Stigma, like beauty, is in the eye of the beholder

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Reducing stigma and discrimination has been at the forefront of Jamaica’s national response to HIV for several years. One week ago today, in Kingston Jamaica, we presented some recommendations for how the capacity of healthcare workers could be improved so that stigma and discrimination experienced by people living with and vulnerable to HIV are reduced at point of care.

Stigma – like beauty – is in the eye of the beholder. Change starts with each one of us, knowing and being honest about our beliefs, prejudices, and morals. A training to address stigma among healthcare workers for example must be transformative – to tap into personal beliefs, values, attitudes and behaviours that are the drivers of stigma. In other words training must not be ‘business as usual’ and in fact have a ‘sparkle’ that can engage the hearts as well as the minds of participants.

Several strategies have been adopted to reduce and mitigate the effects of stigma and discrimination such as policy development and advocacy, education and public awareness campaigns as well as capacity development for health care workers to specifically focus on reducing barriers to accessing health services. Despite concerted efforts, HIV-related stigma and discrimination continue to undermine prevention, diagnosis, treatment and care for HIV in Jamaica.

Often stigma and discrimination are grouped together as though they are one and the same thing. Stigma is commonly known as a process of devaluation of an individual or group; whereas discrimination is treating someone or a group differently and is often seen as the result of stigma. In order to reduce stigma and mitigate its effects, trainings, workshops and other interventions should focus specifically on stigma as distinct but related to discrimination; and vice versa.

We have been working with a team in Jamaica to undertake this assessment of stigma and discrimination in the training of healthcare workers over the last year. Last week we presented the findings at a meeting in Kingston, hosted by the National Family Planning Board. The objectives the assignment were:

  1. To identify the strong points and good practice already in place in Jamaica in regard to the curricula for developing the capacity of health care workers to provide “stigma-free” comprehensive and quality HIV services.
  2. To locate any gaps or training areas that need strengthening.
  3. To make recommendations on how stigma and discrimination trainings for the capacity development of healthcare workers can be improved in Jamaica.

IMG_0108Our assessment found that most of the curricula reviewed did distinguish between stigma and discrimination, but then went on to merge concepts and address both equally in the content that followed. The terms were often interchanged, without an explicit focus on stigma or discrimination separately, nor strategies to address each specifically. Few of the curricula considered internalised stigma. Some linked to discussions about creating an enabling environment, however content related to human rights was abstract and not easily translated to action and implementation at the facility level.

The interviews and focus group discussions we did (and we spoke with more than 70 people in total) highlighted that in trainings at the moment, often stigma relating to HIV is conflated with stigma relating to sexual orientation, and that further engagement with the layers of stigma would be useful.

The results and recommendations of the assessment were presented in a report, titled: “Avoid frying a hardboiled egg: Recommendations and findings from a review of HIV-related stigma and discrimination in training processes to enhance the capacity development of healthcare workers in Jamaica.”

The title of this report is based on suggestions that emerged during the interviews with stakeholders. It was suggested that sensitisation to issues relating to stigma and discrimination should start early, such as in the orientation materials and pre-service training for newly qualified healthcare workers, so that positive normative behaviours are established from the outset. It was noted that this may be an easier and more effective intervention than at later stages in their professional development, once or if negative behaviours have already formed. Otherwise, as one interviewee said, it is starting too late: “like trying to fry a hardboiled egg.”

Further details about the report are available from the National Family Planning Board of the Government of Jamaica. In 2013 aspects of the National HIV/STI Programme were integrated into the National Family Planning Board including work in the areas of human rights and the reduction of stigma and discrimination, through the entity’s Enabling Environment and Human Rights (EEHR) Unit. The recommendations of the assignment are intended to inform the development of a national stigma and discrimination reduction strategy. The report was developed with technical and funding support from the USAID through its implementing partner, LINKAGES Jamaica.

We humbly acknowledge the expanse of innovative and pioneering work to respond to stigma and discrimination relating to HIV in Jamaica over many years. It is hoped that our report and the recommendations contribute to this body of work. We also hope the conversations help to move our collective efforts further forward towards mitigating the harmful personal and societal effects of stigma and discrimination.

In the words of the great Bob Marley,

IMG_8519Get up, stand up. Stand up for your rights. Get up, stand up. Don’t give up the fight.” –Get Up, Stand Up (Bob Marley, Burnin 1973)

One love, one heart. Let’s get together and feel all right.” –One Love / People Get Ready (Bob Marley, Exodus 1977)

Personal commitment and integrity to have the courage to respond to and reduce stigma starts with each one of us.

Lucy Stackpool-Moore

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