Stigma and discrimination against people living with HIV (PLHIV) and other priority populations must be addressed as part of a combination HIV prevention approach.
We sensitize healthcare providers to care for priority populations with respect and offer them services that best fit their needs. We also work with policymakers to eliminate stigma and discrimination through local and national laws and policies.
Many of our clients experience stigma and discrimination because of their age, race, sexual identity, gender identity, form of employment, and/or drug and alcohol use. People who are stigmatized or discriminated against are less likely to seek healthcare and/or legal services, putting them at higher risk of HIV infection and violence. This is especially true in countries where laws specifically target and criminalize activities of certain populations, such as sex workers, men who have sex with men, and people who inject drugs.
People living with HIV are also often targets of stigma and discrimination, hindering their ability to adhere to treatment, seek employment, care for their families, and participate in the community.
To address stigma and discrimination among the populations we serve, PSI works with a wide variety of audiences, including people who experience stigma, as well as key influencers whose own discriminatory attitudes can create an environment that places individuals at higher risk of HIV infection. Some approaches we use to address stigma and discrimination include:
- Sensitizing police and law enforcement about the importance of HIV prevention for key populations, and how restrictive laws and/or police abuse can create barriers to accessing HIV care and prevention products.
- Training health care providers to offer services for stigmatized populations that are free of judgment and discrimination.
- Working directly with populations that face high levels of societal stigma, such as men who have sex with men, to decrease self-stigma that results in high-risk behavior.
- Mobilizing communities to reduce discrimination against people living with HIV and normalize HIV prevention behaviors such as condom use and HIV testing.
We also participate in the development of National HIV Strategic Plans in the countries where we work. As part of this development, we actively promote the adoption of targets for zero HIV-related stigma and discrimination.
Making a Difference
The Pan-American Social Marketing Organization (PASMO), our affiliate in Central America, contributes to the Generación Cero movement to reduce stigma and discrimination towards key populations at risk for HIV infection and people living with HIV: Read about it here.
- “Stigma And Discrimination-Free Zones”: An Innovative Approach to Engaging the Private and Public Sectors in Creating More Inclusive Environments for Key Populations in Central America (TUPED509)
Central America's HIV epidemic is concentrated in key populations (KPs). Despite existing HIV laws and policies that respond to KP's specific needs, there is evidence of widespread discriminatory attitudes and practices towards these populations, and stigma and discrimination continue to be important barriers to accessing HIV services and care. In 2016, under the USAID Combination Prevention Program for HIV in Central America, PASMO designed an intervention entitled “stigma and discrimination-free zones” as part of a broader initiative known as Generation Zero, contributing to the goal of “getting to zero discrimination.”
- Community HIV Care and Treatment for Female Sex Workers in Ethiopia: Successful Service Provision Through Drop-In Centers (THPEE774)
Female sex workers (FSWs) in Ethiopia are disproportionately affected by HIV, with a prevalence of 23%. To improve uptake of ART among FSWs living with HIV, the USAID-funded MULU/MARPs project began offering ART in 25 FSW-friendly drop-in-centers (DICs) in October, 2016. DICs are safe hubs for FSW located in hot-spots, and providing integrated behavioural and clinical services including peer support in a “one-stop-shop” format.
- HIV Care is Fine, But What if I Get the Flu? (THPED546)
In Guatemala, a concentrated epidemic within a highly stigmatizing social context creates an environment fraught with challenges for reaching, testing, and linking vulnerable men who have sex with men (MSM) and transgender women (TW) with HIV testing and care. PASMO commissioned an ethnographic study in 2016-2017 to understand the sexuality, identity construction, health care seeking behaviors, and MSM/TW-health provider relationships to design consumer-focused strategies to facilitate access to HIV services.
- Sexual Practices of Men Who Have Sex with Men (MSM) in Madagascar (WEPED432)
MSM are a vulnerable population with a high prevalence of HIV (14.8%) and low HIV testing coverage (16.5%) in Madagascar. This study aims to examine barriers and motivation to HIV prevention, specifically on HIV testing, and condom and lubricant use among MSM in order to refine behavior change communication and programmatic strategies.
- “If you don’t have the courage to go get a test, you won’t have the courage to go for treatment”: Consumer Perspectives on the Introduction of HIVST in Central America (WEPEC187)
The introduction HIV self-testing (HIVST) could overcome stigma-related barriers to HIV testing among Central America''s vulnerable populations, including men who have sex with men (MSM), female sex workers (FSW) and transgender women (TW). The Pan American Social Marketing Organization, through the USAID Combination Prevention Program in Central America, explored knowledge and acceptability of HIVST among vulnerable populations in four studies.
- Quadrupling HIV Case Finding: Social Media Improves HIV Testing and HIV Case Finding Among Key Populations in Myanmar (WEPEC169)
At PSI's TOP clinics serving key populations, there was consistently high HIV yield among peers using social media. Myanmar experienced a digital technology leapfrog. In January 2017, PSI invested in a dedicated social media team at TOP to responded to private messages (on Facebook, Line, Bee-talk, GRINDR and Viber), fielded hotline calls and offered online referral vouchers, which allowed us to track each conversation from online messaging to arrival at the clinic.
- Mapping Population Sizes and Hotspot Locations for Female Sex Workers Improved Targeting for HIV Prevention Interventions in Ethiopia (TUPEE702)
HIV prevalence among female sex workers (FSWs) in Ethiopia is approximately 23%. To address risk of HIV in this population, the MULU/MARPs combination HIV prevention project was launched in 2012 across 168 Ethiopian towns/cities. Implementation was challenged by insufficient data on FSW locations and sizes. A rapid size estimation approach was developed to aid program implementation.