WITH HIV STIGMA INDEX THE PEOPLE LIVING RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

Transcription

1 THE PEOPLE LIVING WITH HIV STIGMA INDEX RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

2 EXECUTIVE SUMMARY Prepared by Anuar Luna and Juan Simbaqueba ASSESSORSHIP Hege Wagan, UNAIDS Rodrigo Pascal, UNAIDS Rubén Antonio Pagés, UNAIDS Miguel Martínez, CRAT EDITORIAL DESIGN Antonio Muñoz Alberto Herbel Coordination: Centro Regional de Asistencia Técnica para Latinoamérica y el Caribe de Vía Libre - International HIV/AIDS Alliance. June Panama.

3 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA THE PEOPLE LIVING WITH HIV STIGMA INDEX SITUATION AND RESPONSE ANALYSIS AND STRATEGY DEVELOPMENT TOWARDS 2015

4 SUMARY BACKGROUND OBJECTIVES COUNTRIES THAT HAVE THE INDEX OF STIGMA IN PLHIV METHODOLOGY SITUATION AND RESPONSE ANALYSIS WITH THE RESULTS OF THE PEOPLE LIVING WITH HIV STIGMA INDEX IN LATIN AMERICA LESSONS LEARNED AND TECHNICAL RECOMMENDATIONS BY THEME FOR COUNTRIES THAT WILL BEGIN THE PLHIV STIGMA INDEX IMPLEMENTATION PROCESS. STRATEGY TOWARDS 2015 FOR THE PEOLE LIVING WITH HIV STIGMA INDEX IN LATINAMERICA

5 BACKGROUND The People Living with HIV Stigma Index (PLHIV Stigma Index) resulted from a collaboration between UNAIDS, the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV/AIDS (ICW) and the International Planned Parenthood Federation (IPPF) in 2004; this alliance developed a tool to measure the stigma experienced among people living with HIV. The project s backbone is its advocacy focus through a comprehensive process, that includes the empowerment of people living with HIV; and emphasizes the necessary nuances for a better understanding and documentation of stigma among people living with HIV. The ultimate aim of the PLHIV Stigma Index is to improve programs and policies, with the objective of achieving universal access on prevention, treatment, care and support through the use of the data. The PLHIV Stigma Index is a tool that can be used to evaluate efforts to addressing stigma, and to collect evidence and generate advocacy strategies to promote structural, social and attitude changes. UNAIDS Regional Support Team for Latin America has a particular interest in developing a study on the situation and response analysis, as well as a strategy towards 2015 for The People Living with HIV Stigma Indexes in the region. Other relevant interests are: the follow-up to the results of the Latin American Universal Access Regional Consultation (March 2011), where it was agreed that a key action was to establish baselines about stigma and discrimination towards people with HIV; using the PLHIV Stigma Index; as well as the follow-up to the civil society demands in the HIV LAC Regional Forum (Sao Paulo, September 2012) where the need to monitor the agreements of the Regional Consultation was emphasized. Up to now, eight countries have concluded The People Living with HIV Stigma Index: Argentina, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Mexico and Paraguay. And five countries (Belize, Costa Rica, Nicaragua, Honduras and Panamá) are beginning to develop the PLHIV Stigma Index with the support of Central American Network of People Living with HIV (REDCA+) Global Fund project. THE PEOPLE LIVING WITH HIV STIGMA INDEX 1

6 OVERALL OBJECTIVE: To contribute in the use of the PLHIV Stigma Index in the countries that have already concluded it, and support the PLHIV Stigma Index implementation in those countries where the process is beginning; through the situation and response analysis done so far and the development of the strategy towards SPECIFIC OBJECTIVES: a To describe the current situation and the response analysis of the PLHIV Stigma Index in the eight Latin American countries that have concluded it, to strengthen their implementation on regional and national levels, and to identify the needs of technical support for the implementation of the PLHIV Stigma Index in the five countries in Central America that are starting the process. b Develop a strategy towards 2015 for the PLHIV Stigma Index in Latin America, that includes lessons learned and practical recommendations for three years taken from the situation and response analysis components of the PLHIV Stigma Index. 2 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

