20th International AIDS Conference - Melbourne, Australia


THPE292 Poster Exhibition

Tackling stigma and discrimination in health facilities in St. Kitts and Nevis: lessons learned for moving towards stigma-free HIV services

Presented by Gardenia Destang-Richardson (Saint Kitts and Nevis).

G. Destang-Richardson1, A. Hypolite2, R. Mclean3, M. Fitzgerald4, L. Nyblade5

1National AIDS Program, Ministry of Health St. Kitts & Nevis, Basseterre, Saint Kitts and Nevis, 2Health Policy Project, Futures Group, Bridgetown, Barbados, 3University of the West Indies, Health Economics Unit, Port of Spain, Trinidad and Tobago, 4Health Policy Project, Futures Group, Washington, DC, United States, 5Health Policy Project, RTI International, International Division, Washington, DC, United States

Background: Stigma and discrimination (S&D) undermines prevention, care, and treatment and negatively impacts health. In response, the National Advisory Council for HIV/AIDS of St. Kitts and Nevis, with support from the USAID- and PEPFAR-funded Health Policy Project, initiated a comprehensive program, based on the PANCAP Stigma Framework, to reduce health facility-based stigma in order to create an enabling environment resulting in improved health outcomes.
Description: The program included the following steps.
1)Data collection with all health facility staff to inform program design and catalyze action;
2)Participatory data analysis of the survey results with health workers/policymakers that led to recommendations, including workplace training and development of facility-level codes of conduct for healthcare workers to reduce S&D;
3) Capacity strengthening for S&D-reduction programming through training of 24 facilitators in S&D-reduction;
4) Training of all levels of health facility staff by trained facilitators, with 595 staff (89% of total workforce) trained to date;
5) Development of a Code of Conduct through a participatory workshop with key representatives of different departments within health facilities, representing all levels of health facilities within the country.
Participants agreed on expected norms and behaviors related to patient confidentiality, rights and respect, and quality of care. The final output will be to publicly displayed Code of Conduct posters in all departments within all facilities.
Lessons learned: Participatory data analysis and formulation of recommendations creates ownership and is a strong catalyst for action, providing guidance for a tailored response to stigma in health facilities. Building a strong cadre of S&D-reduction trainers allows for rapid expansion of programming to reach all levels of facility staff - including hard-to-reach doctors or administrators-is critical to changing the facility environment. Bottom-up, participatory development of codes of conduct creates ownership among staff for driving behavior change.
Conclusions/Next steps: Working towards stigma-free services, even in resource-constrained settings, is feasible and desired. Collaborative data collection coupled with training for all staff levels and the development of health-facility staff-driven codes of conduct provides an effective approach for promoting stigma-free services. Next steps include institutionalizing S&D-reduction further, through incorporation into on-boarding processes, performance reviews, customer satisfaction surveys, continuing medical education, and further targeted facility-level interventions.

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