Combating Stigma & Discrimination In Healthcare Settings
This challenge is seeking to tackle stigma and discrimination faced by key populations in healthcare settings regardless of profession, gender or sexual identity. Solutions may be proven interventions or proof of concept innovations in need of piloting and scale-up.
Challenge Close: This challenge is now closed. Please see the Winners Page for information on the winning submission.
Up to $100,000
In Collaboration With:
The International AIDS Society
The International AIDS Society (IAS) is the world’s largest association of HIV professionals, with members from more than 180 countries working on all fronts of the global AIDS response. The mission of the IAS is to lead collective action on every front of the global HIV response through its membership base, scientific authority, and convening power.
In over thirty years of responding to HIV, stigma and discrimination is still a persistent and harmful barrier for people living with or at risk of HIV. Compounded stigma and discrimination reduces access to essential healthcare services and reduces health seeking behaviours. This can hinder health and social outcomes, in particular for key populations – men who have sex with men (MSM), transgender people, sex workers, and people who inject drugs. Access to these health services for key populations greatly depends on the degree to which frontline healthcare workers and facilities welcome them and safeguard their rights.
The World Health Organization states that fear of stigma and discrimination is the main factor preventing people from seeking health services. One study found that participants who reported high levels of stigma were over four times more likely to report poor access to care. Healthcare professionals can make a tangible difference to holistic HIV care delivery for key population communities by:
- Accessing prevention methods that match the realities of their lives
- Providing integrated care and treatment services and retaining key populations living with HIV in care
However, in many countries a person’s HIV status or perceived risk often elicits discriminatory attitudes and judgements about their behaviour, work, sexual orientation and/or gender identity. These views are frequently fuelled by arguments of culture, religion, tradition and community – to which many healthcare professionals are central. Key populations are particularly likely to experience stigma and discrimination in healthcare settings when they seek out HIV and related services. Some healthcare professionals themselves recognise that they can foster negative judgements towards these groups, despite their ethical obligation to care for and treat people impartially.
Positive Action Challenges and the International AIDS Society are seeking to combat stigma and discrimination faced by key populations in healthcare settings by scaling up and fostering best practices by which every person will be treated with dignity and respect, regardless of their profession, behaviour, gender or sexual identity. This challenge aims to a) scale up proven action that is replicable and sustainable or b) encourage new ‘proof of concept’ innovations that will lead to impactful change.
Challenge statement: Find a solution (proven or innovative) that reduces stigma and discrimination in healthcare settings faced by key populations (in general or by category – sex workers, MSM, transgender people, people who inject drugs) leading to increased up-take of primary prevention options and Voluntary Counselling and Testing (VCT) and/or reduction in Loss to Follow Up (LTFU) through retention in care.
Success measures for increased up-take of primary prevention and VCT may include:
- Integration of services: Integration of VCT services into other essential healthcare services, including sexual and reproductive health; STI prevention and management;
- Community links: Each clinic linked with a key population community organisation to reach beyond the clinic;
- Breadth and scope of services: Additional key population clients access a range of services (by type).
Success measures for key population client retention and reduced LTFU may include:
- Retention time: LTFU measured every 6 months from last contact; No percentage increase in LTFU over 24-month period.
- Adherence for life: Increase in adherence to treatment through viral load suppression.
Case Study: Responding to stigma and discrimination among key populations in Vietnam
In 2011 and 2014, the Vietnam Network of People Living with HIV (VNP+) conducted the PLHIV Stigma Index survey to assess both current stigma and discrimination and changes over that period. Sampling was undertaken among people who inject drugs (PWID), men who have sex with men (MSM) and female sex workers (FSWs).
The Stigma Index revealed concerns about the quality and confidentiality of healthcare and HIV testing: many PLHIV (60.1% of all respondents in 2014) reported not having been able to discuss their treatment with a healthcare worker. FSWs are particularly vulnerable, with 3.6% being denied healthcare services. Of particular concern is the fact that 3.1% of respondents (and 5.6% of PWID) said that they were coerced into testing, while 7.6% of all respondents were tested without their knowledge. Additionally, high rates of disclosure to others without consent persist, with over one-third of all respondents (37.5%) and nearly half of PWID (45.3%) reporting this.
The results among MSM living with HIV often stood out with higher levels of stigma and discrimination linked to their sexual orientation. MSM were more likely to report issues with health care, including a lack of access. They had very low rates of talking to healthcare workers (only 16.6% reported having done so) and a total of 28.3% reported avoiding going to local clinics because of self-stigma. Finally, MSM reported even less confidence in the confidentiality of their test results than other respondents, and a decrease since 2011.
Some of the key recommendations included:
- Specific measures to increase the confidentiality of test results in order to reduce the fear of disclosure without consent, while increasing the likelihood that people will be tested early enough to maximise the preventative benefits of treatment
- The quality of healthcare for people living with HIV, particularly interactions with healthcare workers (especially for MSM living with HIV), should be improved through education and training for healthcare workers (in collaboration with networks of PLHIV.)
- Healthcare services and VNP+ member groups should establish a collaborative mechanism to refer and support PLHIV who have experienced stigma and discrimination at the hands of healthcare workers
In evaluating entries and determining winners of the challenge prizes, the Judges will apply the following core criteria. In addition to these criteria, entries must specifically show that they reduce stigma and discrimination faced by key populations in healthcare settings. Please see the details tab for information on this challenge.
- People Centred: Entries may focus on a process, technology or other method but the ultimate benefit must be measurable in terms of impact on people’s lives. Must ensure privacy, demonstrate an ability to not perpetuate stigma and discrimination associated with HIV and enhance active community participation in solution development.
- Replicable: Entries can be replicated and adapted by others at low cost to ensure broader implementation and uptake as quickly as possible in similar settings.
- Scalable: Entries must demonstrate how they can be scaled beyond pilot programmes to large scale responses that can be implemented at greater/national scale.
- Affordable: Entries must demonstrate affordability (low-cost or no-cost to the end users) within resource limited settings or other similar settings as detailed in the individual challenges.
- Sustainable: Entries must demonstrate how they are implementable in the longer term (beyond the lifecycle of prize funding) using the resources that already exist or which can be incremental to existing service delivery.
- Achieving substantive change: Successful entries are expected to change the thoughts, processes and other barriers that prevent people living in resource limited settings from receiving the best care possible within the resources (financial and other) available, demonstrating a clear benefit to the people and systems targeted.
Click Apply Now to access the PAC Community portal where you can register or log in to start an application. Once registered you can connect with fellow solvers to share ideas, find collaborators and work on applications.
Submit a Concept Note to provide a summary of your innovation. You can seek input/feedback from other community members or submit right away. Concepts are shortlisted to progress to the next stage by the PAC team based on the challenge criteria.
The best eligible Concept Notes are invited to submit a Full Application. This stage requires more detail about the development and implementation of your innovation. This is the final stage for applicants before the judging process begins.
For more detail, see How it Works.