Scaling Up HIV Stigma Reduction in Health Facilities: Outcomes of a Health Policy Project Expert Consultation

HIV-related stigma and discrimination (S&D) continue to adversely affect the health and well-being of millions of people worldwide, infringing upon the rights of those affected and undermining the effectiveness of HIV responses. Agencies such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) acknowledge the central importance of addressing S&D, which remain significant barriers to progress at both the global and national levels. The Health Policy Project (HPP), funded by USAID and PEPFAR, has worked in collaboration with global and country-level institutions to advance understanding and approaches to measuring and addressing HIV-related stigma. At the global level, HPP led efforts to review, prioritize, adapt, test, and synthesize existing measures and programmatic tools for stigma reduction in health facilities. This resulted in the development of a comprehensive package for "stigma-free" health facilities, which targets all health facility staff and offers a complete response to S&D in health facilities. The package was piloted in several Caribbean countries and offers a total facility approach that includes research, action, and monitoring. HPP, in partnership with the Stigma Action Network and other global experts, has also worked to improve indicators for measuring and monitoring stigma. As a result, population and health facility level indicators have been adopted at the global level, which should increase the attention paid to stigma reduction. These indicators include those based on HPP's measurement tool in health facilities, population-level S&D indicators, revised stigma questions in demographic health surveys, language on stigma in State Department human rights reports, and inclusion of S&D indicators in the WHO Consolidated Strategic Information Guidelines for HIV in the Health Sector. Despite this progress, there is a clear need to continue to refine and adopt standardized stigma monitoring indicators to support integration into existing systems and standards. In an effort to facilitate further scale-up and refinement of these successful approaches, HPP convened an expert meeting in Washington, DC on June 3, 2015, to discuss and strategize a way forward to scale up S&D-reduction efforts in health facilities. The consultation was organized around six key themes central to adapting and scaling up: implementation and service delivery strategies, health sector governance and accountability, leadership and political will, stakeholder engagement, research and evaluation, and attention to key populations. The consultation yielded valuable insights and recommendations, which emphasized the central importance of finding ways to integrate S&D reduction into existing systems and health facilities. Participants recommended searching for opportunities to integrate S&D indicators and approaches into already funded initiatives and making better use of existing systems, including integrating S&D reduction into pre-service and in-service training curricula for health workers, standards of care, supervisory standards, performance reviews, and codes of conduct. They also emphasized the need for continuous quality monitoring that integrates S&D indicators and the importance of using integration to enhance accountability and improve quality of care.