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Dr. Madhumita Das ICRW

Community and Structural-level Interventions to Reduce HIV-related Stigma: The Missing Components for Effective Biomedical Prevention. Dr. Madhumita Das ICRW . Engaging key populations is critical to the effectiveness of biomedical prevention.

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Dr. Madhumita Das ICRW

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  1. Community and Structural-level Interventions to Reduce HIV-related Stigma: The Missing Components for Effective Biomedical Prevention Dr. Madhumita Das ICRW

  2. Engaging key populations is critical to the effectiveness of biomedical prevention Engaging key populations in HIV prevention efforts is a critical challenge

  3. Stigma must be addressed at: • Multiple levels • Multiple target pops • Most interventions: • Attempt to shift individual attitudes • e.g. students, teachers, health care workers • Few seek community or societal-level norm shifts Source: Stangl, A., K. Fritz; L. Brady. Technical Brief: Measuring HIV stigma and discrimination. 2012. STRIVE

  4. Two examples of community-level stigma-reduction interventions in India

  5. PANCHAYAT-LED HIV RELATED STIGMA REDUCTION PROGRAM A Unique Model Developed in Nandi, Karnataka Nandi Grama Panchayat

  6. Program Highlights Action against stigma and discrimination part of Panchayat Agenda Panchayat members and community leaders = ‘Stigma Busters’ Messages against stigma through games Created platforms for discussions between key populations, PLHIV and Panchayat Misperceptions of PLHIV reduced from 64% to 19% Awareness of HIV increased from 30% to 94% DAPCU and District Administration to replicate model

  7. Key Lessons Source: Stigma Busters: Empowering and Enabling Local Governance to Work towards Stigma-free Gram Panchyat. Swasti Health Resource Centre and ICRW, 2013. • Importance of PRIs in stigma reduction efforts: • Panchayat members have great influence in the community and can be excellent role models • Pride, visibility and real role can be key drivers for leaders to commit to stigma reduction program. • Stigma activities can be mainstreamed within the regular GP activities (Grama Sabha, VHSC, Primary Health Center) • Lessons for working with PRIs: • Implementing organizations should be neutral; should not intervene in PRI internal affairs. • Take all stakeholders into consideration with patience and positive approach

  8. Sex worker-led advocacy campaign in Bangalore • Led by 3 networks of sex workers covering entirety of Bangalore • Empowered WSW to challenge S&D via targeted advocacy • General population • Key stakeholders (e.g. police and HCWs) • 221 events aimed to sensitize about issues faced by WSW and PLHIV

  9. Sex worker led advocacy campaign in Bangalore led to increases in: • HIV testing among network members • Number of HIV+ FSW seeking HIV services (from 497-794) • Enrolment in govt. ART centers (from 30% to 60%) Source: Stangl, A. et al. Tackling HIV-related stigma and discrimination in South Asia. 2010. The World Bank.

  10. An example of a structural–level intervention in India

  11. Indian government to integrate stigma-reduction framework into NACP-IV • UNDP supported 5 pilot projects • Global framework adapted to Indian context • Implementation guidelines developed Source: ICRW, UNDP, STRIVE. 2013.

  12. Rigorous research needed to… • Assess the efficacy and effectiveness of community-level stigma reduction interventions • Particularly in the context of biomedical prevention approaches such as UTT, MMC, and PrEP • Understand the influence of national-level policies to reduce stigma and discrimination • How best to implement? • How best to scale-up multi-level stigma-reduction interventions?

  13. Thank you! www.icrw.org http://strive.lshtm.ac.uk/ www.stigmaactionnetwork.com

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