7 The ultimate aim of the PLHIV Stigma Index is to improve programs and policies, with the objective of achieving universal access on prevention, treatment, care and support through the use of the data. THE PEOPLE LIVING WITH HIV STIGMA INDEX 3

8 COUNTRIES THAT HAVE THE INDEX OF STIGMA IN PLHIV MEXICO GUATEMALA EL SALVADOR COLOMBIA ECUADOR BOLIVIA PARAGUAY ARGENTINA 4 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

9 Five countries are beginning to develop with the support of Central American Network of People Living with HIV (REDCA+) Global Fund project: Belice Costa Rica Nicaragua Honduras Panama THE PEOPLE LIVING WITH HIV STIGMA INDEX 5

10 METHODOLOGY This work is divided in two main products: Situation and response analysis of the PLVIH Stigma Index in Latin America Strategy towards 2015 for the PLHIV Stigma Index in Latin America Three different segments of analysis were done for the situation and response analysis of the PLHIV Stigma Index in Latin America. Two of them focused on the study of the PLHIV Stigma Index reports in eight countries (secondary sources), and one of them focused on the opinions and perceptions of the key actors involved in the implementation and development of the projects in those eight countries that have concluded the study (primary sources). The opinions and perceptions of two key actors involved in the PLHIV Stigma Index implementation in Central America, by the Round 9 grant of the Global Fund for the Central American Network of People Living with HIV (REDCA+), were included. In the full report of the consultancy there is a detailed description of the methodology aspects. 6 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

11 For the design of a strategy towards 2015, priority areas of operation, objectives and key actions were defined for the use of the PLHIV Stigma Indexes in the eight countries that have completed it, as well as for the PLHIV Stigma Index implementation in the five Central American countries that are beginning with the process, and five other South American countries that have not yet commenced the implementation process. This section was made with a projection for the period; with emphasis in four areas or action mechanisms: management, technical support, advocacy and monitoring and evaluation. THE PEOPLE LIVING WITH HIV STIGMA INDEX 7

12 SITUATION AND RESPONSE ANALYSIS WITH THE RESULTS OF THE PEOPLE LIVING WITH HIV STIGMA INDEX IN LATIN AMERICA Below is a summary of the main findings in the comparative exercise of the PLHIV Stigma Indexresults, by section, according to the order of the research instrument. Demographic aspects The samples used in the countries turned out to be very inclusive and homogenous with respect to the distribution of participants according to sex/gender. Men s participation varied between 50% and 65%, while women s participation varied between 25% and 50%. Participation of transgender women varied between 2% and 15%. The distribution by age shows that the majority of the people interviewed were between 30 and 39 years of age, followed by the group between 40 and 49 years of age, and finally the group between 25 and 29 years of age. According to the length of time since the diagnosis, the majority of the people interviewed were in the range between 1 to 9 years of being diagnosed. Between 50% and 80% of the participants were in this range. The sample varies significantly with regards to relationship status. Although it is possible toassert that the main similarities among the samples consist in that the majority of the people interviewed are either married, live with their partners or are single, the rest of the options (e.g. divorced, widowed, separated) show differences between the countries. Regarding the sense of belonging to other vulnerable groups, an interesting aspect for reviewing and evaluating is the fact that with the exception of Mexico and Colombia, between 50% and 80% of the participants do not identify with any of the vulnerabilitycontexts presented by the PLHIV Stigma Index. It would be worth looking at whether these vulnerability contexts are appropriate for the 8 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

