Programmatic Guidance for Reducing HIV and Key Population Stigma and Discrimination: For the Greater Mekong Region Countries of Thailand, Lao PDR and Myanmar

They negatively impact HIV testing, disclosure, entry into care and treatment, and mental health, and contravene human rights. The fear of S&D prevents people from seeking HIV testing, disclosing their status, and accessing care and treatment. Evidence from the region and globally demonstrates that S&D has a significant impact on mental health outcomes, quality of life, and life chances. People living with HIV who experience S&D experience poorer mental health outcomes, lower quality of life, and reduced life chances. S&D also leads to delays in the initiation of HIV treatment, resulting in sub-optimal timing of treatment initiation and lower adherence rates once on treatment. The cycle of stigmatization is a key factor in the perpetuation of S&D. The cycle begins with the stigmatization of key populations, such as men who have sex with men, sex workers, and people who inject drugs. This stigmatization leads to the marginalization of these populations, making it difficult for them to access HIV testing and treatment services. The marginalization of these populations further exacerbates the cycle of stigmatization, perpetuating S&D. A framework for addressing and measuring S&D in health care facilities has been developed. The framework consists of four steps: (1) assessing the current situation, (2) developing a plan to address S&D, (3) implementing the plan, and (4) evaluating the effectiveness of the plan. The framework also includes guidelines for health care providers, clients, and the wider community to interact with each other in a way that reduces S&D. Guiding principles for stigma and discrimination reduction programming have been developed. The principles include promoting human rights, promoting the involvement of people living with HIV, promoting the involvement of key populations, and promoting the use of evidence-based interventions. An example application of the guiding principles is provided for the health care system in Thailand. The health care provider, client, and wider community interaction is a critical factor in reducing S&D. Health care providers should be trained to provide non-judgmental care to clients, and clients should be empowered to disclose their HIV status without fear of stigma or discrimination. The wider community should also be involved in reducing S&D, through community-based interventions and advocacy efforts. Institutionalizing S&D reduction as a national health best practice through existing governmental and professional association mechanisms is essential. This can be achieved through the development of policies and guidelines that promote S&D reduction, and through the provision of training and technical assistance to health care providers. The Greater Mekong Region (GMR) is a region with a high burden of HIV infection. The region includes Thailand, Lao PDR, and Myanmar. The region has a high prevalence of HIV infection among key populations, such as men who have sex with men, sex workers, and people who inject drugs. The region also has a high level of stigma and discrimination against these populations. The HIV epidemic in the GMR is characterized by a high prevalence of HIV infection among key populations, and a high level of stigma and discrimination against these populations. The epidemic is also characterized by a high level of HIV transmission among key populations, and a high level of HIV-related mortality. The Thai Ministry of Public Health has implemented a number of initiatives to address the HIV epidemic in the country. These initiatives include the provision of HIV testing and treatment services, the provision of harm reduction services, and the promotion of HIV prevention and treatment among key populations. The Lao PDR has also implemented a number of