ALQ, September 2007 Edition – Stigma Mitigation

Editorial...

…stigma and discrimination simultaneously reduce the effectiveness of efforts to control the global epidemic and create an ideal climate for its further growth…stigma prompts people to act in ways that directly harm others and deny them services or entitlements…stigma prevents many people from negotiating safer sex, taking an HIV test, disclosing their status tot heir partners or seeking treatment, even when services are made available… [UNAIDS 2005]

Stigma and discrimination are recognised barriers to HIV prevention, testing, treatment, support and care and so are the correlations between stigma and ‘HIV risk’, in that stigma and discrimination leads to a heightened risk of HIV infection, while actual or perceived HIV infection leads to a heightened risk of stigma and discrimination. However, despite acknowledging that stigma and discrimination are as much reducing ‘the effectiveness of efforts’, as they ‘further’ the HIV and AIDS pandemics, there seems to have been, thus far, very few ‘real’ efforts, and/or very little impact made with efforts, to mitigate stigma and discrimination.

It is within this context that this edition of the ALQ is focusing on stigma mitigating efforts, and exploring experiences and challenges of a wide range of ‘anti-stigma’ strategies, programmes and interventions. The need for not only an integrated approach, but an ‘evolving and shifting’ approach to ‘anti-stigma’ work; a rights-based workshop approach challenging the stigma ‘within us’ and ‘around us’; a ‘zero tolerance’ approach in rural Limpopo; as well as strategies for free, informed and confidential HIV testing are some of the issues discussed in this edition.

This issue is also introducing experiences and challenges from a project in Lethabong, North West, aimed at enhancing rural communities’ access to information; examining HIV-related stigma and discrimination in healthcare facilities in Nigeria; and ‘making a point’ about HIV-related law and policy reform in the SADC region.

In this edition, Pierre Brouard explores various causes and forms of HIV-related stigma. Examining stigma, its related concepts and dynamics; its various psychological and social functions; and its impact on individuals, communities and society, he discusses potential interventions to mitigate HIV-related stigma and discrimination and argues that even though there is no ‘quick fix solution’, an integrated approach can work. Thus, for any anti-stigma intervention to be adequate and effective, they need to evolve and shift, as stigma evolves and shifts constantly.

Experiences of challenging stigma and discrimination are introduced by Johanna Arendse and Johanna Kehler. Discussing a workshop approach aimed at not only addressing the various causes and forms of HIV-related stigma and discrimination, but also challenging underlying beliefs, values and norms leading to both the stigma ‘within us’ and the stigma ‘around us’; and exploring the ‘ups’ and ‘downs’ of this process, the article argues that while change is difficult, there are ‘opportunities’ for change – provided the need for, as the ‘barriers’ to, change are recognised.

Recognising the lack of impact of existing advocacy strategies, Fiona Nicholson introduces the concept of the ‘Zero Tolerance Village Alliance’ as a potential strategy for behavioural change. Discussing the goals, objectives and methodology of the ‘zero tolerance’ behavioural change concept, as ‘tried and tested’ in Thohoyandou, Limpopo, she argues that event though there are no ‘blue prints’ for this concept, there is hope – provided the programme succeeds in creating an enabling environment for people to feel safe and supported enough to ‘speak out’ and ‘stand up’ for their rights.

Gahsiena van der Schaff provides the ‘provincial feedback’ and explores stigma and discrimination as the barriers to HIV testing. Analysing provincial views and responses on the ‘why’, ‘who’ and ‘when’ to test for HIV; and HIV testing barriers, such as fear, prevailing stigma and discrimination, lack of knowledge, and conditions of, and within healthcare provision; and introducing provincial strategies for free, informed and confidential HIV testing, she argues that an uptake in HIV testing services can only be achieved as and when the environment of both people’s lives and healthcare facilities are challenged and transformed.

Various programme activities focussing on young people and aiming at behavioural change through access to information and skills are introduced by Sizwe Hlatshwayo. Discussing experiences and challenges of the various Amanzimtoti YMCA programme activities, which are primarily aimed at enhancing young people’s skills to cope with, and respond to, life’s challenges, including risk of HIV infection and HIV-related stigma, he argues that despite the many obstacles there is hope, since young people are as committed to the programme, as they are committed to behavioural change.

