The Community Led Monitoring (CLM) programme is working towards improving HIV service delivery outcomes in 14 districts with a high HIV burden, across three states in India – Delhi, Maharashtra and Telangana. To get a deeper understanding of the issues being faced by populations affected by HIV and by those who are at a high risk of contracting it, the project collects periodic feedback from the programme’s key populations (people living with HIV, female sex workers, transgenders, men who have sex with men and injecting drug users) to gauge how comfortable they feel while accessing HIV services and to learn more about the issues they face.
When speaking about the barriers that stop or hinder key populations from accessing HIV services, the most common one across interviews is that of stigma.
Stigma is often born out of fear or a lack of knowledge and while anybody is susceptible to stigma, it is often directed towards individuals or groups based on characteristics such as gender, sexual orientation, ethnicity, race or health conditions. People living with HIV/AIDS are often stigmatised (self induced or stigma from others) which can have an adverse effect on their health outcomes – this encompasses their physical and mental health. The dangers of HIV stigma are numerous, and while it can be a major barrier to accessing HIV services, it can also lead to discrimination, isolation and even violence. When looking to healthcare and access to it, stigma threatens to:
- Reduce access to healthcare: People who are stigmatised are less likely to seek healthcare, due to fear of poor treatment, discrimination or judgment.
- Provide a lower quality of care: Even when people who are stigmatised do seek healthcare, they risk receiving lower quality care than those who are not stigmatised. This could be because healthcare providers may have negative stereotypes about people with stigmatised conditions and may therefore not provide them with the same attention and care as to any other patient.
- Lead to social isolation: People who are stigmatised are prone to experiencing social isolation, as others may avoid them or treat them differently. This also makes it tougher for them to receive the support they need and this has the potential to lead to loneliness and depression among other mental health-related issues.
- Result in poorer health outcomes: People who experience stigma are more likely to experience poorer health outcomes, such as chronic diseases or even death.
The CLM programme is working to reduce HIV stigma by raising awareness about its negative consequences, letting communities know that they deserve quality care and by training and sensitising service providers. In this manner, the programme is also empowering communities to challenge stigma, by helping them understand their rights and social support better, so that they can advocate for their rights and hold healthcare providers accountable. By engaging with high risk groups to create leadership within communities, the programme is fostering safe spaces for community members to express their concerns and issues, for them to receive support and have their challenges communicated to key decision makers.
The CLM programme firmly believes that everyone has the right to live a healthy and productive life, regardless of their HIV status. By engaging communities to create a second line of leadership for key populations, CLM is working towards reducing stigma for members of high risk communities. In this manner, it is also working towards its goal of enhanced HIV service delivery and HIV outcomes, while also fostering a more supportive and inclusive society, where equity prevails to provide safer and healthier lives.
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