MODELS for dialogue

Between

PLHIV networks &

Religious Leaders and Faith Communities

Christoforos Mallouris

29 November 2011, Toronto

Outline

• Background

• Evidence informed response - PLHIV evidence, some examples

• Response from faith communities and religious leaders

• Determining the scope of dialogue to inform model development

• Conclusions

• Group work

Models for Dialogue

• Religious Leaders Summit, Netherlands 2010

• Religious Leaders’ Commitment for Action

• Immense response

• In parallel evidence from PLHIV Stigma Index and other methodologies pointing towards need for action and dialogue

• Dialogue does happen, but can be supported to be more systematic, systemic, and quality assured

Evidence base

PLHIV Stigma Index

• Representative survey on stigma and discrimination faced by PLHIV (external and internal)

• Participatory research by and for PLHIV, led by national PLHIV networks

• Process is as important as the evidence gathered

• Evidence forms the base for development of action

• PLHIV Stigma Index results for monitoring progress

• International coordination (GNP+, ICW, UNAIDS) and informing global and regional level

PLHIV Stigma Index

• Over 30 countries in process of roll-out, finalisation, reporting or post-reporting action

• Draft reports from Ukraine, Ethiopia, Kenya, Nigeria, Zambia, Myanmar (2010 – 2011)

• What is relevant to model for dialogue?• Stigma in religious settings / places of worship• Levels of disclosure to religious leaders and relevance of

faith communities to PLHIV• General experiences within the community and

possibilities for action for faith communities• Internal stigma impacting on access to one’s faith, spiritual

support and psychosocial status and access to services

PLHIV Stigma Index

Compared to levels of disclosure to religious leaders

Levels of stigma experienced in religious activities/places of worship

Evidence (contd.)

13.410.8

14.216.9

26.1

0

5

10

15

20

25

30

Orthodox C atholic P rotes tant Mus lim Traditionaland Others

Figure 3.3: Percentage of respondents that reported exclusion from religious activities or places of worship in the last 12 months by the religious group they belong to, 2010(Ethiopia PLHIV Stigma Index Report)

Key populations – where is the data?

Percent distribution of respondents who had been excluded from religious activities in the last 12 months (Zambia)

Qualitative DATA

• “A religious organization revealed the result of my HIV test. The leader of this organization forbade members to visit my home”. Sagaing Division

• “I try to console myself with religion”. Yangon Division

(Myanmar PLHIV Stigma Index Report)

Beyond Faith…

Table 2: General stigma and discrimination in the previous 12 months (Kenya, PLHIV Stigma Index Report)

About 30% physically assaulted!

Over 50% verbally assaulted!

About 40% excluded from social gatherings!

Internal stigma

Table 3.10: Percentage distribution of perception and fears respondents had had for themselves as a result of their HIV-positive status by gender and place of residence, 2010 (Ethiopia)

Internal stigma

People are afraid of Infection, 33.1

Pople don't under-stand HIV trans-

mission, 40.9

People think HIV is shameful, 36.4

Religious Beliefs/moral judgements, 18

People disapprove of my lifestyle, 11.3

Looks HIV symp-tomatic, 15.3

I don't know/not sure reason, 14.5

Percernt

Figure 6 indicates what respondents think lies behind the HIV-related stigma they experienced. (Kenya)

Key populations

Myanmar

Access to health

19

27

28

30

30

36

Have never belonged torisk groups

IDUs

LGBT

Prisoners

SWs

Migrants

Fig. 2.5. Integral indicator: People who faced restrictions during the last 12 months in access to social and health care services for reasons that included HIV status (by social groups, %) (Ukraine)

Sexual and Reproductive Health and Rights needs

Myanmar

Impact on employment

Myanmar

The role of FBOS In combating Stigma?

Table 4.11: Types of organisations rendering support on stigma mentioned by respondents, 2010 (Respondents'’ knowledge; Ethiopia)

Other PLHIV evidence

• Interviews with PLHIV regarding their needs or experiences with faith communities and religious leaders (stigma reduction? support for food security and employment opportunities?)

• Reports of PLHIV not accessing ART based on advice from religious leaders (anecdotal? Unknown how serious this issue is?)

• Other?.... Very little evidence on support needed and given from the PLHIV perspective

Response from faith community

• Spiritual support

• Orphans and vulnerable children and family support

• Addressing stigma and discrimination in the community

• Service providers (treatment, care and support)

• Gender based violence (some)

• PMTCT (some)

• Very little information on• The most affected populations• Prevention• Harm reduction• SRHR• Multi-faith responses

Some ConclusionsIS there scope for MORE?

• Current programmes tend to focus on ‘general population’ of PLHIV

• Similar (consistent) policies on some issues and variant (inconsistent) practice on other issues

• Documented and anecdotal evidence variance

• The role of faith communities to address issues within faith community AND/OR the role of faith communities to address needs of PLHIV beyond faith

Possibilities for Dialogue and Collaboration

• Concentrate on what is currently being done well and agreement on how to do proeceed where there is disagreement (may not correspond to evidence-based PLHIV priorities; but low resources and time investments)

• Expand to more ‘difficult’ thematic areas (corresponding to evidence-based PLHIV priorities; but higher ‘internal’ policy and practice reflection and change with long-term commitment of time and resouces)

Determining scope of dialogue

• Survey• What do PLHIV need as priorities? And what are the perceived priorities of

PLHIV by religious leaders and faith leaders? What are experiences of religious leaders living with HIV? What are the experiences of religious leaders in responding to needs of PLHIV?

• Most importantly… what do PLHIV expect from religious leaders and faith communities? And likewise, what do faith communities and religious leaders expect from PLHIV?

• Coming to a common ground

• Interviews (PLHIV networks, religious leaders, faith based organisations)

• Model development (draft, based on above)

• Testing at country level (2 countries)

• Revision following testing

• Dissemination of findings and model

• Evaluation and long-term monitoring (?)

Group Work

• Using the PLHIV Stigma Index evidence to spark discussion, not go into details on the methodology

• What are opportunities for dialogue and areas of action?

• What are the challenges?

• What are success factors and ways to overcome challenges?

• What is possible, what is not?

• Concentrate on what is possible now? Or move towards making what is now impossible to possible in the long-term?

• What are the expectations from each stakeholder?