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MTCT-stigma and discrimination

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									         Module 4



Stigma and Discrimination
    Related to MTCT
                          Exercise 4.1
                       Labels Group Game




PMTCT Generic Training Package             Module 4, Slide 2
                          Module Objectives

 Identify HIV-related stigma and discrimination.
 Discuss the impact of stigma and discrimination on
  people living with HIV (PLHIV).
 Discuss strategies to address stigma and discrimination
  in the delivery of PMTCT services.




PMTCT Generic Training Package                      Module 4, Slide 3
                                 Session 1



                 Concepts of Stigma and
                     Discrimination




PMTCT Generic Training Package               Module 4, Slide 4
                       Session 1 Objectives


 Identify HIV-related stigma and discrimination.
 Discuss the impact of stigma and discrimination on
  people living with HIV (PLHIV).




PMTCT Generic Training Package                      Module 4, Slide 5
                  Introduction to Stigma and
                        Discrimination
 HIV is one of the greatest human rights challenges of
  our time
 Those aware that they are HIV-infected are burdened
  not only with the disease but also stigma and
  discrimination.
 Stigma and discrimination are major barriers to
  preventing HIV transmission and providing treatment,
  care and support


PMTCT Generic Training Package                   Module 4, Slide 6
                   Introduction to Stigma and
                       Discrimination (Continued)


  The most effective responses to the HIV epidemic work
   to prevent stigma and discrimination and protect the
  human rights of people living with HIV and those at risk




PMTCT Generic Training Package                    Module 4, Slide 7
                       Stigma: Definition




                            What is stigma?




PMTCT Generic Training Package                Module 4, Slide 8
                             Stigma: Definition

 Stigma: unfavourable attitudes and beliefs directed
  toward someone or something


 HIV-related stigma: unfavourable attitudes and beliefs
  directed toward people living with HIV, their family and
  friends, social groups, and communities




PMTCT Generic Training Package                    Module 4, Slide 9
                         HIV-related Stigma

 Stigma particularly pronounced when behaviour causing
  disease is perceived to be under individual’s control,
  e.g., sex work or injection drug use
 Certain groups, e.g., poor people, men who have sex
  with men, sex workers and injection drug users, often
  bear heaviest burden of HIV-related stigma.
       People who are HIV-infected are often assumed to be
        members of these groups, whether they are or not



PMTCT Generic Training Package                       Module 4, Slide 10
                          Examples of Stigma




        What are some examples of stigma?




PMTCT Generic Training Package                 Module 4, Slide 11
                        Examples of Stigma

 Believing HIV is divine punishment for moral
  misconduct
 Thinking women are responsible for transmitting HIV
  and other STIs in our community
 A daughter refusing to visit her father once she finds out
  he has HIV because she felt "dirtied" by contact with
  him
 A woman with HIV refusing to join a support group or
  tell people outside the family about her HIV because
  she fears being stigmatized

PMTCT Generic Training Package                    Module 4, Slide 12
                      Discrimination: Definition




                     What is discrimination?




PMTCT Generic Training Package                 Module 4, Slide 13
                     Discrimination: Definition

 Discrimination: the treatment of an individual or group
  with prejudice
 Discrimination includes the denial of basic human rights
  such as health care, employment, legal services and
  social welfare benefits




PMTCT Generic Training Package                  Module 4, Slide 14
                    Stigma and Discrimination
                             Linked
 Stigmatizing thoughts can lead a
  person to discriminate against another
 Discrimination is a way of expressing
  stigmatizing thoughts; a distinction
  made about a person based on
  stigma that results in unfair or unjust
  treatment of that person




PMTCT Generic Training Package              Module 4, Slide 15
       Stigma: Other Diseases and HIV

 Stigma and discrimination also occur with other
  diseases: TB, syphilis, leprosy


         HIV-related stigma appears to be more
         severe than the stigma associated with
                other infectious diseases
                 Examples of Discrimination



                What are some examples of
                      discrimination?




