Vienna/Washington, July 21, 2010 — HIV prevalence in India and South Asia is growing among sex workers, injecting drug users, and other marginalized groups largely because of a widespread failure to prevent stigma and discrimination toward people living with AIDS, or at high risk of contracting the virus, according to a new report launched today at the global AIDS summit in Vienna, Austria.
The new report by the World Bank and the International Centre for Research on Women―Tackling HIV-Related Stigma and Discrimination in South Asia―says that despite prevention and other efforts to reduce high-risk behaviors such as unprotected sex, buying and selling of sex, and injecting drug use, HIV vulnerability and risk remain high. Stigmatizing attitudes in the general population and discriminatory treatment by health providers and local officials, among others, intensify the marginalization of vulnerable groups at highest risk, driving them further from the reach of health services and desperately needed prevention, treatment, care, and support services. Daily harassment and abuse also cause health problems and affect mental health, thereby leading to depression, social isolation, and an array of adverse socioeconomic outcomes related to HIV.
“Discrimination against people in these high-risk, marginalized groups is so strong that they feel their lives aren’t worth protecting or prolonging, which stops them from reaching out for the prevention, treatment, care, and support services they need to fight the disease,” says Dr. Mariam Claeson, Program Coordinator for the World Bank’s South Asia region, and co-author of the new report. “We have been supporting efforts that tackle prejudice about HIV and AIDS at community and national levels and break down the walls of fear and suspicion that poison the lives of people with, or at high risk of acquiring, HIV and AIDS.”
As a result of a World-Bank-led regional competition to find successful ‘grass roots’ anti-HIV discrimination programs, 1,000 groups from across Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka submitted proposals for small grant funding to the 2008 South Asia Region Development Marketplace.* Of these applications, 26 programs from six countries were chosen to pilot their work more widely over 18 months, with total grant funding of US$1.4 million, and maximum individual grants of US$ 40,000.
A common feature of the winning programs was that they empowered people from marginalized groups― sex workers, injecting drug users, trans-genders, and men who have sex with men, and others―to innovate and correct misinformation about their activities and HIV/AIDS in general. Using television and radio shows, beauty pageants, community theatre, outreach with community leaders, and private businesses run by sex workers, marginalized groups were able to reach out successfully to neighbors and local officials to raise their awareness about stigma and discrimination, and ensure less active hostility toward them.
“When communities assume leadership of their own programs, they become equitable and sustainable,” says Michel Sidibé, Executive Director of UNAIDS, and Under Secretary-General of the United Nations.”It breaks the cycle of stigma and discrimination. It restores their dignity and rights to good health and development. This book provides some excellent examples of this.”
In explaining their case to others, many anti-stigma coordinators reported feeling better about themselves and their identities. For example, in the new report, Muthukumar Natesan, one of the 26 winners of the World Bank’s Development Marketplace and a leader of a community-based organization for men who have sex with men that is also working on stigma reduction, explains:
“Despite all my knowledge and years working to promote condom use, I only started using condoms consistently when I felt my existence was important. . . . [Y]ou can talk as much as you want about the need to protect oneself, you can provide as many condoms… as you want, but unless men who have sex with men feel their existence is worthwhile, they are not going to bother to protect themselves or others. . . . My existence became important and my life worth living when I received the acceptance of friends, family, neighbors, health care providers, and the community in general. Now I use condoms consistently.”
Lessons from Successful Stigma-Fighting Programs
As part of the South Asia Region Development Marketplace contest on HIV stigma and discrimination, the World Bank invited researchers from the International Center for Research on Women, and other groups to assess the application and to evaluate common lessons for wider use. Their conclusions suggest that while one formula cannot capture the diversity and ingenuity of the 26 final programs, the winning groups shared a number of principles.
Community organizations achieved a great deal for relatively little investment. The South Asia Region Development Marketplace funding totaled US$1.04 million across 26 projects. The results suggest that, combined, the projects reached more than 96,264 people; trained 4,905 people; led to 504 news articles; and developed 426 products such as training curricula, information, education and communication materials, documentaries, and plays. Community organizations, some of which had received little or no external support before, undertook new activities and developed new capacities despite the relatively small maximum grant size of US$40,000. Overall, the results suggest a high return on investment.
The South Asia Region Development Marketplace 2008 grants seeded considerable innovation. Project approaches reflected enormous creativity, ranging from beauty pageants to restaurants run by sex workers. The grants led to new alliances—such as those between ‘panchayat’ (local government) leaders and the Indian community organization Lotus Integrated AIDS Awareness Sangam—and to some unlikely partnerships between sex workers, police, lawyers, and health workers. In Afghanistan, one project partnered with the government to support religious leaders to pass on anti-stigma messaging in their Friday prayers.
The most promising work used multiple strategies and stakeholders to address stigma. Even where projects initially appeared to be single-focus interventions (for example, theater), successful implementation required a range of other activities, such as training, engagement with policy makers, and media relations.
Effective efforts were led by or continuously engaged marginalized communities. Involving marginalized communities is essential for strengthening capacity, ensuring appropriate messaging, and maximizing results. Strategies that foster some interaction between marginalized communities and the public—either directly or through the mass media—can be powerful in inspiring change. Products such as films or plays that are developed by, or strongly reflect the input of, marginalized communities, are likely to be more compelling to audiences and to enjoy rapid dissemination.
“The world desperately needs new HIV prevention strategies because for every two people who receive life-saving AIDS treatment, another five become newly infected, which is an impossible situation for many poor countries and their communities,” says Dr. David Wilson, the World Bank’s newly appointed Director for its Global HIV/AIDS Program.
An international authority on HIV prevention, Wilson is leading the World Bank team at the International AIDS Society summit in Vienna this week.
“This new study shows us how people living with AIDS, and others at high risk of HIV infection, can use their ‘people power’ to fight the stigma and discrimination that stands between them and gaining their rightful access life-saving prevention, care, and treatment services,” Wilson says.
Wilson says the World Bank continues to recognize AIDS as a serious development challenge that has inflicted widespread human tragedy as well as serious economic loss.
To date, the World Bank has provided US$4.5 billion for HIV prevention, care, treatment, care, and mitigation programs in developing countries. Since 2006, 4.3 million people have received counseling and testing through World-Bank-supported projects focused on HIV prevention. A founding co-sponsor of UNAIDS, the UN umbrella groups that coordinates the global HIV/AIDs response, the World Bank Group is strongly committed to helping countries and their partners halt and reverse the spread of the epidemic.
What is the Development Marketplace?
The South Asia Region Development Marketplace Partnership 2008 was sponsored by the World Bank Group, The Government of Norway, SIDA, UNAIDS, UNICEF, and UNDP. The Government of the Netherlands contributed to the report through the World Bank-Netherlands Partnership Program, and the International Center for Research on Women evaluated the project and co- authored the report. The Development Marketplace is a competitive grant program that identifies and supports small-scale development projects that have the potential to be expanded or replicated. The program operates at a global, regional, or country level, and uses a transparent process to support innovations that address development challenges at the community level. Development Market competitions are designed to attract ideas from a range of innovators: civil society groups, social entrepreneurs, foundations, academia, private sector corporations, non-governmental organizations, etc. They draw together people and institutions with varied affiliations and objectives to work in partnership to find innovative development solutions.