New report says HIV stigma is driving new infections in South Asia by marginalizing vulnerable groups.
Bank’s Development Marketplace funded the piloting of 26 grassroots anti-HIV discrimination programs across South Asia.
Pilots showed that even small investment in grassroots efforts has great impact on reducing stigma.
July 26, 2010−People living with HIV/AIDS, or at high risk of contracting the disease, have long suffered the sting of HIV stigma and discrimination in the countries of South Asia.
But with the search for an AIDS vaccine still coming up empty-handed, and the lingering impact of the global recession squeezing country AIDS budgets and supporting donor aid, it is increasingly clear that HIV stigma and discrimination are more than a cause of personal sorrow. They are also a key driver of new infections.
A new report released last week by the World Bank and the International Center for Research on Women―Tackling HIV-Related Stigma and Discrimination in South Asia―describes how, despite widespread prevention and other efforts to reduce high-risk behaviors such as unprotected sex, buying and selling of sex, and injecting drug use, HIV vulnerability and risk remain high.
A prominent Indian researcher, Dr. Raghu Roy, reported at a recent Bank South Asia regional knowledge forum that 64% of respondents in a recent poll regarded HIV infection as “punishment from on high for doing something bad.”
Distorted attitudes like these and discrimination by health providers and local officials, among others, marginalize vulnerable groups at highest risk, and drive them further from the reach of health services and desperately needed prevention, treatment, care, and support services. Daily harassment and abuse also cause health problems and affect mental health, thereby leading to depression, social isolation, and an array of adverse socioeconomic outcomes related to HIV.
“Discrimination against people in these high-risk, marginalized groups is so strong that they feel their lives aren’t worth protecting or prolonging, which stops them from reaching out for the prevention, treatment, care, and support services they need to fight the disease,” says Dr. Mariam Claeson, Program Coordinator for the Bank’s South Asia region, and co-author of the new report.
Tackling Prejudice
As a result of a Bank-led regional competition to find successful grass roots anti-HIV discrimination programs, 1,000 groups from across Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka submitted proposals for small grant funding to the 2008 South Asia Region Development Marketplace.
Of these applications, 26 programs from six countries were chosen to pilot their work more widely over 18 months, with total grant funding of $1.4 million, and maximum individual grants of $40,000.
A common feature of the winning programs was that they empowered people from marginalized groups― sex workers, injecting users, trans-gendered people, and men who have sex with men―to innovate and correct misinformation about their activities and HIV/AIDS in general. Using television and radio shows, beauty pageants, community theatre, outreach with community leaders, and private businesses run by sex workers, marginalized groups were able to reach out successfully to neighbors and local officials to raise their awareness about stigma and discrimination, and ensure less hostility toward them.
“The world desperately needs new HIV prevention strategies because for every 100 people who go on life-saving AIDS treatment, another 250 become newly infected, which is an impossible situation for poor countries and their communities,” says Dr. David Wilson, the Bank’s newly appointed Director for its Global HIV/AIDS Program.
“This new study shows us how people living with AIDS, and others at high risk of HIV infection, can use their ‘people power’ to fight the stigma and discrimination that stands between them andgaining their rightful access life-saving prevention, care, and treatment services,” Wilsonsays.
In explaining their case to others, many anti-stigma coordinators reported feeling better about themselves and their identities.
“Despite all my knowledge and years working to promote condom use, I only started using condoms consistently when I felt my existence was important,” says Muthukumar Natesan,one of the winners of the Bank’s Development Marketplace competition and a leader of a community-based organization for men who have sex with men.
“You can talk as much as you want about the need to protect oneself, you can provide as many condoms… as you want, but unless men who have sex with men feel their existence is worthwhile, they are not going to bother to protect themselves or others.”
Lessons in Fighting Stigma
As part of the 2008 South Asia Region Development Marketplace contest on HIV stigma and discrimination, the Bank invited researchers from the International Center for Research on Women, and other groups, to assess applications and to evaluate lessons for wider use. Such lessons included:
Community organizations achieved a great deal for relatively little investment. Development Marketplace funding totaled $1.04 million across 26 projects. Projects reached more than 96,264 people; trained 4,905 people; led to 504 news articles; and developed 426 products such as training curricula and education materials. Community organizations undertook new activities and developed new capacities despite the relatively small maximum grant size of $40,000.
Development Marketplace grants seeded considerable innovation. Project approaches reflected enormous creativity, ranging from beauty pageants to restaurants run by sex workers. The grants led to new alliances—such as those between local government leaders and the Indian community organization Lotus Integrated AIDS Awareness Sangam—and to some unlikely partnerships between sex workers, police, lawyers, and health workers. In Afghanistan, one project partnered with the government to support religious leaders to pass on anti-stigma messaging in their Friday prayers.
Effective efforts were led by or continuously engaged marginalized communities. Involving marginalized communities was essential for strengthening capacity, ensuring appropriate messaging, and maximizing results. Products such as films or plays that are developed by, or strongly reflect the input of, marginalized communities, are likely to be more compelling to audiences and enjoy rapid dissemination.
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