Community of Practice explores innovations to reduce stigma and discrimination

The Southeast Asia Stigma Reduction Quality Improvement (QI S & D) Community of Practice held its eleventh meeting in Bangkok, Thailand from November 23 to 25, 2022.

This community of practice is co-convened by the University of San Fransisco California (UCSF) HEALTHQUAL, Asia Pacific Network of People living with HIV (APN+), and UNAIDS Asia Pacific. It seeks to accelerate the integration of stigma and discrimination reduction activities into routine HIV quality management programming through cycles of continuous measurement, implementing improvements, and peer-to-peer exchange. The QI S & D Learning Network currently convenes representatives from Ministries of Health and community-based organizations from Cambodia, Lao PDR, Thailand, Vietnam, Malaysia and the Philippines.

During the meeting, country representatives presented on progress made in routine measurement of stigma and discrimination. They also pointed to subsequent improvements in access to services and the quality of health service delivery.

Malaysia, for instance, has expanded from 7 to 55 primary health facilities since the inception of the initiative in 2020. Data collected through online surveys has been used to effect changes in service delivery. Staff have received training and coaching to deliver stigma-free services and make health facilities a place where people living with HIV (PLHIV) and key populations can seek health and HIV services without fear. Partnership with PLHIV at facility level as volunteers has contributed to improved relations between healthcare staff and PLHIV, thereby addressing the layers of stigma that exist on either side.

Cambodia, Lao PDR, Thailand, Vietnam and the Philippines have used the data collected from the different rounds of surveys to improve health services. Healthcare professionals have been empowered with skills and knowledge to provide services to PLHIV without stigma, in an environment that encourages the PLHIV and key populations to return to the facilities for healthcare services.

Carla Treloar, from the University of New South Wales, spoke about the universal precautions approach to reducing stigma in healthcare and getting beyond HIV-specific stigma. She noted that it is not feasible, realistic or consistent with principles of universal access to healthcare, to expect health systems to produce separate stigma reduction programmes for the many stigmatized conditions presented within the health system. Sustainable systemic change, she noted, requires tackling stigmatizing conditions, policies and practices across the heath system and across areas of stigma.

Khun Rena Janamnuaysook, Program Manager at the Tangerine Clinic in Bangkok spoke about the clinic’s integration of peer-led screening for depression and anxiety and linkage to care intervention. She noted that clients at the clinic who accepted screening for depression and subsequent linkage to care only did so because it was introduced by their peers.

“Development of mental healthcare implementation strategies that are led by members of key populations and are adapted to local cultural contexts can expand health resources,” Ms. Janamnuaysook said.

Khun Jemma Samitpol, Clinic Supervisor at the Tangerine Clinic, noted that the lack of legal recognition of transgender persons in most countries in the region makes it difficult for them to navigate life including accessing healthcare and acquisition of identification and travel documents that bear their true identity. She added that even where universal healthcare exists, in most cases it is not acceptable and does not include gender affirming related healthcare.

On community-led monitoring (CLM), Rocky Rinabor from the Library Foundation in the Philippines noted that the end goal of CLM is not data collection, but using the resulting evidence to improve policy and practice through advocacy. 

The meeting ended on a high note with participants keen to continue with the coordination of routine measurement, capacity building and effecting change from the facility level to the policy level to ensure significant reduction in instances of stigma and discrimination in health settings. Participants noted that the periodic network meetings and continuous sharing of information through the community of practice, contribute to cross-learning among peers which translates into strengthened programmes. A key resource is the online dialogue space, HIV-related Stigma and Discrimination Community of Practice: Asia & Pacific Region. The next network meeting will be held in quarter two of 2023.

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