Integration and scale-up of efforts to measure and reduce HIV-related stigma: the experience of Thailand

Abstract

Note 1: Relative risk compares the incidence of two populations. Incidence for sex workers, people who inject drugs and transgender people was estimated and then divided by the global incidence of HIV among adults aged 15-49, estimated using the Spectrum models. Incidence for gay men and other men who have sex with men was estimated and then divided by the global incidence of HIV among male adults aged 15-49. Note 2: Transgender people estimates are derived only in the Asia and the Pacifi c, Caribbean, Latin America, and western and central Europe and North America regions. Note 3: Relative risk is interpreted as follows: sex workers have 21 times greater risk of acquiring HIV than adults aged 15-49 in the total population. Source: UNAIDS special analyses using Spectrum 2019 results and 2019 Global AIDS Monitoring submissions, supplemented by data from published literature.More than half of new infections are among key populations and their sexual partners Key populations make up a small proportion of the general population, but they are at extremely high risk of HIV infection. Available data suggest that the risk of HIV acquisition among gay men and other men who have sex with men was 22 times higher in 2018 than it was among all adult men. Similarly, the risk of acquiring HIV for people who inject drugs was 22 times higher than for people who do not inject drugs, 21 times higher for sex workers than adults aged 15-49 years, and 12 times higher for transgender people than adults aged 15-49 years (Figure 2.8).Strong progress in settings with high HIV prevalence in eastern and southern Africa, where HIV is predominantly transmitted within the general population-combined with a mixture of progress and setbacks in lower prevalence regions-has seen the global distribution of new HIV infections in 2018 cross a notable threshold: the majority of global infections were among key populations and their sexual partners. (Figure 2.9) Gay men and other men who have sex with men accounted for an estimated 17% of new HIV infections globally, including more than half of new HIV infections in western and central Europe and North America, 40%

Using a mixed‐methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana

“…Modular sessions accommodate differing hospital schedules. Depending on the setting and adaptation, the curriculum can range from a total of 6–14 hours delivered in 1–3 hour sessions [46, 47]. Stigma‐reduction champions, which emerge organically from the trainings and are supported by HCF management, develop and implement additional stigma‐reduction activities in their facilities.…”

“After all, we are all sick”: Multi-stakeholder understandings of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda

“…It's on this account that integrating NCDs into HIV care is being promoted in low resource countries in East Africa [20]. In developed countries, integration has been adopted and scaled up to ensure that HIV related stigma is dealt with [21]. Based on our consultations, it's clear that integrating NCDs into HIV care will be a strong pillar in eliminating stigma in the health care system especially for chronic conditions.…”

A pretest‐posttest design to assess the effectiveness of an intervention to reduce HIV‐related stigma and discrimination in healthcare settings in Vietnam

“…As patients often receive healthcare from more than one healthcare provider and from multiple facilities, it is possible that ongoing discrimination may have occurred at facilities that were not participating in the intervention. These findings highlight the importance of employing ongoing efforts to measure, understand and reduce HIV‐related stigma [27] and suggest that a system‐wide response may be necessary to fully tackle stigma and discrimination in the healthcare setting [32].…”