Recognising the protective constitutional and legislative framework, Erica Kessie raises the question as to whether or not workers are indeed protected against HIV-related stigma and discrimination at the workplace. Looking at a particular incidence, she argues that as long as ‘management’ fails to support and be actively involved in HIV awareness and education at the workplace, constitutionally guaranteed rights to equality, non-discrimination, dignity and fair labour practices are no more than ‘paper rights’ providing very little protection to workers living with HIV or AIDS.

The dire need for access to information for rural communities in the North West Province is highlighted by John Moerane. Introducing experiences of facilitating human rights and HIV education and training in various areas in and around Lethabong, he argues that despite all challenges information is the ‘key to change’, since rights-based information and messages are taken forward and thus, contribute towards behavioural change.

The impact of HIV-related stigma and discrimination on healthcare services in Nigeria are explored by Busari Olusegun. Discussing various causes of HIV-related stigma and discrimination; various form of how it exhibits itself in healthcare services; and Nigerian approaches to, and experiences with, addressing HIV-related stigma and discrimination, he argues that stigma and discrimination will remain the greatest barrier to progress in the response to HIV and AIDS, unless a human rights-based solution to this all important aspect of these pandemics is found and implemented.

Looking at various legislation and policy provisions, Eric Axelrod is ‘making a point’ about the effectiveness of HIV-related law and policy reform within countries of the SADC region. Exploring the development pertaining to labour legislation, mandatory HIV testing in the military, public health law, and criminal law; and recognising the progress made, he argues that laws are only as effective as they are adhered to and ‘enforced’, since without a ‘culture of legal accountability’ legislation will remain ‘empty’ and provide little ‘real’ protection to people living with HIV or AIDS in the SADC region.

While the strategies addressing HIV-related stigma and discrimination may vary in their programme design and ‘target group’, there seems to be the common understanding that ‘change’, and particularly behavioural change, is the key to any effective ‘anti-stigma strategy’; as there is the common acknowledgement that without the much needed ‘change’ in both the external and internal environment, stigma and discrimination will remain to be the barriers to HIV prevention, testing, treatment, support and care efforts. The extent to which stigma mitigating interventions, programmes and activities are adequate and effective appears thus not to be defined by the utilised approach – irrespective of whether or not it is a ‘zero tolerance’, rights-based, multi-prong, innovative, integrated and/or holistic approach – but instead by the extent to which any chosen approach does indeed create ‘opportunities for change’.

If we are to agree that there is a need for ‘change’ as there is for creating ‘opportunities for change’, then we are to acknowledge that the societal context in which ‘change’ is to occur, is the very same societal context which seems largely reluctant and resistant to ‘change’ – thus, ‘threatening’ the very concept of ‘change’. Similarly, if we are to agree that the ‘tried and tested’ approaches thus far failed to mitigate HIV-related stigma and discrimination, then we are to equally agree that it is imperative to ‘try and test’ new approaches to stigma mitigation – approaches that indeed carry the potential to not only address, but challenge and transform the very foundation of the stigma ‘within us’ and ‘around us’.

Thus, any effort ‘capable’ of mitigating HIV-related stigma and discrimination has to , arguably, be ‘capable’ of creating ‘real’ opportunities to ‘change’ the very same foundations for stigma and discrimination – ‘us’ and the societal context in which we live and ‘stigmatise’. Only as and when stigma mitigating interventions are aimed to address, challenge and transform both the stigma ‘within us’ and ‘around us’ will these interventions carry the potential to ‘remove the barriers’ and to ‘break the cycle’ of stigma and discrimination as a cause for, and consequence to, HIV infection. As long as stigma and discrimination not only prevail, but are seemingly largely justified and condoned by ‘society’, stigma and discrimination will continue to be as much the reasons for our ‘efforts’, as the reasons for our ‘failure’ – and thus, the cycle continues and so do stigma and discrimination…

Johanna Kehler