PMTCT Generic Training Package              Module 4, Slide 17
             Discrimination: Examples

 HCW denies services to person who is HIV-infected
 Family or village rejects wife and children of man who
  died from AIDS
 Man loses job because people learn he is HIV-infected
 Community rejects woman who decides not to
  breastfeed because they assume she is HIV-infected
 HIV-infected clients receive poor care at a clinic
  because of HCWs’ fears about caring for people
  infected with HIV
                 HIV: 3 Epidemics


1.   Epidemic of HIV
2.   Epidemic of AIDS
3.   Epidemic of stigma, discrimination and denial
     around HIV and AIDS
                    Women and HIV Infection

 Numbers of infected women worldwide growing more
  rapidly than men
 Women more vulnerable to HIV than men due to:
       Poor access to MCH
       Poor access to prevention information and methods
       Economic, social inequalities (e.g. unable to negotiate
        safer sex)
       Biological factors

PMTCT Generic Training Package                        Module 4, Slide 20
                     Women and HIV Infection
                                  (Continued)



   The woman is often the first person in a couple to be
    tested for HIV
       If found to be positive, may be blamed by her partner for
        introducing HIV into the family
       Implicated in mother-to-child transmission
       May experience violence, loss of shelter and economic
        support
       May even lose the support of family, community
   All of these reasons may compel a woman to keep
    her HIV status secret

PMTCT Generic Training Package                         Module 4, Slide 21
            Women and HIV Infection (Continued)

    Women with HIV may be doubly or triply stigmatized:
      1. As women
      2. As a person living with HIV
      3. As a partner of a person who is HIV-infected or the
         widow of person who died of AIDS




PMTCT Generic Training Package                    Module 4, Slide 22
              Women and HIV Infection (Continued)



       The stigma and discrimination associated with
       women with HIV can limit access to effective
       prevention, care, treatment and support
       services




PMTCT Generic Training Package                   Module 4, Slide 23
              International Human Rights and
               HIV Stigma and Discrimination

                  Freedom from discrimination is a
                        basic human right


 According to United Nations Commission on Human
  Rights, discrimination against people living with HIV or
  thought to be infected is a clear violation of human
  rights



PMTCT Generic Training Package                       Module 4, Slide 24
                     Human Rights in Relation
                            to HIV
 All people have a right to make decisions about their
  sexual and reproductive health
 Children have a right to survival, development and
  health
 Women and girls have a right to information about HIV
  and a way to protect themselves against HIV infection




PMTCT Generic Training Package                   Module 4, Slide 25
                     Human Rights in Relation
                          to HIV (Continued)
 Women have the right to HIV testing and counselling
  and to know their HIV status
 Women have a right to choose not to be tested or to
  choose not to be told their test result
 Women have a right to make decisions about infant
  feeding, on the basis of full information, and to receive
  support for the course of action they choose



PMTCT Generic Training Package                     Module 4, Slide 26
               Stigma: Actions and Attitudes

 A person’s word, action, or belief may be unintentionally
  stigmatizing toward an individual who is HIV-infected,
  e.g.:
       A person who is against stigmatization may believe people
        with HIV behave immorally, “deserve what they got,” or are
        being punished by God
       A person who knows HIV cannot be transmitted with casual
        contact may refuse to buy food from a vendor who is HIV-
        infected
          A person’s behaviours may conflict with their beliefs


PMTCT Generic Training Package                           Module 4, Slide 27
                Stigma: Choice of Language

 Language is central to stigma
 People may not realize they are stigmatizing those with
  HIV by choosing certain words, for example:
       Referring to HIV indirectly: "that disease we learned
        about"
       Calling people with HIV “walking corpses” or “those
        expected to die”




PMTCT Generic Training Package                          Module 4, Slide 28
               Lack of Knowledge → Stigma

                  Incomplete knowledge and fear act
                    together to allow stigma to grow

 Many people lack complete or accurate knowledge
  about HIV
 Many believe an HIV-positive test result = certain death
 The fear of death is so powerful that many avoid people
  suspected to have HIV—even when they know HIV is
  not transmitted casually

PMTCT Generic Training Package                         Module 4, Slide 29
                  Shame & Blame Associated
                          with HIV
 Stigmatization often focuses on the sexual transmission
  of HIV
 Many assume that people who are HIV-infected:
       Must have been infected through sexual activities that
        are socially or religiously unacceptable
       Are unable to control themselves, and are therefore
        responsible for their infection