13 region, or if the people have difficulty to identify themselves with them. Exploring this panorama could become an exercise for future analysis. Sexual activity as a measure of the sexual and reproductive rights of the people living with HIV is an indicator in the PLHIV Stigma Index. The regional situation shows that countries like Ecuador, Paraguay and Colombia have the highest percentages of sexual activity among those interviewed, while Bolivia, El Salvador and Guatemala are 20 percentage points below the rest of the countries. The level of education and work life of the people living with HIV vary and are less homogeneous than the rest of the demographic aspects explored so far. Although the majority of the people had access to elementary or secondary education, there are significant differences from country to country. The work situation of those interviewed also shows significant differences between the countries. More than half of the people interviewed in Bolivia are full time informal workers. Unemployment is consistent and worrying between women in Mexico and Guatemala: around 40%. In Colombia, Bolivia, Ecuador, Paraguay and El Salvador, unemployment is above 25%, getting close to 40%. If we would show the percentages of unemployment together with the full time and part time informal workers, the panorama is quite worrying considering that around 70% of the people living with HIV in these countries are in what researchers consider occupational fragility, this shows the seriousness regarding the working rights in the context of living with HIV. This situation reveals the need of having social protection policies that ensure the basic rights of the people and their social surroundings. Having official national data about unemployment in each country would generate a contextual framework for this information. 70% PLHIV in these countries are in what researchers consider occupational fragility THE PEOPLE LIVING WITH HIV STIGMA INDEX 9

14 THE EXPERIENCE OF STIGMA AND DISCRIMINATION IN THE COMMUNITY OR AT THE HAND OF OTHERS Below we show important facts about external stigma, making emphasis on the most relevant. There is a significant difference in the data from Guatemala compared with the rest of the countries (where close to 95% of the people interviewed reported not being excluded from social activities). This can be due to the true absence of discrimination or to other factors like levels of disclosure of HIV status.. In the analysis of some of the countries, the percentages of exclusion coincide with level of disclosure. It is also important to highlighting the differentiated impact of the situation between transgender women, whom are clearly much more discriminated against in wider society. Stigma and Violence The most evident manifestations of stigma and discrimination are marked by actions of violence in different levels. From the data shown in the PLHIV Stigma Index reports included in the analysis, we took four indicators that constitute clear evidence of the ways in which stigma is manifested, camouflaged and naturalized in the contexts of interaction with people living with HIV: gossiping, verbal aggressions, physical aggressions and emotional manipulation. Feeling that people gossip is manifested with a frequency that varies between 55% and 95% (the highest in the case of transgender women in Mexico). Situations like this, are naturalized in such a way that people incorporate them in their everyday lives, and most of the times they prefer not to pay attention in spite of the impact those have on their self-esteem. Feeling that people gossip incorporate them in their everyday lives, and most of the times they prefer not to pay attention in spite of the impact those have on their self-esteem. 10 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

15 With regard to violence due to stigma, figures show that physical and verbal aggressions vary between 20% and 30% in the typical distribution of the region. If we make a cross reading with disaggregated data from other countries, we observe that violence has a differentiated impact and that the transgender population is clearly in disadvantaged. Physical aggressions vary between 7% and 43%, this being a strong indicator of the discrimination experience by other people. Emotional manipulation from the partners it is not neutral and it is presented in proportions that vary between 5% and 20%. Work, Health and Education Conditions related with health access, occupational fragility described in the demographic aspects of the analysis and problems, and universal access to education and educational facilities are elements that affect people living with HIV in a particular way. The development of a fulfilling life entails the assurance of basic citizenship rights. Stigma generates barriers for access to services, either by direct refusal, by exclusion or due to the difficulties in reporting abuses and claiming rights. Internalized Stigma The fact that people living with HIV have negative feelings is not a result of an introspective exercise, but a result of interactions and social pressures that determine or facilitate this types of feelings and behaviors. The negative feelings associated with the fact of living with HIV, include self-blame, shame and guilt. Self-blame is the top negative feeling in every country except for Guatemala, followed by guilt and then shame. A complex reality appearing in this panorama is the high prevalence of suicidal ideation, that ranges from 13% to 25%. The development of a fulfilling life entails the assurance of basic citizenship rights. THE PEOPLE LIVING WITH HIV STIGMA INDEX 11

