20th International AIDS Conference - Melbourne, Australia


TUPE342 - Poster Exhibition

Health facility stigma and discrimination reduction package: changing the norm with participatory planning, assessment, training, and policies to improve HIV services

L. Nyblade1, A. Jain2, D. Carr2, R. Kidd3, S. Clay4, R. Macinnis2

1Health Policy Project, RTI International, Global Health Division, Washington, United States, 2Health Policy Project, Futures Group, Washington, United States, 3Health Policy Project, RTI International, Consultant, Gabarone, Botswana, 43C Regional Consultants, Lusaka, Zambia

Background: Stigma and discrimination (S&D) confronting people living with HIV and key populations violate people''s rights and can adversely affect HIV prevention, care, and treatment. However, standardized approaches for quantifying and responding to health facility S&D have been unavailable. The USAID and PEPFAR funded Health Policy Project led a collaborative global effort to review, prioritize, adapt, and synthesize existing measures and programmatic tools. This effort involved researchers, trainers, other experts, and stakeholders. The resulting stigma-reduction package supports a comprehensive, research-to-action response in health facilities.
Description: The four-step development process is reflected in the final suite of tools:
1) Develop a framework for programmatic action and measurement in health facilities;
2) Review existing measures to develop and field-test (six countries) a questionnaire for measuring S&D among facility staff;
3) Present tailored training modules and menus for different staff, derived from field experience in nine countries in Africa, the Caribbean, and Asia; and
4) Synthesize guidance for participatory development of facility codes of conduct, manager checklists, and action plans.
Lessons learned: A short, standardized questionnaire applied to all facility staff can catalyze action within facilities. Findings provide evidence of the need for action that involves all staff, and direction for participatory decision making on how to tailor a response. Early field experience indicates a need to address fears of workplace HIV transmission, both from contact where HIV cannot be transmitted (e.g., taking temperatures) to more invasive procedures (e.g., blood draws), as well as stigmatizing attitudes. Provision of predefined training options helps to counter information overload. Bottom-up and top-down approaches are key: trained staff developing their own codes of conduct strengthens ownership for behavior change, while facility managers develop policies, procedures, and supplies to support staff in providing stigma-free services.
Conclusions/Next steps: This stigma reduction package synthesizes existing tools into an accessible, streamlined approach for practitioners. The global collaboration that produced the package provides a workable model for standardizing tools across settings and presenting users with “best of” material based on field experiences. Next steps include evaluation in five countries that are implementing the package, and testing ways to integrate the package into routine facility operations.

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