On July 27 Khuat Thi Hai Oanh, the Executive Director of SCDI (the Alliance Linking Organisation in Vietnam), gave a FANTASTIC presentation on stigma and discrimination at the International AIDS Conference in Washington.
She was speaking symposium session entitled Getting to Zero Excuses: Understanding and Addressing HIV-Related Stigma and Discrimination. You can watch a webcast of the session here.
The session description was as follows: HIV stigma and discrimination are consistently recognised as critical barriers to uptake of treatment, disclosure of status, timely entry into care and adherence. Yet investments in community level stigma and discrimination reduction efforts remain small in comparison to the stated need.
Oanh’s presentation was entitled ‘Working with community to tackle and discrimination’.
In Vietnam, two of the main drivers of the HIV epidemic are drug use and sex work. Until 2011, the Vietnamese Government’s approach to these ‘social evils’ was compulsory detention centers.
Oanh outlined three levels of stigma:
- Social network (micro-environment)
- Society at large (macro-environment)
She then discussed the following interventions to reduce stigma and discrimination:
- Peer counseling
- Soft skills: self-esteem, coping with stigma, and anger management
- Community building: creating a sense of belonging and connectedness
- Practical support: access to methadone maintenance treatment (MMT), testing, treatment, job training, and microcredit
SCDI and their partners have built on and created networks of persons living with HIV, sex workers, and drug users.
At SCDI they know that such interventions make a huge difference to people’s lives. Take for example the story of Pham Thi Minh. She used heroin for 11 years and was in and out of the rehabilitation centres three times before joining an SCDI self-help group which helped to turn her life around. Minh showed a natural flair for leadership and within days the group chose her as their leader. After that there was no stopping her, Minh now coordinates a coalition of people living with or affected by HIV and manages a self-help group for drug users. You can read her full story here.
SCDI also produce a magazine entitled Song Chung Voi HIV (Living with HIV). People living with HIV produce 80% of the content.
The impact of the kind of work SCDI is doing can be seen in an evaluation conducted by the Yale School of Public Health. It found that members of drug user clubs in Vietnam have a higher quality of life and use clean needles more often than non-members. SCDI have produced a photo book which illustrates their work with people who use drugs entitled Face-to-Face with Drugs.
Following SCDI and its partners combined efforts:
- Stigma and discrimination against people living with HIV were prohibited by law in 2007.
- Harm reduction was legalized in 2007
- Drug use was decriminalized in 2009
- Compulsory rehab centers for sex workers were abandoned in 2012
- Compulsory rehab centers for drug users are to be reduced from 2012
1) Tackling stigma and discrimination is a long-term battle requiring multiple approaches, some specific to stigma and discrimination and some integrated into personal or organizational development, program interventions, communications, and advocacy and
2) We need to wear ‘stigma-sensitive lenses’.
As Oanh said in conclusion of to her presentation “community is the heart and the brain of any intervention.”
The other presenters on the panel were: Georgina Caswell of South Africa on the People Living with HIV Stigma Index; Maurice Tomlinson of Jamaica on HIV criminalization; Shari Margolese of Canada on reproductive justice for people living with HIV; Laura Nyblade of the U.S. on programmes and tools for reducing stigma and discrimination.