16 Rights, laws and policies The lack of knowledge of the national policies for prevention, comprehensive care of HIV, and of the Declaration of Commitment signed by the governments in the response to HIV, are evidence of the lack of knowledge about the law and rights of the people living with HIV in the countries where the study took place. Testing and Diagnosis Voluntary Testing and Counseling (VCT) is an important aspect in the lives of the people. It is a situation in a single life moment that generates stress. The results of the interviews suggest that for the majority of the people, the motivation for testing and to receive counseling did not come from themselves; but was due to external agents, for example, as a suggestion from a health professional or some change in their health. Coerced testing and testing without consent varied between 6% and 20% in every country where the Stigma Index was applied, in spite of the legislation in every country which recommends the need for mandatory counseling before and after testing. Between 20% and 40% of the people interviewed did not receive any such counseling. 12 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

17 Confidentiality and sharing the HIV status An essential aspect of the process of living with HIV is the persons capacity to be able to disclose their HIV status, and/or being sure that this information will not be shared by other people without the consent of the person who lives with HIV. The PLHIV Stigma Index explores if people living with HIV were pressured by other people to disclose their status. In this regard, the percentage of people that were never pressured to disclose their status is high, between 86% and 91%. One of the scenarios where the status is usually revealed without consent is in health service facilities. The lack loss of confidentiality from the hands of health workers goes from 10% (El Salvador) to 26% (Bolivia). The level of mistrust that the medical records will remain confidential goes from 7.6% in Mexico to 22.7% en Colombia. Finally, the feeling of sharing the HIV status by the person s own will, was described as an empowering experience in 82% of the cases. Treatment This section explores the quality of health of the people living with HIV and their access to the antiretroviral therapy. It also includes information about the possibility of discussing sexual and reproductive health issues with health care providers. The participants that were taking ARV treatment go from 81% in Bolivia to 96.9% in El Salvador. The level of perception of having guaranteed access to the ARV therapy go from 98% in Mexico to 64.7% in Ecuador. The results of the interviews suggest that for the majority of the people, the motivation for testing and to receive counseling did not come from themselves THE PEOPLE LIVING WITH HIV STIGMA INDEX 13

18 Sexual and reproductive health and HIV The data collected in this section gives a panorama regarding the reproductive options of the people living with HIV and about the way in which stigma and discrimination have become barriers for the fulfillment of the sexual and reproductive rights of these people. It also identifies the gaps in the comprehensive health services, like linking sexual and reproductive health with HIV services. It also describes the effects of prejudice among health care providers regarding sexuality in general, and reproduction in the context of HIV. The topics related to sexual and reproductive health give worrying information regarding practices that range from suggesting not to have children to forced sterilization of women. In Guatemala 34% of the women interviewed were advised by a medical professional not to have any children, while in Mexico 17.5% of women received the same advice. Coerced sterilization happened to 13.6% of the women in Ecuador and 4.6% of the women in Mexico. Access to ARV treatment was made conditional on exchange for a method of family planning for 12% of the women in Bolivia, while 3% of the women in the same country were forced to terminate their pregnancy. The regional review has also highlighted the need for a more consistent way to prepare the cross analysis between categories like sexual orientation, to determine the degree in which gay men have received counseling regarding their sexual health, because that cannot be determined directly from the PLHIV Stigma Index. This difficulty can be due to the election of methodologies that favor a population focus for the design of sample. The topics related to sexual and reproductive health give worrying information regarding practices that range from suggesting not to have children to forced sterilization of women. 14 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

