Stamping out Stigma
This challenge is seeking technological innovations and interventions which foster sustainable collaborations between public clinics and non-governmental organisations (NGOs) to increase stigma-free access to sexual and reproductive health (SRH) and HIV services for key populations.
Challenge Status: This challenge is now closed. See the Winners Page for information on the winning submissions.
Prize amount: $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.
The World Health Organization states that fear of stigma and discrimination are the main factors preventing people from seeking health services. Yet, in 35% of countries with available data, over 50% of men and women report having discriminatory attitudes towards people living with HIV. While efforts have been made to focus on and address stigma and discrimination in healthcare settings, compounded and layered stigma (enacted or internal) and discrimination still persists. This reduces access to essential comprehensive healthcare services and reduces health seeking behaviours which are a key part of improving health and social
outcomes, particularly for key populations - including men who have sex with men (MSM), people who inject drugs, sex workers and transgender people.
Healthcare professionals can make a tangible difference across the HIV cascade through engaging key population communities with the prevention methods that match the realities of their lives, providing treatment services and retaining people living with HIV in care. However, in many countries healthcare information is not confidential and a person’s HIV status often elicits discriminatory attitudes and explicit judgement about their behaviour, work, sexual orientation or gender identity. These views are frequently fuelled by arguments of culture, religion, tradition and community – of which many healthcare providers are part. A perceived lack of confidentiality and trust prevents key populations from being honest with healthcare workers when they seek medical help.
Some healthcare workers themselves recognize that they foster blame and negative judgements towards these groups, despite their ethical obligations to care for and treat people impartially and respectfully. Moreover, in some countries these groups are criminalized, resulting in marginalization and exclusion from essential healthcare services. One study found that participants who reported high levels of stigma were over four times more likely to report poor access to care, highlighting the importance of establishing a culture of best practice within clinics and fostering trusting client-provider relationships as a means of delivering high quality, non-judgemental HIV prevention, care and treatment services.
Historically, non-judgemental information on HIV services for key populations was provided at ‘hotspots’, including bars, nightclubs and social events. While this remains an important strategy for reaching key populations, the HIV response continues to adapt to new technologies and innovations including mobile applications and social media. The HIV response is expanding its use of technology and collaboration as a means of improving stigma-free access to care across the HIV cascade and ensuring that people living in challenging legal, political and social environments can access the information and services they need without fear of discrimination.
Increasingly, addressing stigma and discrimination in healthcare settings in a sustainable manner involves two key enablers:
- Utilising innovative technologies: With expanding, diversifying and new technologies available, it will be critical for the HIV response to continue to innovate, expand and strengthen channels to reach key populations and improve access to information, particularly around the availability of health services. Innovations in mobile applications and social media provide significant opportunity to inform key populations about stigma-free, peer-endorsed HIV services that are available and how they can be accessed through safe and secure channels.
- Innovations in collaboration: Fostering long term, sustainable collaboration between public clinics and NGOs is key to providing friendlier and better quality HIV services to key populations with peer navigators, for example, playing an important and effective role in reaching key populations. Promoting the long-term involvement of peers in the HIV response will be crucial.
Positive Action Challenges (PAC) and IAS are seeking to stamp out stigma and discrimination faced by key populations in healthcare settings across the HIV cascade by scaling up and fostering best practices where every client will be treated with dignity and respect, regardless of their gender or sexual identity. By launching a challenge prize to tackle stigma and discrimination of key populations within healthcare settings, the PAC aims to promote stigma-free mechanisms of increasing access to comprehensive SRH and HIV services through two key enablers: (i) utilising proven technology innovations that improve access to services, and (ii) fostering sustainable and replicable models of collaboration between governments and NGOs.
The challenge: Find a sustainable, replicable or innovative solution that reduces stigma and discrimination in healthcare settings faced by key populations (in general or by type), leading to an increased up-take of comprehensive services - including primary HIV prevention, STI screening, harm reduction programmes; ART access and services for people living with co-morbidities.
Success measures for increasing access to comprehensive SRH and HIV services:
1.Utilising proven technology innovations that improve access to services
Breadth and scope of services: Additional key population clients access a range of services (by type);
Number accessing services: Increased number of people accessing a range of comprehensive services, including HIV testing, STI screening, social justice and harm reduction programmes.
2. Fostering sustainable collaboration between public clinics and non-governmental organizations (NGOs)
Integration of services: Integration of key population friendly services across a range of service delivery entry points;
Community links: Each clinic linked with a key population community organization to reach beyond the clinic;
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.
Challenge statement: This challenge is seeking technological innovations and interventions which foster sustainable collaborations between public clinics and non-governmental organisations (NGOs) to increase stigma-free access to sexual and reproductive health and HIV services for key populations.
 Sayles, J. et al (2009) 'The Association of Stigma with Self-Reported Access to Medical Care and Antiretroviral Therapy Adherence in Persons Living with HIV/AIDS' Journal of General Internal Medicine 24(10)