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Video: Reducing HIV-related Stigma in India

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Fri, 03/15/2013

ICRW researchers spoke to participants of a new project that has transformed attitudes and opened minds.

ICRW researchers spoke to participants of a new project that has transformed attitudes and opened minds.

Watch the video here >>

ICRW Releases Blueprint for Reducing HIV-related Stigma in India

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Indian government officials and others gather to discuss strategy to address HIV-related stigma
Fri, 01/18/2013
By Gillian Gaynair

ICRW helped develop a strategy for the Indian government to reduce HIV-related stigma and discrimination nationwide. On Jan. 18, researchers share their findings with government officials, UN organizations and others during an event in New Delhi. 

The International Center for Research on Women (ICRW) on Jan. 18 debuts a much-anticipated blueprint for how to effectively address HIV-related stigma and discrimination in numerous settings – from hospitals to college campuses – in India.

The country’s National AIDS Control Organization (NACO) tapped ICRW and other select organizations three years ago to devise a strategy for reducing HIV-related stigma and discrimination nationwide.

To that end, ICRW researchers used a global blueprint for reducing stigma that they had previously developed and adapted it to be culturally relevant for India. ICRW then tested the framework in five settings throughout India and assessed whether it would be feasible to integrate the framework into NACO’s – and other organizations’ – HIV programs.

India is the first country to pilot ICRW’s universal framework and evaluate whether it could appropriately guide national efforts to reduce stigma.

ICRW will host an event Jan. 18 in New Delhi to present the results of its study and discuss how the Indian government can move forward with the findings. Officials from NACO, the United Nations Development Programme (UNDP), World Health Organization (WHO), UNAIDS and other organizations will participate in the gathering. ICRW President Sarah Degnan Kambou and Ravi Verma, director of ICRW’s Asia Regional Office, as well as Madhumita Das, a senior technical specialist in that office and Anne Stangl, a senior behavioral scientist and HIV stigma expert in ICRW’s Washington office, will lead presentations.

“Our study, with evidence from multiple sectors, is timely and strategic,” Verma said. “With the right kind of advocacy and support from other international agencies like UNDP, UNAIDS and WHO, the framework we have developed can be at the forefront of the Indian government’s efforts to curb HIV.”

Despite a nearly 60 percent drop in HIV prevalence over the past decade, the epidemic persists among India’s most vulnerable populations, such as sex workers and intravenous drug users. ICRW experts say this suggests that more is needed to reduce barriers – like stigma and discrimination – that certain groups face in accessing HIV treatment, care and prevention.

Indeed, tackling stigma is a key component in NACO’s latest phase of programming in response to the epidemic.

For ICRW’s study, researchers worked in partnership with five organizations in three states to carry out a variety of activities aimed at decreasing stigma and discrimination. Specifically, the project took place among university faculty, female sex workers living with HIV, local government members, hospital workers and leadership teams in workplaces. 

ICRW ultimately determined that the global framework for reducing HIV-related stigma could indeed be adapted for India. ICRW found that to do so would require:

  • Addressing a fear of HIV infection and social judgment that is prevalent among many different populations
  • Working with several key groups in the same setting to influence the different factors that drive stigma, such a fear of infection through casual contact
  • Focusing on how HIV-related stigma may also intersect with other types of stigma and discrimination – such as that related to one’s caste or occupation
  • Working with family and peers of populations affected by HIV
  • Using a range of activities to engage a variety of groups – from families to institutions – to help foster an environment that can support lasting change
  • Creating opportunities to meet members of groups who experience stigma – such as transgender people – to help break down discriminatory attitudes

“Our findings will set the stage for a right move forward by the national government as it carries out efforts to address the HIV epidemic,” Verma said. “Our experience in India also demonstrates that the global framework ICRW designed can be adapted by other countries eager to address the underlying factors, like stigma and discrimination, that fuel HIV transmission and impede people’s access to services.”

Watch a video of participant attitudes toward HIV-related stigma here. 

Read the full summary report, “A Global HIV Stigma Reduction Framework Adapted and Implemented in Five Settings in India."

A First Step

Submitted by Priti Prabhughate on Thursday, July 26, 2012
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College faculty take on HIV-related stigma

ICRW's Priti Prabhughate writes about helping to train professors from a Catholic college in India on how to teach students about HIV and the stigma that many people living with the virus face.

For three days earlier this year, a few of my colleagues and I gave a training workshop on how to reduce stigma against people living with HIV. What made the training especially unique was that our audience included priests and nuns.

Blueprint for Reducing HIV-related Stigma in India

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ICRW researchers worked in partnership with five organizations in three states in India to carry out a variety of activities aimed at decreasing HIV-related stigma and discrimination. The project took place among university faculty, female sex workers living with HIV, local government members, hospital workers and leadership teams in workplaces. ICRW spoke with some of the participants about how the project has changed their attitudes.

