Stigma and discrimination, barriers to HIV prevention

ON THE occasion of World AIDS Day (WAD) 2016, whose theme is ‘Keep the Promise, Hands Up for HIV Prevention’, the National Family Planning BoardSexual Health Agency (NFPB-SHA) pauses to reflect on our own promise. With the integration of enabling environment and human rights as well as HIV prevention into the family and population planning programme of the NFPB-SHA, our work has revealed that stigma and discrimination continue to pose a real deterrent to the mitigation of the epidemic.

We know that the right to health is a fundamental human right. The promotion and protection of human rights, inclusive of sexual and reproductive health (SRH) rights, are integral to the creation of a supportive environment, regardless of HIV status, sexual orientation and gender identity, as well as disability, for all Jamaicans to access SRH information, goods and services in a discrimination-free environment.

Yet the NFPB-SHA is cognisant of the fact that stigma and discrimination towards PLHIV and their families, MSM and SW continue to adversely affect testing, uptake of HIV services, adherence to ART and access to supportive services. Stigma and discrimination associated with HIV and AIDS occur most frequently in the community and also within the health sector. As a consequence, reduction of stigma and discrimination continues to be important to HIV and AIDS prevention activities. Stigma and discrimination interventions targeting individuals, communities, institutions and seeking to establish an enabling policy and legal framework that addresses stigma effectively are being pursued. The interventions of the NFPB-SHA address key drivers of HIV related stigma including lack of knowledge, fear, cultural norms and practices and increase accountability to and enforcement of human rights standards.

BARRIERS OF VULNERABILITY

The NFPB-SHA’s enabling environment and human rights national response focuses on implementing strategies that seek to advocate for the alleviation of the barriers that increase vulnerability to HIV, other STIs, gender-based violence and unplanned pregnancies. These barriers include poverty, cultural and gender norms, as well as policy and legislative issues. Some of the fundamental rights to be upheld include:

The rights of women and men to a satisfying and safe sexual life, the capability to do so and freedom to decide if and when to do so;

The right to equality before the law, equal protection of the law and freedoms from all forms of violence, coercion and discrimination;

The right to a comprehensive range of health services; and

The right to privacy and confidentiality.

IIIIThe persistence of HIV-related stigma and discrimination is evident in research and programmatic data alike, despite treatment advances that have turned HIV into a chronic, manageable condition, and presented us with the possibility of eliminating AIDS as a public health threat. Decades into the HIV pandemic, stigma and discrimination continue to impede individuals and communities from accessing and benefiting from effective prevention and treatment strategies.

Key population groups have demonstrated an intractable challenge for the HIV and SRH response, and as such, the NFPB-SHA’s National Strategic Integrated Plan (NSIP) for SRH, place keen attention on these groups. The NFPB-SHA considers it absolutely necessary that our behaviour change interventions across these populations focus on condom promotion, STI treatment, partner reduction and HIV testing. Data shows that these programmes are most effective when structural problems including economic, social and cultural issues that contribute to SRH and HIV vulnerability and transmission are also addressed.

At a time when we see overwhelming evidence that global solidarity and shared responsibility are transforming the vision of an AIDS-free generation, there is no question that the stigma and discrimination associated with HIV and AIDS can be reduced through evaluated interventions.

Gone are the days when it was thought that the stigma surrounding HIV was too abstract to be measured. The field of stigma research related to HIV has advanced rapidly, and while many questions remain unanswered and gaps in empirically derived data exist, there is no question that stigma can be reduced. Specific research strides include a solid evidence base of valid measures that capture multiple domains of stigma associated with HIV.

GUIDING PRINCIPLES

The guiding principles of the NFPBSHA’s Integration Plan determine the priorities, the design of the interventions, and the approach to integration. The overarching principles of protection, confidentiality, consent and human rights are applicable throughout the plan.

It is necessary to have discussion regarding the evidence for stigma and discrimination reduction efforts. It is also a call to action for even more refined research activities, for greater community involvement (particularly of key populations in research and programmatic efforts) and for scale-up of some programmatic principles that have been identified, while including high-quality monitoring and evaluation strategies to further expand the evidence base.

It is my hope, and the hope of many others, that within the next decade, cost-effective interventions will be identified and that Jamaica will be collecting programmatic data demonstrating the impact of stigma and discrimination reduction on HIV prevention and care outcomes.

As stakeholders we must intensify our

Marge Roper, counsellor conducting rap session. actions to build effective stigma-reduction programmes and policies; protective laws and protocols; and appropriate legal, social and policy frameworks that will eliminate stigma, discrimination and violence related to HIV. It is a global shared responsibility, and one that includes continued research into causes, manifestations and new metrics and monitoring approaches.

Stigma isn’t abstract; it’s very, very real. And it

affects not just people living with HIV, but their families, those who care for them, and those who may be at heightened risk for exposure to HIV. We have come a long way to measure and understand stigma, but we have much further to go to ensure our findings drive real action by governments and donors to create the programmes, policies, and practices that will improve health outcomes and save lives, in this instance by preventing HIV infections. DR DENISE CHEVANNES Executive Director NFPB-SHA