Stigma and discrimination are firmly established as key barriers to HIV prevention, care, and treatment—both inside health facilities and beyond. Stigma impedes scale-up of care and treatment, impacting all stages of the treatment cascade. Often, the individuals and groups most likely to experience HIV-related stigma and discrimination are also those who are most at risk of HIV infection. HP+ is designing and implementing evidence-based approaches to stigma-reduction, giving health facilities and decision-makers the tools to fight stigma and discrimination and accelerate progress toward achieving epidemic control.
HP+ is implementing comprehensive approaches to reduce stigma and discrimination, leading groundbreaking research and initiatives to create globally standardized tools and indicators for measuring and addressing stigma in health facilities. Specifically, HP+ is working with country partners to:
Improve national reporting and monitoring of discrimination in Ghana and Jamaica
HP+ Efforts to Reduce Stigma in Health Facilities Featured in AIDS Special Issue
September 2020 —
A journal article authored by HP+ project staff in collaboration with local partners was published this month in a special issue of AIDS. The article, which describes the development and implementation of a three-stage approach to reducing HIV stigma in health facilities, features the approach that HP+ implemented in Ghana and Tanzania. It is an evidence-based, adaptable, scalable approach that has proven successful in generalized and concentrated epidemic settings and can be used to address stigma toward any population. Results of endline evaluations in both countries demonstrate the intervention’s effectiveness, showing significant reduction in drivers and manifestations of stigma and discrimination among facility staff.
Journal of the International AIDS Society Publishes HP+ Article on Reducing Stigma and Discrimination in Ghanaian Health Facilities
April 2020 —
This month, a project-authored article on reducing stigma and discrimination in health facilities in Ghana was published in the Journal of the International AIDS Society. The article, which evaluates the impact of a “total facility” stigma‐reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff, found that respondents at stigma intervention facilities were 19 percent more likely to report that staff behavior towards people living with HIV had improved over the last year, compared to those at non-intervention facilities. These results provide a solid foundation for scaling up health facility stigma‐reduction within national HIV responses.
Stigma and Discrimination Total Facility Approach Featured by PEPFAR
January 2020 —
The HP+ “total facility approach” to reducing stigma and discrimination in health facility settings is being featured on the PEPFAR solutions website. This showcases the work carried out by HP+ in Tanzania and Ghana as an important solution for the HIV response. PEPFAR Solutions are impactful, data-proven approaches intended to guide others in program design and implementation. U.S. government staff and partners around the world use the solutions website as a resource for HIV program design. Having the stigma-reduction approach featured also makes it accessible to mission staff around the world as they embark on their COP20 planning processes.
The National Network of Key Population Associations in Mali Adopts a Strategic Plan
August 2019 —
Mali's National Network of Key Population Associations (RENAPOC), which advocates for its members to seek health services, prioritized addressing the barrier of stigma and discrimination to increase health access to HIV prevention and treatment services. All 36 members from Bamako, Kayes, Koulikoro, Sikasso, Ségou and Mopti came together to discuss and approve the contents of the strategic plan and on March 2, 2019, with technical and financial support from HP+ Mali, finalized and adopted a strategic plan. The RENAPOC strategic plan is now accepted as the validated strategic plan of the various key population associations and will allow RENAPOC to operate with a stronger structure and strengthened autonomy. This strategic plan will serve as a reference tool, both for internal and external partners, for the next 5 years.
PEPFAR Report to Congress Features GSD Training
April 2018 —
The US President’s Emergency Plan for AIDS Relief (PEPFAR’s) Annual Report to Congress features the Gender and Sexual Diversity (GSD) blended learning package. The training package is designed to help PEPFAR improve its effectiveness at serving its most vulnerable populations with a focus on staff training. Health Policy Plus and PEPFAR built on the success of a series of in-country trainings to develop the GSD blended learning package, which includes online and in-person training components. All PEPFAR field and headquarters staff are required to spend 90 minutes participating in the online interactive curriculum. All staff must also join an in-person panel discussion with local gender and sexual minority representatives around HIV, human rights, and meaningful engagement of GSD in PEPFAR programming. Thus far, more than 400 PEPFAR field and headquarters staff have taken the online training.
Combating HIV-related Stigma and Discrimination and Strengthening Redress in Jamaica
December 2017 —
To raise awareness and promote redress, the Jamaican Network of Seropositives (JN+) re-branded the Jamaica Anti-discrimination System for HIV (JADS), formerly the National HIV-Related Discrimination Reporting and Redress System. Through JADS, Jamaicans can report cases of HIV-related discrimination and potentially receive mediation and/or damages. For the past several years, USAID and PEPFAR through the Health Policy Plus (HP+) project, and its predecessor Health Policy Project, has been supporting JN+ and the Ministry of Health, a JN+ redress partner, to strengthen and evaluate their redress systems and address HIV-related stigma and discrimination.
Reducing HIV-related Stigma and Discrimination in Health Facilities
March 2017 —
USAID and PEPFAR, through the Health Policy Project’s (HPP) follow-on, Health Policy Plus (HP+), shared best practices, resources, and the project’s current work to reduce HIV-related stigma in health facilities during a recent webinar. The HPP/HP+ stigma-reduction package is comprised of a series of tools (assess, train, and sustain); includes a total-facility approach to reducing stigma and discrimination; and is based on a globally validated measurement tool, participatory training materials, and experiences from Africa, the Caribbean, and South and Southeast Asia. The stigma-reduction package has been implemented globally, with work ongoing in Ghana, Tanzania, and Jamaica. During the webinar, Suzie Jacinthe of USAID/Ghana commented, “We’ve never been able to quantify [stigma-reduction activities] in a way to show that what we’re doing is measurable change. With this activity, the beauty about it is that we…do questionnaires for the health facility as well as questionnaires from the PLHIV perspective of their experiences with those facilities to: gauge both [perspectives], come up with interventions out of the findings of the assessment, pilot them…and measure that change.” Jacinthe went on to say that HP+’s current effort to also cost these interventions, a first, will help governments demonstrate the real costs, alongside the measurable benefits, of implementing and replicating stigma-reduction interventions.
Curriculum Endorsed as a Valuable Tool in Achieving Global HIV Targets
March 2017 —
Ahead of Country Operational Plan reviews, the USAID- and PEPFAR-supported Health Policy Plus project—along with representatives from the Jamaica Ministry of Health, Jamaican civil society, and USAID—presented updates to their Positive, Health, Dignity, and Prevention (PHDP) Training Modules, to USAID staff and missions around the world. The webinar highlighted key changes to the PHDP—a curriculum by and for people living with HIV and key populations to promote personal health and advocate for high-quality HIV services—and its potential application in settings outside of Jamaica. During the February 2017 webinar, Dr. Chevannes, executive director of Jamaica’s National Family Planning Board, Sexual and Reproductive Health Agency Health commented, “…I wish to endorse the critical importance of PHDP in helping the address the structural barriers that result in depressed treatment cascades through loss to follow up among communities of persons living with HIV as well as key populations. As Jamaica moves to Test and Start PHDP is a valuable tool in achieving the 90-90-90 targets.” The revised PHDP will be available later this spring.