PMTCT Generic Training Package                        Module 4, Slide 30
              Stigma in Caring Environments

 Loving, supportive caregivers may stigmatize and
  discriminate against people with HIV
  (e.g., blaming, scolding, saying “those people”)
       May not recognize behaviour as stigmatizing

 Stigmatizing happens even among individuals
  opposed to HIV-related stigma (including HCWs)
 People can have correct and incorrect
  information about HIV


PMTCT Generic Training Package                        Module 4, Slide 31
                      Exercise 4.2
                Examples of Stigma and
               Discrimination: large group
                       discussion

PMTCT Generic Training Package          Module 4, Slide 32
                    Stigma and Discrimination:
                            Examples


  What are some examples of stigma and/or
         discrimination in the media?




PMTCT Generic Training Package             Module 4, Slide 33
                     Stigma and Discrimination:
                             Examples
In the media:
 Suggesting specific groups of people with HIV are guilty
  (e.g., commercial sex workers or injection drug users)
  while others are innocent (for example, infants)
 Portraying HIV as a death sentence, leading to:
      Fear and anxiety
      Believing HIV cannot be managed
       like other chronic diseases
 Referring to HIV as, e.g., the “killer disease”
 Showing stereotypical gender roles
 PMTCT Generic Training Package                     Module 4, Slide 34
                    Stigma and Discrimination:
                         Examples   (Continued)




  What are some examples of stigma and/or
              discrimination in
            healthcare settings?




PMTCT Generic Training Package                    Module 4, Slide 35
                    Stigma and Discrimination:
                         Examples       (Continued)




In healthcare settings:
    Refusing to provide treatment,
     care, support to PLHIV
    Providing poor quality of care
     for PLHIV
    Breaking confidentiality
    Providing care in specialized settings (e.g., clinics for
     people with sexually transmitted infections) can further
     stigmatize, segregate PLHIV

PMTCT Generic Training Package                        Module 4, Slide 36
                    Stigma and Discrimination:
                         Examples       (Continued)




In healthcare settings, cont’d:
 Using infection control procedures (e.g.,
  gloves) only with clients thought to be
  HIV-infected, rather than with all clients
 Advising or insisting PLHIV undergo
  procedures, (e.g., abortion or
  sterilization) not routinely suggested for
  women who are not HIV-infected



PMTCT Generic Training Package                        Module 4, Slide 37
                    Stigma and Discrimination:
                         Examples   (Continued)




  What are some examples of stigma and/or
       discrimination in the workplace?




PMTCT Generic Training Package                    Module 4, Slide 38
                  Stigma and Discrimination:
                       Examples          (Continued)




In the workplace:
 Requiring testing before hiring
 Refusing to hire people who
  are HIV-infected and HIV-affected
 Requiring periodic HIV testing
 Firing someone because of HIV status
 Breaking confidentiality
 Refusing to work with colleagues who
  are HIV-infected


PMTCT Generic Training Package                         Module 4, Slide 39
                    Stigma and Discrimination:
                         Examples       (Continued)




  What are some examples of stigma and/or
             discrimination in the
                         context of religion?




PMTCT Generic Training Package                        Module 4, Slide 40
                   Stigma and Discrimination:
                        Examples       (Continued)




In the context of religion:
 Not letting PLHIV participate in
  funerals and other religious traditions
  and rituals
 Refusing to perform marriage
  ceremonies for PLHIV




PMTCT Generic Training Package                       Module 4, Slide 41
                    Stigma and Discrimination:
                         Examples   (Continued)




  What are some examples of stigma and/or
             discrimination in the
              family and local community?




PMTCT Generic Training Package                    Module 4, Slide 42
                    Stigma and Discrimination:
                         Examples      (Continued)




In the family and local community:
 Isolating people who are HIV-infected
 Restricting participation of PLHIV in local events
 Refusing to allow children who are HIV-infected or
  HIV-affected to go to local schools
 Not including partners and children of PLHIV in
  activities or gatherings


PMTCT Generic Training Package                       Module 4, Slide 43
                    Stigma and Discrimination:
                         Examples       (Continued)




In the family and local community, cont’d:
 Using violence against a partner who has
  tested HIV-positive
 Denying support for grieving family
  members, including orphans




PMTCT Generic Training Package                        Module 4, Slide 44
                                 Effects of Stigma



             What are the effects of stigma?




