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BackgroundWhyDefinitions
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1. Principals, Approaches and Tools for Stigma-Reduction in Health FacilitiesLaura Nyblade, PhDSenior Technical Advisor, Stigma & DiscriminationHealth Policy Project and RTI
2. Background
Why
Definitions & Conceptualization
Forms & consequences
Overview of general stigma-reduction program strategies
Examples of how they have been applied in health care settings
Tools & Resources
Presentation “Guide”
3. “…. If we do not appreciate the natureand impact of stigma, none of our interventions can begin to be successful.”– Edward Cameron, Constitutional Court Justice in South Africa
4. Powerful social process that:
Turns “difference” into inequity & disadvantage
Maintains/upholds inequitable structures
Leads to social & economic exclusion
Fuels and can be used to justify violations of human rights, discriminatory policies & laws
Intensifies & sustains vulnerability
Impedes access to health & other services
Why? Prevention
Testing
Disclosure
Safe Sex (e.g. condom negotiation)
PMTCT
26% to 53% of vertical transmissions due to stigma
Risk Recognition
Treatment
Access
Uptake & Adherence
Delivery/Quality of Care
Human capacity/staff
Prevention
Testing
Disclosure
Safe Sex (e.g. condom negotiation)
PMTCT
26% to 53% of vertical transmissions due to stigma
Risk Recognition
Treatment
Access
Uptake & Adherence
Delivery/Quality of Care
Human capacity/staff
5. Stigma impedes programmatic efforts Prevention
Testing
Disclosure
Risk Recognition
Treatment
Treatment
Access
Timely uptake
Adherence
Delivery/Quality of Care
Human Capital
Health care providers receiving care
Secondary S&D
6. Forms-Impact on People’s Lives Physical and social isolation
Loss of relationships
Gossip & Verbal Abuse
Loss of livelihood
Loss of housing
Rejection by peers
Loss of reputation
Violence
Denial or sub-standard health care
Internalized stigma
7. Forms-Health ProvidersStigma Indicators Working Group, Tanzania, 2005 Neglect Had to wait longer Not having bed pans changed Receiving less care/attention Denied care Denied treatment Referral to another provider/facility Senior provider pushed client to a junior provider Junior provider pushed client to a senior provider Differential treatment HIV test required before care was given HIV test required before scheduling surgery Using gloves for non-invasive exams Extra precautions in sterilizing instruments Lack of consent HIV testing without consent Disclosing HIV status to family without client’s consent