STRIVE: Addressing the Structural Drivers of HIV

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STRIVE is a research consortium investigating the social norms and inequalities that drive HIV. Despite substantial progress in addressing AIDS, the number of people newly HIV-infected continues to outstrip the number entering treatment. Although the importance of addressing the structural drivers of HIV is increasingly recognised, there is limited evidence on how best to intervene.

A six-year international research consortium, STRIVE research focuses on gender inequality and violence, poor livelihood options, alcohol availability and drinking norms, and stigma and criminalization. The consortium seeks to understand how these forces drive the epidemic; what programmes are effective in tackling them; how such interventions can, affordably, be taken to scale; and how best to translate this research into policy and practice.

Duration: 
2011-2017
Location(s): 
India
Location(s): 
South Africa
Location(s): 
Tanzania

Strategic Framework and Implementation Guidelines for Reducing HIV-related Stigma in India

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Globally, stigma and discrimination impede HIV prevention, testing and treatment efforts. Yet research by ICRW and others shows that stigma and discrimination can be reduced in different contexts, such as the community and health facilities, thus contributing to the success of HIV programs and services.

India’s National AIDS Control Organisation (NACO) recognizes HIV-related stigma as a key challenge to controlling the epidemic. With support from the United Nations Development Program (UNDP) and in collaboration with NACO, ICRW designed and tested a strategic framework and implementation guidelines for stigma reduction in multiple settings in India. The framework built on one previously developed by a global working group made up of stigma experts and led by ICRW. The framework for India identifies key entry points for stigma-focused programming and measurement.  

ICRW also provided technical support to select organizations in applying the framework and guidelines for stigma reduction.  ICRW then collected data on the organizations’ experiences in applying the tools and used the information to finalize the strategic framework and implementation guidelines. The final tools as well as study outcome was widely disseminated to guide policymakers and practitioners in addressing HIV-related stigma and discrimination at the local and national levels.

Overall, ICRW found that the global framework was relevant to the Indian context and feasible for use by organizations and institutions in guiding stigma-reduction program development, implementation and measurement. Learning from the pilot interventions offers guidelines for broader implementation.

Duration: 
November 2011 to March 2013
Location(s): 
India

Commentary: Getting to Zero

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Why Medical Science Alone Won’t Yield an AIDS-free Generation
Wed, 11/30/2011
By Katherine Fritz

On this World AIDS Day, ICRW challenges the global community to ensure solutions to the pandemic encompass both medical and social science. Only then will we achieve zero new infections, zero discrimination and zero AIDS-related deaths.

Imagine this: A pregnant woman is infected with HIV, but she doesn’t know it. She’s unaware she could transmit the virus to her baby. However, if she were to take a pill at the right time during her pregnancy she could drastically reduce the chances of transmission. Sadly she does not, and another generation is born into the world living with HIV.

Tragic, preventable scenarios like these continue to play out again and again across the developing world today. Despite advances in the development and roll-out of antiretroviral drug regimens, 400,000 children were born with HIV in 2010, according to the latest report from UNAIDS.

The reasons why are varied and complex. The short answer is that medical approaches, such as drugs to prevent mother to child transmission, will inevitably run up against the obstacles of people and societies – their behaviors, motivations, and cultural and social norms.  This can play out in a variety of ways: A woman decides against testing for fear of the stigma and discrimination that could come with a positive diagnosis. An HIV-positive mother cannot make it to the clinic for her treatment because it’s far from her home and the cost of transportation is too high or because she can’t afford to give up a day’s work in the fields.

Poverty, gender inequality, stigma and discrimination – these are invisible factors that increase an individual’s vulnerability to HIV infection, seriously undermining global prevention and treatment efforts. Thirty years into the epidemic, we still have more questions than answers when it comes to untangling how human behavior and social forces influence HIV vulnerability and developing interventions that work to mitigate them.  

There are those who believe the underlying causes of HIV vulnerability are too complicated to be addressed by donor-funded global health programs. It’s much easier to count the number of people on treatment than it is to understand why a pregnant woman would turn down a chance to give her child a healthy start in life.  Yet, complementary social science research is critical to fulfill the promise of medical breakthroughs like male circumcision, female microbicides and ultimately, perhaps, a vaccine. We must address social change in tandem with medical innovations to achieve zero new infections, zero discrimination and zero AIDS-related deaths.     

It’s a challenging approach. It will require more collaboration across many scientific disciplines. It will mean financial investments that encourage large, innovative studies. Take stigma and discrimination as an example. AIDS workers and researchers have long identified it as an entrenched barrier to prevention, treatment and care. Thanks to a decade of research and program work, we know what causes stigma. We know its consequences. And we have strategies that can effectively reduce it. Implementing a large-scale randomized study of a stigma-reduction intervention would yield much needed evidence on how such programs could be replicated. It has yet to be done.