PMTCT Generic Training Package                       Module 4, Slide 45
                                 Effects of Stigma

              1. Stigma deters disclosure and limits
                         access to services
 Non-disclosure due to fear of response from
  others  reduced access to support from family,
  friends, community
 Avoidance of health and social services due to fear of
  unfair treatment/ fear that action would be admission of
  HIV-status
       increased risk of transmission to partners or children
       limited choice in health care

PMTCT Generic Training Package                         Module 4, Slide 46
                          Effects of Stigma     (Continued)




                    2. Stigma fuels new HIV infections

 May deter people from getting tested
 May make people less likely
  to recognize their risk of infection
 May discourage those who are HIV-infected from
  discussing their HIV status with partners



PMTCT Generic Training Package                           Module 4, Slide 47
                          Effects of Stigma   (Continued)




Fuels new infections, cont’d
 May prevent PLHIV from adopting risk-reduction
  practices that may label them as HIV-infected (e.g.,
  replacement feeding)
 May obstruct prevention, treatment, and care programs




PMTCT Generic Training Package                         Module 4, Slide 48
                          Effects of Stigma         (Continued)




                     3. Stigma can lead to social
                              isolation

 Face rumours and gossip
 Be told to leave home
 Be rejected by partners and community
 Be abused physically and/or verbally



PMTCT Generic Training Package                               Module 4, Slide 49
                          Effects of Stigma      (Continued)




Social isolation, cont’d:
 People’s emotional response to HIV may influence them
  more strongly than their knowledge
       Someone may shake hands with several people in room
        but fail to shake hands with person they think “looks like
        they have AIDS”
       Fear of catching HIV may lead someone to require that
        person with HIV drinks from glass no one else uses



PMTCT Generic Training Package                            Module 4, Slide 50
                          Effects of Stigma                (Continued)




                  4. Stigma can occur by association
                          (secondary stigma)

                        For example:
                                  “If I sit near someone with AIDS, others
                                   will think that I have AIDS too”
                                  Stigma may extend to family members
                                   and family or workers intimately involved
                                   in caring for someone with HIV



PMTCT Generic Training Package                                      Module 4, Slide 51
                   Effects of Stigma on Use of
                        PMTCT Services
Women may avoid:
 Accessing antenatal care
  services
 Receiving HIV testing  miss
  opportunity for PMTCT
  interventions
 Discussing HIV test results
  with partners, families

PMTCT Generic Training Package            Module 4, Slide 52
                   Effects of Stigma on Use of
                      PMTCT Services               (Continued)




Women may avoid:
 Accepting PMTCT interventions
  e.g., ARV therapy and prophylaxis
 Accepting referrals for treatment,
  care and support
 Taking their children for HIV testing
 Ensuring their children receive ARV prophylaxis and/or therapy
 Using recommended PMTCT safer infant feeding practices (e.g.,
  replacement feeding, exclusive breastfeeding, or early cessation of
  breastfeeding)

PMTCT Generic Training Package                              Module 4, Slide 53
                                 Session 2



         Dealing with Stigma and
   Discrimination in Healthcare Settings
            and Communities



PMTCT Generic Training Package               Module 4, Slide 54
                            Session 2 Objective


 Discuss strategies to address stigma and discrimination
  in the delivery of PMTCT services.




PMTCT Generic Training Package                    Module 4, Slide 55
                Addressing Stigma in PMTCT
                       Programmes
 Implement interventions that address HIV-related
  stigma at all levels:

                                 Individual
                                   HCW
                                   PMTCT
                                 Programme
                                 Community
                                  National


PMTCT Generic Training Package                 Module 4, Slide 56
                           National Level

 National policies:

       Addressing human rights
        of PLHIV
       Prioritizing HIV-related
        prevention,
        treatment, care support
        services



PMTCT Generic Training Package              Module 4, Slide 57
                            National Level   (Continued)




 High-ranking politicians, other well-known individuals:
       May serve as leaders and role models
       Advocate for legislation
       May engage the media to increase publicity
       Promote implementation and enforcement of legislation

 Educate and engage the national media




PMTCT Generic Training Package                             Module 4, Slide 58
                             Community Level


          What can we do to address stigma
           and/or discrimination within our
                    communities?