19 Perceptions and opinions of key actors involved in the PLHIV Stigma Index implementation that concluded in eight Latin American countries and in five Central American countries that are on the process of implementation. Situation of the PLHIV Stigma Index in eight countries up to December 2012 Between 2009 and 2011 the Stigma Index was implemented in eight Latin American countries. To date, all these countries have concluded the process and have published their results (printed and electronic versions). The majority are now in the process of disseminating the results with key institutions and with people living with HIV, as well as in cities and regions where the information was gathered. Mayor successes of the PLHIV Stigma Index implementation in eight countries The GIPA Principle was promoted through the engagement and training of people living with HIV in most of the stages of the process. Work quality across multisectorial teams. Strengthening of organizations and networks of people living with HIV. Ownership of the study by government institutions (Health Ministries and Town Counsels). Positioning in the public agenda of the subject of stigma and discrimination on a national level, by utilizing the evidence as an advocacy tool. Achieving the implementation of the first study about stigma among people with HIV. Visualization of the problems related with stigma and discrimination. Opportunity of delivering counseling and advice during the instrument s implementation process. The impact on the understanding of stigma and discrimination among the people interviewed as part of the process. THE PEOPLE LIVING WITH HIV STIGMA INDEX 15

20 Main barriers and obstacles during the PLHIV Stigma Index implementation in eight countries Implementation of the work plans according to the design of the samples. Adapting the language of the instrument to the cultural context of each country. There were conflicts in the definition and ownership of the Index concept. The study was not always considered an Index. The long duration of the application of the instrument and the extended length of time due to peer counseling interventions for interviewers. Weaknesses in the capacities, abilities and experience of the implementation teams, and lack of understanding among the research teams and the people living with HIV. Desertion of members of the research teams. Inexistence of networks or groups of people living with HIV in certain countries or regions. Weak collaboration with partners and key stakeholders prevented full compliance with the work agreements. Lack of adequate physical spaces for the application of the instrument. Inability to cover wide geographic zones o rural areas and the presence of natural disasters. Limited availability of financial resources. Engagement and involvement of the people living with HIV during the Stigma Index implementation in eight countries In general, the engagement and involvement of the people living with HIV was successful. Each country had different processes and mechanisms. The PLHIV Stigma Index s main focus which consists in the engagement and involvement of the people living with HIV, was satisfactory. 16 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

21 Creation of alliances for the Stigma Index implementation in eight countries: successes and difficulties The successes that stand out in the creation of alliances for the implementation are: the creation of a consensus for the development of protocols, samples and reports, complementarity among organizations and networking, and formulation of pacts to ensure the fulfillment of agreements. The opportunity to bridge differences between the government and the civil society and the use of a multisectorial focus were also mentioned. Finally, it was recognized that institutional synergy generates technical quality. The difficulties that stand out in the creation of alliances are: lack of capacity for a consensus protocol design and the technical approach to the final reports, institutional and personal interests for the project, capacity inequalities in some of the research teams, non-compliance of the agreements in medium levels and lack of capacity to mobilize financial resources. Use of the Stigma Index results as an advocacy tool in eight countries To date, most of the countries have advanced in an incipient usage of the data as a way to influence decision makers. Other forms of advocacy include actions for increasing capacity building and for the promotion of human rights. The use of the results to modify programs, policies and laws has not yet been initiated in a systematic way. In most of the countries the PLHIV Stigma Index implementation process has concluded with the dissemination of the results and the sharing of the results with key stakeholders. It is necessary to go beyond this process and develop strategies for mobilizing technical and financial resources so the countries can be able to advance in using the results as an advocacy tool. The dissemination of results among people living with HIV, NGO s, stakeholders, decision makers, governments and the general public, is the first THE PEOPLE LIVING WITH HIV STIGMA INDEX 17

22 element of advocacy. Up until the time of the interviews, most of the countries were in this process. The results as input for UNGASS reports, the development of national strategic plans and draft legislations were also mentioned as ways to use the results of the PLHIV Stigma Index. With the purpose of covering the programmatic aspects with the response to stigma and discrimination, it is necessary to offer technical support for the development of components and proposals for the Global Fund projects, and for other sources of funding that are linked to the national results of the PLHIV Stigma Index. The development and implementation of the advocacy plans based on the PLHIV Stigma Index s results, is a primary step that will enable to have a direct impact in the modification or repeal of public policies related with labor, sexual health and education, that are obstacles to the response to stigma and discrimination, and in consequence to the response to HIV. Each country must go forward in developing an advocacy agenda together with budgeted work plans that show objectives and concrete actions. The operative advocacy plans must include community mobilization components, social capital development, empowering of networks of people living with HIV and the establishment of strategic alliances that allow multisectorial collaboration. The development and implementation of the advocacy plans based on the PLHIV Stigma Index s results, is a primary step that will enable to have a direct impact in the modification or repeal of public policies 18 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

