case study www.aidsalliance.org Supporting community action on AIDS in developing countries
REDUCING STIGMA AND DISCRIMINATION IN EL SALVADOR
An innovative approach to tackling stigma and discrimination in Mexico has been adapted for El Salvador, with impressive results.
AIM
Contribute to the eradication of HIV stigma and discrimination faced by key populations
The Vida Digna (Life with Dignity) programme is one of the first in Central America to address the high levels of stigma, discrimination and even violence faced by key populations. In Central America, stigma and discrimination are preventing key populations from accessing basic services like health care, education and housing. Rights violations and underrepresentation in decision-making processes, particularly of sex workers and transgender women, are also seriously undermining their ability to be part of the HIV response.
But thanks to the Vida Digna programme, these groups are now gaining visibility and a voice at the national level. The programme has been engaging with service providers, working to reduce stigma and discrimination with more than 8,000 people. Vida Digna has been strengthening key population organisations, helping to make the HIV response more sustainable. The programme was designed by Colectivo Sol, the Alliance Linking Organisation in Mexico, and by ViiV Healthcare’s Positive Action programme. It ran in Mexico from 2005 to 2010, and has now been successfully adapted to El Salvador. The project is being implemented by Alliance Linking Organisation Atlacatl, a Salvadoran organisation run for and by people living with HIV, and four partner organisations.
Using the Participatory Community Assessment
Participatory Community Assessment (PCA) activities encourage participants to examine stigma and discrimination at all levels, from individual through to national. They help participants make the connection with human rights, and give them tools to tackle these issues through official channels. Here are some examples: I suffer discrimination, I also discriminate Participants recall a time when they were discriminated against, how they felt, what they did and how it changed them. Then they recall another time when they discriminated against someone. The workshop leader facilitates this powerful reflection.
Engaging key populations In concentrated epidemics, engaging key populations is essential to an effective HIV response. In El Salvador this includes gay men and other men who have sex with men, people living with HIV, sex workers and transgender women. In El Salvador the HIV prevalence rate in transgender women is estimated to be 23%, compared to 0.45% in the general population. Source: Ministry of Health (El Salvador), 2012.
Valuing the services that we use Participants rate the cost, quality and user-friendliness of services they use, such as medical care, insurance and legal services. They analyse how well these services are meeting their needs, and whether or not they are discriminated against. PCA is used throughout the project as a needs assessment with key populations, a tool for developing advocacy and work plans for partner organisations, and for raising awareness with the general population.
PCA in practice
For one activity, sex workers surveyed members of the public at a local shopping centre about their perceptions of sex work. Next, they produced a report on the stigma and discrimination they face. This is an excellent example of how Vida Digna builds the capacity of key populations: the women gather evidence, identify problems they face and define advocacy strategies based on their findings. Participant’s drawing from workshop identifying stigma in daily life. © Atlacatl
key programme activities Influencing nationally
Partner organisations are gaining greater visibility as a result of their participation in the Vida Digna programme and association with Atlacatl. This visibility is helping key populations to advocate and lobby; one of the ways they are making their voices heard at the national level. For example, two Vida Digna partner organisations participated in the drafting of a new law on sexual and reproductive health rights to ensure that the rights of transgender women were addressed. As a result, the draft law now refers to issues such as hormone regimes and transgender women’s right to see specialist doctors. This is an important step in encouraging the state to address gender identity issues formally. When the first national legislation on HIV was drafted in 2001, there were no organisations representing sex workers, transgender women, gay men or men who have sex with men. Now, as the government looks to review and update the legislation, there are many more empowered and capable groups who can participate in the consultation process. – Odir Miranda, Atlacatl director
Training Service Providers
Partner organisations are carrying out training to reduce stigma and discrimination with those service providers they have identified as discriminating against them. For example, in 2011 sex workers ran workshops for health care providers and police officers; gay men worked with their peers; and transgender women trained prison officers and civil servants. More than 8,000 people were reached as a result. The benefits are immediate. Since running workshops for health care providers, sex workers know where they can access stigma-free services. Sometimes police officers get up and walk out of the trainings, or make offensive comments, but in every session there are also people who are receptive and who want to learn more. – Julio Ramirez, Atlacatl programme director
Building capacity
Intensive organisational development is a key part of the Vida Digna programme. Building the capacity of key population organisations creates stronger organisations and means the HIV response is more sustainable. This support is proving invaluable, making sure that the voices and needs of key populations are at the heart of the HIV response. The Vida Digna Programme strengthened COMCAVIS TRANS in a powerful way, in terms of new skills and technical support. The COMCAVIS TRANS team today knows a lot more about accounting and technical and financial reporting. – Karla Avenar, director of an organisation for transgender women living with HIV
Participant at a Vida Digna workshop © Atlacatl
ripple effects •
Atlacatl has increased its legitimacy regionally and nationally by engaging deeply with key populations. It has even developed an accredited diploma programme on HIV, stigma and discrimination.
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Colectivo Sol continues to use the PCA and Vida Digna approach beyond the end of the programme to train more than 60 organisations as part of a HIV prevention community of practice in Mexico.
• Atlacatl uses the PCA to raise awareness on stigma and discrimination across its other projects, including with workers on a private sector road-building project, FOMILENIO. •
The Vida Digna programme is expanding across Central America via two regional networks (Redtrasex for sex workers, and Redlactrans for transgender women), with support from Positive Action and the Alliance.
For more information please visit the El Salvador page on the Alliance website: www.aidsalliance.org The programme is supported by ViiV Healthcare’s Positive Action programme. © International HIV/AIDS Alliance, 2012 Registered charity number 1038860