PMTCT Generic Training Package                 Module 4, Slide 59
                             Community Level

HIV education:
       Target media, community members,
        journalists and
        HCWs in referring organizations




PMTCT Generic Training Package                 Module 4, Slide 60
                  Community Level           (Continued)




HIV education:
 Educational, informational and media campaigns can:
       Increase knowledge about HIV
       Raise awareness of issues faced by PLHIV
       Increase awareness of domestic
        violence faced by newly-diagnosed women
       Communicate that violence
        against women is inappropriate, immoral, illegal


PMTCT Generic Training Package                            Module 4, Slide 61
                         Community Level         (Continued)




HIV education:
       Encourage leaders to make workplaces “HIV-friendly”
       Promote PMTCT activities as a central part of HIV
        prevention, care, treatment
       Educate communities about PMTCT interventions,
        stressing importance of community, family support
       Increase referrals to and from PMTCT services
       Secure involvement of community members and PLHIV
        in HIV prevention, education and support programmes


PMTCT Generic Training Package                            Module 4, Slide 62
                         Community Level         (Continued)




 Community awareness of PMTCT interventions:
       Helps men and women recognize their roles and
        responsibilities in protecting themselves and their
        families against HIV
       Greater community awareness may strengthen support
        from the partner and other family members




PMTCT Generic Training Package                            Module 4, Slide 63
                         Community Level   (Continued)




 Community partnerships:
       Build partnerships with
        religious, educational,
        social, civic organizations
        when developing PMTCT
        services
       Promoting PMTCT services
        helps develop broad base of
        support



PMTCT Generic Training Package                      Module 4, Slide 64
                         Community Level      (Continued)




 Other community level interventions:
       Facilitate exchange of information,
        ideas among healthcare
        professionals and other caregivers
        of PLHIV during roundtable case
        discussions and social activities
       Provide input into curricula for
        students in healthcare professions
        (for example, nurses, midwives,
        physicians)


PMTCT Generic Training Package                         Module 4, Slide 65
                        PMTCT Service Level



         What can we do to address stigma
         and/or discrimination within our work
                       settings?




PMTCT Generic Training Package                Module 4, Slide 66
                          PMTCT Service Level

 HCWs and managers of the facilities in which the
  PMTCT interventions are based can take the lead in
  challenging long-held community beliefs and
  practices, including stigmatization of and
  discrimination against PLHIV and PMTCT clients.




PMTCT Generic Training Package              Module 4, Slide 67
                    PMTCT Service Level              (Continued)




 Role of the PMTCT manager:
       Implement, enforce policies & procedures, including on
        discrimination and confidentiality. Discipline staff in
        violation.
       Ensure staff follow Standard Precautions
       Support HIV-infected workers to continue to work
       Implement policies guaranteeing clients equal treatment
       Give clients a confidential means of reporting
        discrimination


PMTCT Generic Training Package                           Module 4, Slide 68
                    PMTCT Service Level              (Continued)




 Integrate PMTCT into MCH
       Integrate all PMTCT interventions into maternal child
        health (MCH) care services for all women
       Offer HIV screening to all pregnant or clinic attendees
        who have recently delivered
       Include HIV services as part of routine MCH services to
        help normalize HIV care and treatment




PMTCT Generic Training Package                          Module 4, Slide 69
                    PMTCT Service Level              (Continued)




 Encourage participation of male partners
       Educate partners about PMTCT interventions
       Stress importance of partner testing, partner and family
        support for PMTCT
       When male partners do not normally attend ANC clinics,
        PMTCT service should reach out to them in male-friendly
        settings, e.g., workplaces, barbershops, taxi stands,
        stadiums




PMTCT Generic Training Package                          Module 4, Slide 70
                    PMTCT Service Level                (Continued)




 Provide educational sessions
       Group or individual education sessions (on-site and off-
        site) can help draw attention to the role partners play in
        HIV transmission
       Couple counselling offers
        another opportunity to:
            Emphasize couple's shared
             responsibility for HIV prevention
             and PMTCT
            Reduce the blame that can be directed at women

