taken 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 access to non-discriminatory 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.