Reducing HIV Stigma and Discrimination: A Critical Part of National AIDS Programmes

This 56-page document, published in 2007 by the Joint United Nations Programme on HIV/AIDS (UNAIDS), discusses how the United Nations (UN) system, funding mechanisms, and bilateral partners can support countries - through advocacy, strategic planning, technical assistance, resource mobilisation, and other means - to reduce stigma and discrimination related to HIV. Answers to the question "How can national AIDS authorities, UNAIDS, UN Joint Teams on AIDS and other partners help reduce stigma and discrimination?" include the following:

• "Build an understanding of and commitment to stigma and discrimination reduction by using existing tools for measuring stigma and discrimination to “know your epidemic” in terms of the prevalence of stigma and discrimination and their impact on the response to HIV.
• Provide leadership on the necessity of reducing stigma and discrimination in national AIDS responses. Inspire leadership, understanding, and high-level commitment regarding the need to seriously expand efforts to address stigma and discrimination in national AIDS programmes.
• Facilitate the inclusion of stigma/discrimination reduction in national HIV strategic planning, funding and programming activities. Ensure that planning, funding and programming efforts include attention to stigma and discrimination and support the implementation of promising programmes to address stigma and discrimination.
• Use or promote approaches that address the root causes of stigma and discrimination. Implement programmes that tackle the actionable causes of stigmas, i.e. lack of awareness of stigma and discrimination and their negative consequences; fear of acquiring HIV through casual contact; and linking HIV with behaviour that is considered immoral or improper.
• Advocate for a multifaceted national approach to stigma and discrimination. A national response which employs a range of approaches will have the greatest impact, e.g. “know your rights” campaigns; social change communication; social mobilization; participatory education; interaction between people living with HIV and key audiences; celebrity champions and media campaigns; legal support to those affected by stigma and discrimination.
• Facilitate the scale-up of effective programmes. National AIDS programmes – working with partners - can identify promising approaches to stigma and discrimination that can be taken to scale to achieve sufficient impact across the country.
• Promote and facilitate programme evaluation and operational research. Measurement helps evaluate effectiveness and the identification of programmes to scale up and can be built into programmes during design and implementation."

Sections of the document are the following:

Section 1: Why stigma and discrimination are major "road blocks" to universal access to HIV prevention, treatment, care, and support
Section 2: How national AIDS programmes can reduce stigma and discrimination
Section 3: Steps toward effective responses to HIV stigma and discrimination
Conclusion

Annex A. describes programmes that work on reducing HIV stigma and discrimination. Among legal, advocacy, and communication strategies, some examples include:

1. Involvement of People Living with HIV and Their Families in HIV-Prevention Activities, Belarus - "Provided people living with HIV with psychological support and legal advice to tackle internalised stigma (feelings of worthlessness, shame, and depression associated with an HIV diagnosis) and engage in advocacy; and implemented rights-based campaign with the media and government to raise awareness on HIV stigma."
2. China-United Kingdom (UK) HIV and AIDS Prevention and Care Project, China (Sichuan and Yunnan Provinces) - "Used study tours, pilot projects and advocacy to challenge political objections to harm reduction programmes (e.g. drug substitution, needle exchange) and to reduce punitive responses to drug use, men who have sex with men and sex work."
3. Stigma and Violence Reduction Intervention, India - "Utilizing participatory research methods, or 'community-led action research,' key populations and the community at large worked together to research, design and implement a stigma reduction program, which sought to increase condom use between intimate partners, decrease stigmatisation toward people living with HIV, and decrease tolerance of intimate partner violence."
4. Soul City, South Africa - "Engaged journalists and other communication professionals to steer away from sensationalized, fear-inducing coverage that perpetuated negative stereotypes and produce more accurate, positive portrayals of people living with HIV."
5. Catholic AIDS Action, Namibia - "Engaged traditional and faith-based leaders to reconsider and reform customs and attitudes that fostered stigmatising attitudes and behaviours [including training sessions in stigma reduction]; trained community leaders on community mobilisation, home-based care and HIV counselling; and conducted peer-education training programmes for behavioural change."
6. Champions for Change, Caribbean - "Engaged celebrities, political leaders, sports stars and other influential people in advancing and modelling non-stigmatising attitudes and behaviours; engaged traditional and faith-based leaders to reconsider and reform customs and attitudes that foster stigmatising attitudes and behaviours; promoted indirect and direct interaction between people living with HIV and key audiences to dispel myths about people affected by HIV; and addressed homophobia, sexual violence, attitudes about drug users, and other underlying factors contributing to stigma and discrimination."

Annex B. of the document includes an assessment checklist called "Items that can be used to assess stigma at the community-level", as well as monitoring and evaluation information.

The document's Annex C. has a section describing the contents of Understanding and Challenging HIV Stigma: Toolkit for Action, as well as other toolkits and manuals. 

In its annex of keypoints for advocacy, the document concludes that there are a number of proven strategies by which to address stigma and discrimination.
These include the following:

• "Empower people living with HIV and other vulnerable groups to know and assert their rights.
• Enlist public figures, including religious leaders, to advocate against stigma and discrimination.
• Promote laws and legal support to protect the rights of people living with HIV and other vulnerable groups."