aids 2010 combination hiv prevention evaluation 22 july 2010 laurel sprague, gnp+
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AIDS 2010 Combination HIV Prevention Evaluation 22 July 2010 Laurel Sprague, GNP+ Wayne State University. PLHIV Doing It For Themselves Lessons from the PLHIV Stigma Index. 22 July 2010 Combination HIV Prevention Evaluation. 2. PLHIV Stigma Index. Joint initiative of: - PowerPoint PPT PresentationTRANSCRIPT
AIDS 2010 Combination HIV Prevention
Evaluation22 July 2010
Laurel Sprague, GNP+Wayne State University
www.gnpplus.net
222 July 2010 Combination HIV Prevention Evaluation
PLHIV Doing It For Themselves
Lessons from the PLHIV Stigma Index
www.gnpplus.net
322 July 2010 Combination HIV Prevention Evaluation
PLHIV Stigma Index Joint initiative of:
International Community of Women Living with HIV (ICW) International Planned Parenthood Federation (IPPF) Joint Programme on HIV/AIDS (UNAIDS) Global Network of People Living with HIV (GNP+)
Measures PLHIV experiences with stigma, discrimination, and human rights violations
Participative research based in GIPA principle and human rights
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422 July 2010 Combination HIV Prevention Evaluation
HIV-Related StigmaStigma = Social devaluingDevaluing occurs when one:
Tests positiveAccesses prevention, testing, or treatmentDiscloses one's positive statusBecomes visibly illAssociates with vulnerable communities
Incentives not to know or tell
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What's Stigma Got To Do With It?
Combination HIV Prevention:Biomedical ART, PMTCT
Behavioral
Social
Structural
Education, testing, risk reduction, disclosure, treatmentNorms about violence, gender, relationships, private-public space; secondary marginalization; mobilization and social movementsLegal, political, justice, health, economic, and family systems
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622 July 2010 Combination HIV Prevention Evaluation
Measurement Challenges• Identifying newly emerging and locally specific
concerns• Interpreting results from general population
studies• Reaching “hard to reach” populations• Drawing linkages between individual, social and
structural level interventions and effects
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Country and Sample SizeAsia PacificBangladesh (238)China (2096)Myanmar (324)Philippines (80)EuropeUK (867)
AfricaKenya (1086)Rwanda (1530)Zambia (854)Latin AmericaDominican Republic (1000)Paraguay (256)
www.gnpplus.net22 July 2010 Combination HIV Prevention Evaluation
Identifying Newly Emerging and Locally Specific Concerns
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Testing Barriers in Zambia
22 July 2010 Combination HIV Prevention Evaluation
Testing facility issues
Fear of the Results
Fear of Stigma or Discrimination
Confidentiality Concerns
Lack of education about testing
Issues with counseling
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
39%
29%
16%
6%
5%
3%
HIV Testing and Diagnosis - ZambiaMain Problems and Challenges
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Interpreting Results from General Population Studies
22 July 2010 Combination HIV Prevention Evaluation
www.gnpplus.net22 July 2010 Combination HIV Prevention Evaluation
Family Exclusion in ChinaExcluded from family life/activities:
– 5% of sampleResponse to HIV infection was supportive or very
supportive– 69% of spouses/partners– 62% of other adult family members– 80% of children
Percent who disclosed to close family members– Fewer than 2 out of 3 (50-61%)
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22 July 2010 Combination HIV Prevention Evaluation
Discrimination by Health Care Workers
Denied health services in the last 12 months because of HIV status:
– Philippines – 8%– China – 12% – Paraguay – 17% – UK – 17%
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Reaching “Hard to Reach” Populations
22 July 2010 Combination HIV Prevention Evaluation
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Key Populations in Myanmar Sample
22 July 2010 Combination HIV Prevention Evaluation
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23
21
17
10
88
Migrant workersFemale sex workersMen who have sex with menPrisonersInjecting drug usersInternally dis-placed personsIndigenous group
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Drawing Linkages Between Individual, Social, and Structural Level Interventions and Effects
22 July 2010 Combination HIV Prevention Evaluation
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22 July 2010 Combination HIV Prevention Evaluation
Voluntary Counseling and Testing
Tested under coercion or without consent:Philippines – 44%Paraguay – 24%
Received no pre- or post-test counseling:China – 35% Myanmar –
16%Philippines – 31% UK – 32%Dominican Republic – 27%
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22 July 2010 Combination HIV Prevention Evaluation
Human Rights Violations in the Philippines
23% experienced at least 1 human right abuse in the last 12 months
17% of them tried to get legal redress for this violation
Main reasons for not attempting redress:– Intimidated or scared– Insufficient financial resources– No or little confidence of success
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22 July 2010 Combination HIV Prevention Evaluation
Effecting Change in Kenya
Yes NoYes 75% (577) 25% (192)
No 26% (74) 74% (207)
*p=0.000
In the last 12 months, have you confronted, challenged or educated
someone who was stigmatizing you?
Are you a member of
a PLHIV network?
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22 July 2010 Combination HIV Prevention Evaluation
Concluding ThoughtsStigma creates a significant barrier to prevention efforts
and must be taken into account in prevention programs.
The PLHIV Stigma Index can help to handle measurement challenges with stigma and prevention evaluation –
Identifying new and local concerns Translating general surveys into useful information Reaching, hearing, and protecting “hard to reach” populations Linking individual, social, and structural effects– Particularly in combination with other evaluation tools
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22 July 2010 Combination HIV Prevention Evaluation
Concluding QuestionsWhat opportunities exist for collaboration with
other research tools?How can we build in funding and time for capacity-
building and technical assistance for both PLHIV networks and academic researchers to support collaboration?
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This research has been made possible by the people living with HIV who participated, in
Bangladesh, China, the Dominican Republic,Kenya, Myanmar, Paraguay, the Philippines, Rwanda, the UK, and Zambia
For more information please [email protected]@gnpplus.net
Or visit www.gnpplus.net
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