Communitybased Stigma Reduction Programming: A TANZANIAN EXPERIENCE Kimara Peer Educators and Health

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Community-based Stigma Reduction ProgrammingA
TANZANIAN EXPERIENCE Kimara Peer Educators and
Health Promoters Pfiriael Kiwia
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Kimara Peer Educators

• Community based organization
• Founded 1992
• Operating in a high HIV prevalence peri-urban
  community of Dar es salaam, Tanzania
• National HIV prevalence 7
• Dar-es-Salaam 10.9
• (Tanzania HIV indicator Survey, 2003-2004)

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Core activity areas

• Integrated prevention, Information dissemination,
  Care and support
• Capacity building to local emerging NGOs/CBOs on
  HIV/AIDS Programming
• Participation in research and linking it to
  grassroots communities for effective HIV/AIDS
  responses
• Networking and collaboration

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Context Issues

• Poor VCT uptake
• Over 80 of the infected people do not know their
  HIV status
• For those knowing status, low disclosure to
  partners, family
• impedes prevention
• Poor PMTCT uptake and adherence
• Poor TB diagnosis and treatment adherence

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WHY?

• Community saying HIV-related Stigma and
  Discrimination
• Joined Research Project on SD
• Research Confirmed SD as a major factor (ICRW
  MUCHS, 2003)

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Steps to address SD in Kimara programs

• Level one
• Focusing on the organization (staff and
  volunteers) and key community leaders
• Level two
• Community mobilization events dealing with SD
  and promoting non-tolerance to SD

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Level one Participatory Training

• Increased understanding of SD
• Reflection on how SD affects people in different
  contexts
• Built skills in the utilization of the guide
  Challenging HIV related Stigma Toolkit for
  Action
• Developed plans of action for incorporation of
  SD into ongoing activities

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Level two Forging Community Support and
Understanding

• Integration of SD into all progam activities
• Community based outreach sessions for information
  dissemination (on stigma specifically?)
• Special focus on PLHAs and supportive sessions in
  families affected and those caring for a PLHA

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Lessons Learned What works

• Need to start with own staff first
• Create awareness of and deal with SD at home
• Equip with necessary skills and tools
• Provide ongoing space for reflection and feedback
• Inclusivity Incorporate as many stakeholders as
  possible in the discussions

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Lessons Learned What works

• Build community partnerships
• Involve key local leaders trusted by community
  who shape opinions and have power to mobilize
• Involve PLHA sharing of true life experiences is
  powerful and motivational

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Lessons Learned What works

• Focus on PLHA
• Post HIV test clubs peer to peer support
• Reduce self-stigma Lays foundation for coping,
  accessing support and services
• Build on existing organizational and program
  strengths
• Link to other groups, networks, services
• Share experiences, train others, referrals

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Lessons Learned What works

• Understanding and Challenging HIV Stigma Toolkit
  for Action
• Allow people to
• Talk Reflect
• Start-up committed actions
• Does this by
• Simple tools visuals alone highly effective
• Participatory methods
• Providing safe spaces for discussion and
  reflection of sensitive and challenging issues

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Gaps in Knowledge Programming

• Documentation and sharing of lessons learned
  across settings and groups
• How to scale up what works locally to national
  level
• Role of increased availability of ART and other
  HIV/AIDS services
• Will it reduce stigma or increase it?
• Use of ART and use of HIV/AIDS services confirms
  positive HIV status

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Gaps in Knowledge Programming

• Intersection of vulnerability of women and
  children and stigma
• Property grabbing
• Abandonment
• Violence
• Modified stigma-reduction tools
• Youth
• Religious Leaders
• Home based care givers
• Orphan and Vulnerable children and their care
  givers

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Challenges

• High expectations for a quick and large reduction
  in SD
• Within Communities
• By Donors
• Reality is SD eradication is a slow process
• SD is deeply rooted
• HIV causes fear

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Challenges

• Need long-term interventions and sustained
  funding
• Links and a mechanism to share lessons learned at
  community-level nationally
• National and International political and donor
  recognition of stigma as a critical issue to
  address

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Stigma is Actionable!

• Simple tools and intervention models exist
• Communities are ready and open to change