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Targeting stigma and discrimination

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This presentation on what social research indicates will be effective anti-stigma interventions was given by Prof John de Wit, Centre for Social REsearch in Health (CSRH), at the AFAO Members Forum - May 2015.

Publié dans : Santé & Médecine
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Targeting stigma and discrimination

  1. 1. Targeting stigma and discrimination Prof John de Wit
  2. 2. Wednesday, August 6, 2008 ‘Stigma remains the single most important barrier to public action.’
  3. 3. Image sources: https://fasdprevention.wordpress.com/2010/11/18/a-new-way-to-talk-about-the-social-determinants-of-health/ http://justiceequity.com/ http://www.virgietovar.com/blog/rebellious-nursing-conference http://www.positivelyaware.com/archives/2011/11_07/progress.shtml
  4. 4. Continued commitment to the central importance of fighting stigma and discrimination Goals minimise the personal and social impact of HIV Objectives eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people’s health Scope to strengthen implementation No targets specified No indicators specified No implementation plan specified Australian 7th National Strategy Priority actions Eliminate stigma and discrimination in community and healthcare settings and empower priority populations. Remove institutional, regulatory and systems barriers to equality of care for people infected and affected by HIV in the health sector. Work towards addressing legal barriers to evidence- based prevention strategies across jurisdictions. Establish a dialogue between health and other sectors aimed at reducing stigma and discrimination against HIV-infected and affected individuals and communities
  5. 5. • Strengthening and disseminating evidence that stigma and discrimination affect health and well-being of people with HIV • Adapting and implementing proven interventions and designing and testing promising new approaches • Developing stigma indicators and monitoring framework, ensuring comparability across the national BBVS strategies Facilitating and supporting priority action
  6. 6. International research Logie & Gadalla (2009) • Meta-analysis of 24 studies of stigma experienced by people with HIV • Adverse effects on social support, physical health, mental health, • Effects across stigma measures Pascoe & Smart Richman (2009) • Impact of perceived discrimination across health conditions • Meta-analysis of 134 samples • Adverse effects on physical and mental health, stress and health behaviours Australian research NAPWHA Stigma Audit • Mixed methods: interviews and online survey of almost 700 people with HIV • Moderate levels of experienced stigma and discrimination associated with poorer mental health and wellbeing AFAO stigma barometer • Online survey of HIV-positive and HIV- negative/status unknown gay men • Stigma and discrimination play out in particular around sex and relationships • Correspondence of experienced and expressed stigma Evidence of adverse effects of stigma
  7. 7. • Stigma reduction interventions are highly diverse, reflecting different issues, facets, approaches and audiences • Socio-ecological level & audience – Intrapersonal, interpersonal, organizational/institutional, community, government/structural – Stigmatized, stigmatisers • Effective interventions... – Target individual and community levels – Utilise approaches to change the attitudes and behaviours of people expressing stigma or enhance strategies to cope with stigma • Individual level: education, counselling, attitude change • Community level: education, protest, advocacy and contact Foundations for effective interventions Image sources: http://www.fearlesslivemore.org.au/ http://www.enuf.org.au/
  8. 8. • Develop indicators, measures and monitoring frameworks – Comparability across BBVS and affected communities – Corresponding measures of experienced & expressed stigma • Collect baseline data through community surveys – Existing survey systems for people with HIV, gay men/MSM, people who inject drugs – New systems for sex workers, people with hepatitis C, people with hepatitis B • Undertake surveys of to assess expressed stigma – Health workers, general public • Repeat surveys regularly to monitor trends over time • Conduct in-depth qualitative research with priority groups Stigma indicators and monitoring framework
  9. 9. • There is strong evidence that stigma and discrimination negatively impacts on the mental health, physical health, social support and sexual relations of people with HIV • While HIV-related stigma and discrimination are moderate in Australia, people with HIV are nevertheless adversely affected • There is a clear, recognized need and capacity in community organisations to address HIV stigma and discrimination • There is ample research expertise to develop stigma indicators and implement a stigma monitoring framework • Why are we not acting as much as we should? How to move forward?
  10. 10. Image sources: http://ruralleaderonline.com/2013/07/06/this-is-why-we-blog-and-talk-about-mental-health/ http://cdn.fansided.com/wp-content/blogs.dir/318/files/2015/04/thank-you.png