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.

1. Targeting stigma and
discrimination
Prof John de Wit

2. Wednesday, August 6, 2008
‘Stigma remains the single most
important barrier to public action.’

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. 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. • 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. 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. • 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. • 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. • 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. 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