Countering Stigma

While a recent review¹ concluded that "relatively few interventions to reduce AIDS-related stigma have been conducted (or at least rigorously evaluated, documented and published) in developing countries, research undertaken also indicates that local communities have been exploring ways of reducing levels of stigma through:

• the dissemination of information;
• coping-skills acquisition;
• counselling approaches;
• programmes promoting greater involvement of people living with HIV/AIDS;
• monitoring violations of human rights and creating a supportive legal environment; and
• enabling people to challenge discrimination."

In Israel² and in Jamaica³, more positive attitudes towards people living with HIV/AIDS have been promoted through peer education, lectures, pamphlets and workshops, although the effects of such behavioural change remain undocumented.

Combining information-based approaches with counselling has been shown to increase disclosure among people living with HIV/AIDS, and has triggered improved community attitudes compared with baseline measures in countries such as Uganda⁴ and Zimbabwe⁵. In Uganda, the work of The AIDS Support Organisation (TASO) and other community-based groups has been central to encouraging greater openness about the epidemic and in providing support and care to individuals, families and communities living with HIV/AIDS⁶.

Zambia⁷ was one of the first African countries to implement HIV/AIDS home-care services, and the Ndola Catholic Diocese Home-Based Care Programme has been internationally recognized for the high quality of its work. Thanks to strong community participation and the motivation of the programme's volunteers, over 70% of those in need of HIV/AIDS-related care are being reached. Consequently, perhaps, negative attitudes towards HIV/AIDS reportedly lessened and local people have been empowered with the knowledge, skills and self-confidence they need to cope with the impact of the epidemic⁸.

In Phayao Province in the north-east of Thailand, multisectoral work bringing together a range of governmental and nongovernmental organizations was key to reducing new infections in this badly-affected area in the late 1990s, and in promoting good-quality home- and community-based care. A people-oriented approach facilitated greater openness about the epidemic, and the promotion of a 'care not scare' approach reportedly stimulated greater social cohesion and support⁹.

In the United Republic of Tanzania, teachers and health workers implemented a two-to-three-month programme of AIDS-related information, small group discussions, and role play to improve primary-school-age children's knowledge, attitudes and practices. Follow-up 12 months later showed that attitudes towards people living with HIV/AIDS had significantly improved¹⁰.

In the United States of America, an early study used information and coping-skills development to resolve negative feelings among physical therapy students and increase their willingness to treat people living with HIV/AIDS¹¹.

Contact with HIV-infected or -affected groups have been used in several studies and programmes. The belief here is that a more personal relationship with people living with HIV/AIDS (either through face-to-face conversations or by hearing a testimonial from infected or affected individuals) will demystify the disease and dispel misinformation, generating empathy, which, in turn, reduces stigma and prejudice. Such work shows mixed results, with some studies reporting reductions in negative attitudes, and others not.

Notes

1. See www.popcouncil.org/pdfs/horizons/litrvwstigdisc.pdf.
2. Soskolne V et al. (1993) Immigrants from a Developing Country in a Western Society. Evaluation of a HIV Education Programme. Paper presented at the International Conference on AIDS, Berlin.
3. Hue L, Kauffman C (1998) Creating Positive Attitudes towards Persons Living with HIV/AIDS among Young People in Hostile Environments. Paper presented at the International Conference on AIDS, Geneva.
4. Kaleeba N et al. (1997) Participatory Evaluation of Counselling, Medical and Social Services on The AIDS Support Organisation (TASO). AIDS Care, 9, 13-26.
5. Kerry K, Margie C (1996) Cost-Effective AIDS Awareness Program on Commercial Farms in Zimbabwe. Paper presented at the International Conference on HIV/AIDS, Vancouver.
6. Kaleeba N et al. (2000) Open Secret: People facing up to HIV and AIDS in Uganda. St Albans, TALC.
7. Nsutebu E et al. (2001) Scaling up HIV/AIDS and TB Home-based Care: lessons from Zambia, Health Policy and Planning, 16. Summary at www.id21.org/health/h5en1g1.html.
8. www.unaids.org/bestpractice/digest/files/Volunteersinhomecare.html.
9. www.unaids.org/publications/documents/care/general/una0004e.pdf.
10. Klepp K et al. (1997) AIDS Education in Tanzania: Promoting risk reduction among primary-school children. American Journal of Public Health, 87, 1931­1936.
11. Held S (1992) The Effects of an AIDS Education Program on the Knowledge and Attitudes of a Physical Therapy Class. Physical Therapy, 73, 156­164.