Zero Discrimination Day: Breaking down HIV stigma with individual, structural, and health facility policy interventions

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The following is a guest post by Molly Fitzgerald, of Health Policy Project

Molly Fitzgerald Headshot

Molly Fitzgerald

March 1st marks Zero Discrimination Day, a day set aside to celebrate diversity, reject discrimination, and to promote compassion, tolerance, and peace. In a diverse and increasingly globally-connected world, intolerance for diversity and persistent HIV stigma seem astonishing. Arguably, one of the most important settings to address and break down HIV-related stigma is in health facilities. To credibly scale-up HIV services to meet global goals of ending HIV by 2030, people seeking HIV services should be fully engaged without fear of discrimination of any kind.

Studies from different parts of the world reveal that there are three immediately-actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behavior. Experience and research show us that interventions in health service provision aimed at mitigating stigma and discrimination must focus on the individual, environmental, and policy levels. By working at all three of these levels we can achieve long-lasting benefits for health workers, vulnerable populations in need of HIV education and testing, and HIV-positive patients.

In Barbados and Jamaica, the PEPFAR- and USAID-funded Health Policy Project is using this approach to combat facility-level S&D. HPP is delivering two-day stigma-reduction trainings to health facility staff. Adapted from a longer curriculum, the training comprehensively addresses stigma and discrimination by involving all health facility staff (including receptionists, pharmacists, nurses, and administration staff). Staff is taken through a personal and professional journey to understand how various stigma, personal attitudes, and facility policies may negatively affect the success of HIV services.


Photo/image credit: Health Policy ProjectHealth and HIV facility staffs develop the expectations for staff codes of conduct through a participatory process as part of their S&D trainings. The first, developed in St. Kitts & Nevis, are now posted nationwide in all the country’s health facilities. Similar posters are being developed in Jamaica (pictured here) and Barbados, and health staff in Dominica independently adapted the model to create their own codes of conduct. In all four countries, the codes of conduct address quality, respect, confidentiality, and provide contact information for client feedback.

According to Dr. Walter Alleyne, a medical doctor at the St. Philip Polyclinic in Barbados, these are the “basic tenets of public healthcare . . . not overly scientific . . . the core components of health equity and solidarity.” He stressed that “people will resonate with these principals because they are personal, and it’s also public health.”  Dr. Alleyne’s staff, along with staff members from several other health facilities in Barbados was provided with the comprehensive training.

Dr. Francine Kelly is the Medical Officer in charge of the Port Antonio Health Centre and other health facilities in Portland, a rural parish in north eastern Jamaica. Reflecting on the trainings, she noted the importance of training all facility staff on stigma and discrimination, noting, “I saw the usefulness in this training. I mobilized about 70 percent of all the health facility staff to join. A wide cross-section of staff was trained and I saw this as very important.  Many of the staff, like me, who directly engage with clients on their HIV testing, treatment, and care have been exposed to understanding of stigma and discrimination, but that doesn’t mean we have addressed this holistically.” 

Dr. Kelly went on to say, “One of the eye openers of the training was the session on how individuals living with and vulnerable to HIV perceive themselves. Staff was appreciative of this.” Dr. Kelly’s parish manages HIV services for hundreds of people, including HIV treatment which is expected to reach more than 350 people.

In addition to the trainings, HPP is also helping facility staff develop posted “codes of conduct” which outline the expectations for stigma-free services, regardless of HIV status, sexual orientation, or gender.

The codes of conduct posters feature health facility staff photos and contact information for clients to report instances of discrimination. The codes of conduct are being rolled out across health facilities in Jamaica, Barbados, and other countries across the Caribbean.

Dr. Kelly commented, “Our staff is on the codes of conduct poster, all these faces will be familiar to who[mever] attends the facilities. This training and the codes of conduct will have spill-over effects into other areas; the code of conduct is not specific to HIV, so it helps commit our team to quality services across health areas, needs, and services.”

CROI coverage continues: Science Speaks will continue to post news, analysis and followups to presentations from the Feb. 22-25 2016 Conference on Retroviruses and Opportunistic Infections, this week.

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