Stigma and dis­crim­i­na­tion, bar­ri­ers to HIV pre­ven­tion

Jamaica Gleaner - - WORLD AIDS DAY 2016 -

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.


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.


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

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