Toolkit for Reducing HIV Stigma and Discrimination in Clinic Settings

The Toolkit for Reducing HIV Stigma and Discrimination in Clinic Settings was conceptualized and developed by the Center for Community Health Research and Development (CCRD) in partnership with Digisun, with technical assistance from the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP) and funding from Futures.  This innovative and user friendly package of materials is designed  to address the root causes of the problems encountered in the health facilities with staff who are not sensitized to the appropriate behaviors and attitudes needed when working with people living with HIV or possibly having HIV.  The toolkit is available in Vietnamese, Khmer and Thai languages.

Based on the evidence and theory, the key issues and behaviors selected in consultation with the Futures were scripted and filmed to provide easy to emulate behaviors by role modeling these behaviors first in the negative or wrong way to behave followed by clear and positive segments each of which has discussion questions and answers built into the DVD between the segments/scenarios.  The toolkit is simple and easy to use by the healthcare providers either with or without facilitation.  The stand alone, self instructional DVD format ensures that the training will be consistent, correct and compelling and eliminate, as far as possible, risking unskilled or biased trainers.  By allowing the user to pause, stop and replay the DVD and by constructing the question and key topic points to be interactive, the DVD may be used by individuals or small groups of heath care providers at their convenience and as often as needed to reinforce and practice the behaviors.

The toolkit also includes a short facilitator’s guide with additional exercises and provides a ready reference for the steps to be used in carrying out the correct behaviors.  This is for use in those situations in which an actual trainer will introduce and implement the training.  It is simple and user friendly with clear guidelines and steps for activities and exercises to use with the DVD.

The other key supplementary material is a poster which can be placed in counseling and waiting rooms and any other strategic locations in the clinic.  The poster serves a two fold purpose – to remind the counselor or clinic staff of the correct behaviors and to raise the expectation of the clients to receive and even demand this proper treatment from the staff.  By making the principles of the clinic’s and its personnel’s values and beliefs public, it encourages everyone to participate and holds the staff accountable.

AIDS-related stigma and discrimination continues to be a persistent problem worldwide. Stigma and discrimination is experienced by people living with HIV in a variety of settings ranging from the home, community, workplace, and even health care settings. HIV-related stigma is common in health care settings because that is where people are often tested for and discover their HIV status. Stigma and discrimination in the health care setting is a major cause of concern because it may act as a barrier to seeking and receiving essential treatment and care. In health care settings, people living with HIV or suspected of having HIV may receive inferior care or be denied care altogether due to stigmatizing attitudes and discriminatory practices of health care workers.  We believe that this innovation package of materials will be a useful tool to improve the behaviors of clinic staff.

This project was commissioned under the USAID | Health Policy Initiative, Task Order 1 as part of the ASEAN’s Collaboration with USAID under the Asean Work Programme on HIV/AIDS III, specifically Activity 4.

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