Stigma and Discrimination on HIV/AIDS: MTN’ s Experience and Lessons from the Community

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Background• MTN Nigeria workplace Programme on HIV/AIDS was rolled out in

October 2005 after which a robust external programme started.

• Goal : To provide a comprehensive and efficient campaign against HIV/AIDS with focus on care for all MTN staff and their families.

• Objectives:

• To develop a workplace policy with inputs from staff that guides the implementation of the workplace internal and external programme.

In the BeginningIn 2007, the HIV/AIDS programme was transformed

into a wellness programme because– experience showed that an integrated wellness approach

is more effective and efficient in addressing HIV/AIDS stigma 2

Background cont.

• Conducted HCT for employees between October & November 2008 and 43% of the employees participated in the HCT

• 6 persons were positive (3 men, 3 women) showing a prevalence of 0.7%

• HIV prevalence rate among adults (15-49) 3.1%

• Estimated Percentage of Adults living with HIV 4.0

• Estimated new AIDS cases 312,507

• Urban Percentage 4.43

Background: Nigeria HIV profile /Prevalence at MTNF Sites

• Stigma and Discrimination is a major impediment to HIV/AIDS mitigation.

• Uptake of HIV Confidential Counseling and Testing is low as reasons are ascribed to stigma and discrimination.

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Highlights of the National Workplace policy on HIV/AIDS directly relating to Stigma &

Discrimination

• Persons at work who are infected or affected by HIV/AIDS shall not be stigmatized or discriminated against by co-workers, union members, employers, clients, care providers, health professionals, state officials and establishments.

• Employees living with HIV/AIDS shall not be denied access to statutory benefits and occupationally related welfare schemes.

• Deliberate exclusion of PLWHA in workplace activities and decision-making shall receive appropriate sanctions according to law

MTN Nigeria since inception has upheld principles set out in the National Policy as reflected in its internal policy.

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Highlight of the Provisions of MTN HIV/AIDS Policy

• HIV-positive employees will be protected against discrimination

• No employee should suffer negative consequences, whether of dismissal or denial of appropriate alternative employment opportunities, merely on the basis of HIV infection.

• MTNN rejects HIV testing as a prerequisite for recruitment, access to training or promotion.

• MTNN recognises the sensitive issues that surround HIV/AIDS and undertakes to handle these matters in a discreet and private manner

• The Company will treat employees who are infected or affected by HIV/AIDS with empathy and care.

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Internal Intervention Programs

• Development and dissemination of a robust HIV/AIDS Policy

• HIV/AIDS seminars during the induction of new employees• Inclusion of voluntary HIV test in annual medical

examination• Installation of condom dispensers in the office restrooms

with continuous condom replenishment • Dissemination of monthly newsletters with HIV/AIDS

messages• Deployment of HIV/AIDS screensavers• HIV/AIDS messages on pay slips• Management of HIV treatment for staff and dependants• Training of health care providers on HCT

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MTN External HIV/AIDS Programme

Strategies

• HIV Confidential Counseling and Testing

• Prevention of Mother to Child Transmission (Plus)

• In-school Youth

• Care and Support

• Advocacy

• Behavior Change Communication

• Community Mobilization

• Networking

• Monitoring 8

Stigma Reduction Strategy

- Client uptake of services was low in the first phase. This is linked to stigma and discrimination

- Community mobilisation was introduced in phase 2 to mitigate stigma and increase client uptake of services

Community Mobilisation Activities include:• Peer Education• Community Sensitization• Formation of Community Action Teams• Advocacy to Religious/Opinion leaders• House to house intervention (Cross River)

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Internal Achievement and Successes

• Work place policy on non-discrimination that cares for both staff and their families

• Recognition as leading private sector CSR initiative on HIV/AIDS non-discrimination

• Increased HIV/AIDS services uptake:43% of employees accessed HCT in 2008, indicating reduction in stigma & discrimination

• Strong management buy-in necessitating continued funding

• Funding for the greater involvement of people living positively staff at the Nigerian Business Coalition Against AIDS office. A move against stigma and discrimination.

• Trained 207 staff as peer educators to fight stigma

• Provision of comprehensive treatment to 3 employees and their HIV positive spouses

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Achievements : External programme

• The community mobilization activities resulted in increased client uptake of services provided by the project

• Cases of stigma and discrimination of beneficiaries have also reduced as reported: there have been increase in acceptance of PLWHA in their households.

• Disclosures have encouraged the formation of over 8 strong support groups with over 308 members.

• Over 260 PLWHA have overcome stigma and have been trained in various IGA skills and were assisted to set up their businesses.

• Stigma reduction is being achieved as large numbers of community members are getting involved ; over half a million people have been reached with HIV prevention and stigma reduction messages

• Nutritional support programme has been expanded to over 1,782 support group members 14,317 times as a result of improved 11

Achievements cont.

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05,000

10,00015,00020,00025,00030,00035,00040,00045,00050,000

Phase1

Phase2

Phase3

Total

Counseled

Tested

Positive

Success Stories

• Key community stakeholders and traditional rulers have bought into the programme through the strategy and this has caused a ripple effect on other community members in the area of reduction in stigma and discrimination

• Increase in Marriage among PLPs, in Sokoto alone 5 marriages were witnessed. This is an evidence of reduction in self stigma

• Before the strategy, it was common practice for a

particular Church to refuse wedding to couples when one or both tested positive to HIV. After a sensitization seminar at the church, 6 couples were granted marriage

• The Market in Sokoto out of their own volition carried out a sensitization seminar (this is something highly noteworthy considering the docile role women are expected to play in that part of the Country) 13

Internal/External Programme Challenges

• Uptake of VCT and ARV services poor, some staff prefer to access these services outside

• Poor disclosure by HIV positive employees

• Poor reporting and feedback

• Inadequate coverage on stigma issues due to spread of fund over other programme areas.

• Cultural barriers as regards use of sexually inclined languages (especially in the North)

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Key Lessons Learned: Internal/External

Programme • Sensitisation seminars during induction of new staff have

potential for addressing stigma & discrimination

• Consistent management commitment is key

• Partnership with an NGO ensures employee’s confidentiality

• Involvement of persons living positively with the virus in HIV/AIDS program helped in reducing stigma

• Advocacy to community leaders and capacity building of community members is key in achieving programme success.

• The engagement of religious bodies proved very useful.15

The way Forward• KAPB to assess current situation on stigma &

discrimination • More engagement of positive speakers during induction

programmes for new staff• Formation of support group of employees and

dependants living with the virus• Use of various media to promote messages on

reducing stigma and discrimination: pay slips, screen savers, stand alone interactive touch screens

• Integration of other health issues found to increase staff participation and reduction of stigma

• Continued engagement of religious bodies urging them to formulate stigma and discrimination policies16