Kampala Tatler # 28: Stigma-Free Health Services And HIV Viral Suppression

Stigma-Free health services and HIV Viral suppression are connected.

There are people who are working in the HIV Service World and it is important to unpack poly-syllable words. This service is achieved through this article and we are in support for the creation of Prevention-Informed Peers (PIPs). 

This time we bring you:

"Stigma-Free Health Services"

What is that? 

How can the LGBTIQQ and Sex -Workers make it an actionable theme to address, turn around and design Bias-Free Unconditional Positive Regard Spaces (BFUPRS)?

By the end of this short article you will have become a Trauma-Informed-Care aficionado!

Case: 

"On a hot Thursday afternoon, I went to a Health Facility in the Suburbs of Kampala with a team of four friends. We were part of the ARV Chaperone Support (ACS) for two of our friends.

'How is it possible that boys have sex with boys?'

The Clinical Officer made this comment out loud  as we were about to leave and as she was returning our friends' ARV-refill files to the cabin....."

What one witnesses in the above is the situation when stigma is making a full circle. It causes more waves of trauma as we shall see below:

There is the perpetrator, the victim and those who are supposed to address it.

Stigma itself, is one head of a multi-headed hydra. It is important to have this in mind. Stigma is just a manifestation of a larger and more dangerous abuse called violence.

It is like the smoke from a larger smoldering fire. 

The perpetrator of stigma is actually also capable of the 9 D's: denigration, derogation, disliking, distancing, disowning, disruption, dereliction of duty, denial,  and dejection. All these are destructive action verbs or nouns. In other words, stigma is capable of triggering behavior or practices that turn out to be discriminatory. This is the family tree of stigma!

The victim looks at the situation in which stigma is prescribed from two perspectives: The personal and environmental stimuli. At a personal level, there is psychological and physical trauma. At the environmental level, are the triggers in form of memory, locations, cues and actual presence in a space where the perpetrator and victim are in near proximity.

Those who are supposed to address it, have different  tasks which can be broken down into four planes: 

These individuals must attain a working knowledge and skills to deal with the contexts of stigma; there has to be cultural humility and an acknowledgement that they may be in positions of power but that does not mean they are qualified enough. So, they may need to form an existing support team in which experts are included; There is need to create two distinctive support teams-those facing forms of stigma known as Stigma Subject Matter Experts (SSMEs) and dedicated Counter Stigma Focus Days' Activities (CSFDAs).

As far as HIV Prevention, stigma has its repercussions or what are known as distributed denial of services (DIDOS).

1. Beginning with deterring full participation in health seeking by those who fear being stigmatized

2. Demotivates health providers in providing quality, full unconditional and confidential services to clients

3. Increases vulnerability to stigma itself and other forms of abuse

4. Fuels further denial of services 

5. May lead to below optimum ARV adherence and no suppression of virus.

It is our hope that you have come out the wiser and more informed.