23 It is necessary to offer technical support for the development of components and proposals for the Global Fund projects, and for other sources of funding that are linked to the national results of the PLHIV Stigma Index.. The review has established the need to develop training tools for advocacy; these tools must include- in addition to the description of the methodological aspects for advocacy- key aspects on how to influence key policies related with stigma and discrimination linked with the subthemes that are covered by the PLHIV Stigma Index. Finally, a long-term aspect consists on implementing a plan that includes the development of research and additional studies related to the PLHIV Stigma Index, and a later implementation process after its first application, to measure its impact with time. THE PEOPLE LIVING WITH HIV STIGMA INDEX 19

24 LESSONS LEARNED AND TECHNICAL RECOMMENDATIONS BY THEME FOR COUNTRIES THAT WILL BEGIN THE PLHIV STIGMA INDEX IMPLEMENTATION PROCESS. Lessons learned about strategic alliances Work articulately between an academic organization and an organization of people living with HIV, coordinating the operative work of groups with different interests. It is important to reach consensus and have legitimate processes in civil society and the government. Ensure to get feedback from the government, the United Nations System and civil society organizations, that is key for an adequate implementation on a national level. Lesson learned about methodological aspects Overlapping of variables of analysis, where the intersection of variables allows for multiple analysis of the information. Synthesize situations and experiences related with stigma and discrimination. Adapt the technical language to everyday language used by interviewers and interviewees. Link knowledge and technique with activism. Develop studies with a solid technical base to generate legitimate and reliable evidence. Document in the future how the people that were interviewed were able to identify changes in the way they perceive stigma. Adapt global scope projects to the popular national idiosyncrasies. Recognition that inside the community of people living with HIV, there are groups with particular difficulties like transgender people and sex workers. 20 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

25 Lessons learned about the greater involvement of PLHIV The active engagement of PLHIV must occur not only in the operative aspects but also in the decision making process. People living with HIV can get involved in the scientific research field, through solid capacity transference, capacity building and empowerment. Lessons learned about performance of work teams Solid leadership of the coordinating team to guarantee success. Put together multidisciplinary teams to achieve a project of excellence. Document the level of awareness and the skills and capacity increase acquired by the interviewers during the implementation process. The importance that the interviewers generate empathy and trust with the interviewees. Lesson learned about advocacy The nature of the PLHIV Stigma Index as a way to promote human rights. Learn to move in advocacy scenarios to develop more solid research processes. Obtain evidence for advocacy, and its link with the involvement of people living with HIV. THE PEOPLE LIVING WITH HIV STIGMA INDEX 21

26 Technical recommendations about alliances Take into consideration possible conflict of interests. Value the inclusion of public instances as key allies. Establish clear rules for the engagement of allied organizations. Select the person or institution from the HIV sector with adequate capacity and skills for the implementation of the project. The collaboration agreements and terms of reference for and with the health institutions must be established in writing. Technical recommendations about work teams Have a strong community based team of people living with HIV. Team work must be orderly and coordinated, with communication mechanisms. The implementation technical team must work internally to bridge differences, reach consensus and build respect. Have feedback meetings and emotional contention meetings for interviewers throughout the process. The implementation technical team must be sensitive to the gender focus. Include a mental health professional in the team. Technical recommendations about methodological aspects Obtain parametric information for creating the sample, so that it reflects the best possible representation of the population being studied. Have an analysis panel so that external people, not immersed in the process can contribute with different visions. Understand well and manage the project s implementation protocol. Team must have constant technical support. Always link research and implementation processes with a management process linked with advocacy. 22 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