To be fair, some trailblazing donors are focused on understanding the social drivers of HIV infection. The U.K.’s Department for International Development (DFID) is funding a multidisciplinary consortium of research institutions, led by the London School of Hygiene and Tropical Medicine and including ICRW, to investigate how to ameliorate the social factors that compromise HIV prevention and treatment.  ICRW recently completed a three-year project, funded by the Bill & Melinda Gates Foundation, to identify how gender issues that put women at risk of infection can be addressed in national HIV plans. But we need much more.

The world has made tremendous progress in the fight against AIDS, so much so that an end to the pandemic is in sight. In a recent speech, Secretary of State Hillary Clinton urged the global community toward achieving an AIDS-free generation and recommended that science guide our efforts.

“Success depends on deploying our tools based on the best available evidence,” she said. We could not agree more. But to get there, the evidence base must include all the scientific solutions – both medical and social.

Katherine Fritz is ICRW's director of global health.

Understanding and Challenging Stigma Toward Injecting Drug Users and HIV in Vietnam

Understanding and Challenging Stigma Toward Injecting Drug Users and HIV in Vietnam
Toolkit for Action

Dr. Khuat Thu Hong, Nguyen Thi Van Anh, Khuat Thi Hai Oanh, Ross Kidd, Laura Brady, Laura Nyblade, Anne Stangl
2011

Vietnam has a growing problem of illegal drug use and addiction, which has a serious impact on the health and well-being of individuals, families, and communities. This problem is closely linked to HIV transmission, and fear of and stigma toward drug users is further fueling the HIV epidemic. Since 2000 the Vietnamese government and civil society have increased their efforts to address stigma and discrimination toward IDUs, as well as the vulnerability of IDUs to HIV. However, in reality, the stigma against IDUs persists and is still widely prevalent in many places, creating barrier for HIV/AIDS prevention program.

(3.85 MB)

We encourage the use and dissemination of our publications for non-commercial, educational purposes. Portions may be reproduced with acknowledgment to the International Center for Research on Women (ICRW). For questions, please contact publications@icrw.org; or (202) 797-0007.

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Alliance Launches HIV-related Stigma and Discrimination Website

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Stigma Action Network Debuts New Website
Tue, 05/10/2011
By Gillian Gaynair

New website will serve as a space for experts to network and a clearinghouse of information on HIV-related stigma and discrimination.

New website will serve as a space for experts to network and a clearinghouse of information on HIV-related stigma and discrimination.

Stigma Action Network
Visit www.stigmaactionnetwork.org.

A new website that launched May 11 will serve as a clearinghouse of information for a global alliance of practitioners, researchers, advocates, people living with HIV and donors who work in the area of HIV-related stigma and discrimination. The site also will provide networking opportunities through a discussion forum and blog.

This alliance, called the Stigma Action Network (SAN), was launched at the 2010 International AIDS Conference in Vienna. A coordinating body, SAN aims to develop and expand programs, research and advocacy strategies for reducing HIV-related stigma and discrimination worldwide. The network’s website provides a “one-stop shop” for HIV-related stigma and discrimination experts who want to learn about research findings, advocacy efforts, technical resources and new initiatives to reduce stigma.

Stigma and discrimination continue to undermine prevention, treatment and care for people living with HIV. Being stigmatized also increases people’s vulnerability to violence, gender inequity and poverty as well as threatens their access to much needed health care. Experts say that having a central location such as the SAN website to obtain information related to stigma and discrimination is critical to advancing the field and coordinating efforts.

A steering committee provides overall direction to SAN, and is comprised of the following organizations: Colectivo Sol, EngenderHealth, Futures Group, International HIV/AIDS Alliance Africa Regional Programme and The Communication Hub. The International Center for Research on Women (ICRW) serves as the network’s technical secretariat, and will manage SAN’s daily functions for the next three years.

SAN is currently supported by the M.A.C. AIDS Fund.

Gillian Gaynair is ICRW’s writer/editor.

Suspending Judgment

Suspending Judgment
A Report of the Training Workshop on Stigma Reduction for Health Care Workers

International Center for Research on Women
2011

HIV-related stigma in health care settings continues to pose challenges as a major barrier to prevention, testing, treatment and care. In January 2011, the International Center for Research on Women (ICRW) and India’s National AIDS Coordinating Organization (NACO) organized a workshop for health care workers on reducing HIV-related stigma. This workshop brought together both public and private sector health care providers to develop common strategies for stigma reduction. Training approaches and materials on stigma and universal precautions were tested among health care workers.

This report documents the proceedings of the workshop and brings to light health workers’ own fears and concerns around HIV/AIDS, causes and drivers of stigma, effects of stigma on the HIV epidemic, and strategies for prevention. The workshop made use of a wide variety of participatory learning tools, including pictures, case studies, participants’ own stories, role plays, individual quizzes, rotational brainstorming, and individual reflection as a focus for discussion.

(1.9 MB)

We encourage the use and dissemination of our publications for non-commercial, educational purposes. Portions may be reproduced with acknowledgment to the International Center for Research on Women (ICRW). For questions, please contact publications@icrw.org; or (202) 797-0007.

Terms and Conditions »

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