27 Have clarity in the criteria required for the data analysis. It is recommended the national databases are shared with the project s international partners (UNAIDS, GNP+, ICW, etc.). Have a constant monitoring plan for activities. Points of view of the people responsible for REDCA+ s Global Fund Project that will implement the Stigma Index in five countries during 2013 One of the main expectations for the Central American countries participating in the project is their ability to learn from the experiences of other countries in the region where the Index has been implemented. The sub-regional coordination under the responsibility of REDCA+ offers a unique opportunity to standardize the design of samples as much as possible, always respecting the national particularities. REDCA+ s plan includes ensuring the development of advocacy plans based on the results of the PLHIV Stigma Index in a second phase. Technical support needs Among the needs identified by REDCA+, the following stands out: having the capacity to establish a feedback system that answers to questions generated by each country, establish standardized criteria for the development of training guides for the interviewers, review the financial and technical proposals of every country, offer technical support to the countries for the sample design, the data base design, the cross information systems and drafting of the final reports. THE PEOPLE LIVING WITH HIV STIGMA INDEX 23

28 STRATEGY TOWARDS 2015 FOR THE PEOLE LIVING WITH HIV STIGMA INDEX IN LATINAMERICA Presentation The following strategy has been developed based on key information identified during the situation and response analysis collected in this same document. This strategy towards 2015 for the implementation of the People Living with HIV Stigma Index in Latin American has an overall objective and four specific objectives (shown in this Executive Summary). The activities related with each objective can be consulted in the document that has the complete results. It should be noted that this strategy is in accordance with the worldwide strategy agreed by the global partners (GNP+, ICW and UNAIDS), and should be consistent with the strategies developed on regional levels. Overall Objective Establish mechanisms to reach the goals established on the Universal Access Consultation in Mexico in 2011 related with Stigma and Discrimination in Latin America for the period. 24 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

29 Specific Objectives Build a management mechanism that ensures the PLHIV Stigma Index implementation in the remaining Latin American countries; as well as ensuring the implementation of a second PLHIV Stigma Index in the countries that have already done it once. Develop technical assistance and support mechanisms about the methodological aspects related with the PLHIV Stigma Index implementation for the countries with a first time implementation project, and for the countries with a second time implementation project. Deploy mechanisms that make the processes of linking the results of the PLVHIV Stigma Index with advocacy strategies and interventions easier, which will allow to ensure changes in the countries programs, legislature and regulations. Establish a monitoring and evaluation mechanism of the PLHIV Stigma Index implementation in Latin American that will allow to identify the need for technical support and resources for the fulfillment of the implementation projects. THE PEOPLE LIVING WITH HIV STIGMA INDEX 25

30 Prospective leaders for setting up the Strategy towards 2015 for the PLHIV Stigma Index in Latin America In accordance with the proposal for the strategy for the Index implementation, we have foreseen the need for a team of people in charge of setting up this strategy. Our proposal consists on putting together a Regional Technical Committee for the PLHIV Stigma Index implementation. This Committee can be formed by: representatives of the global partners of the Stigma Index (UNAIDS, GNP+, ICW), other key regional stakeholders can be representatives of initiatives like GCTH (Horizontal Technical Cooperation Group) to ensure the creation of strategic alliances with other regional networks and the commitment of the governments. Academics or an expert research institution to ensure methodological quality, ITPC, CRAT of the International Alliance against HIV, REDLA+, REDCA+, REDLACTRANS and RedTraSex, etc. The participation of two or three representatives of the national projects where the PLHIV Stigma Index has been implemented. These are processes to be defined and will be based in representative consultations which will take place during 2013, in coordination with the alliance of the global partners and the international coordinator of the implementation of the Stigma Index among people living with HIV. 26 RESPONDING TO THE UNIVERSAL ACCESS REGIONAL CONSULTATION IN LATIN AMERICA

31 THE PEOPLE LIVING WITH HIV STIGMA INDEX 27