PMTCT Generic Training Package                            Module 4, Slide 71
                    PMTCT Service Level                  (Continued)




 Train healthcare workers
       PMTCT programme success or failure
        depends on attitudes, skills, experience
        of HCWs
       Training should include:
            Complete and accurate information about
             transmission of and risks factors for HIV
            Activities addressing HIV-related stigma
       Educational initiatives should address employee
        attitudes, correct misinformation, teach clinical skills

PMTCT Generic Training Package                              Module 4, Slide 72
                    PMTCT Service Level                    (Continued)




 Involve PLHIV in PMTCT services
       Ensures PMTCT services better
        meet needs of clients
       Involve PLHIV as:
            Volunteers or paid staff
            Peer counsellors
            Support group facilitators
            Peer buddies
            Citizens’ advisory bureau representatives
            Reviewers for training curricula, care guidelines

PMTCT Generic Training Package                                Module 4, Slide 73
                     PMTCT Service Level                (Continued)




 Engage peer and community support
      Mentoring programmes for HIV-infected pregnant women
          Lead to better understanding and acceptance of PMTCT
           interventions
          Mothers who are HIV-infected and have recently given birth
           return to ANC facility to educate, counsel, support peers
          Share personal experiences to encourage adherence; help
           with infant feeding decisions, negotiating care
      Peer support for PLHIV
          PLHIV provide friendship, companionship and advice to client

 PMTCT Generic Training Package                            Module 4, Slide 74
                    PMTCT Service Level              (Continued)




 Ensure infection control
       Provide all HCWs with necessary
        equipment and supplies to adhere to
        infection control policies, prevent
        transmission of HIV
       Teach HCWs to use Standard Precautions
        with all clients, regardless of assumed or
        established HIV status




PMTCT Generic Training Package                          Module 4, Slide 75
                    PMTCT Service Level                   (Continued)




 Protect client confidentiality
       Develop & implement confidentiality policies, procedures
            Include directions on how to record
             and securely store client information
            Ensure medical files (paper or electronic)
             are not labelled to reveal HIV status
            Ensure all client consultations, from
             initial contact with receptionist to the healthcare
             provider, respect personal information


PMTCT Generic Training Package                               Module 4, Slide 76
                                 Individual HCWs



            What can we, as individuals, do to
           address stigma and/or discrimination?




PMTCT Generic Training Package                     Module 4, Slide 77
                                  Individual HCWs

1. Serve as role models
       Treat PLHIV same as clients assumed to be HIV-
        negative
       Be aware of own feelings, thoughts, attitudes about
        HIV
       Ensure feelings, thoughts, attitudes do not have
        negative effect on care provided



 PMTCT Generic Training Package                     Module 4, Slide 78
                           Individual HCWs   (Continued)




2. Know the local community
       Identify local HIV-related stereotypes and
        discrimination
       Address misconceptions at appropriate times
        during service delivery




 PMTCT Generic Training Package                        Module 4, Slide 79
                          Individual HCWs   (Continued)




3. Advocate for women’s rights
       Ensure HIV-infected women know their rights and
        where to get help to challenge discrimination




PMTCT Generic Training Package                        Module 4, Slide 80
                          Individual HCWs   (Continued)




4. Provide counselling and education for PLHIV
       Encourage, empower and support PLHIV to live
        positively with HIV
       Help PLHIV disclose HIV status to family and
        friends
       Goal: PLHIV to be viewed as ordinary community
        members encouraging community acceptance of
        PLHIV

PMTCT Generic Training Package                        Module 4, Slide 81
                                 Exercise 4.3
                                 PLHIV Panel




PMTCT Generic Training Package                  Module 4, Slide 82
                                 Key Points

 While stigma reflects an attitude, discrimination is an act
  or behaviour.
 Stigma and discrimination are related. Stigmatizing
  thoughts can lead to discrimination and human rights
  violations.
 International and national human rights declarations
  affirm that all people have the right to be free from
  discrimination based on HIV status.


PMTCT Generic Training Package                    Module 4, Slide 83
                           Key Points   (Continued)




 Healthcare workers have a responsibility to respect
  the rights of all women and men, regardless of their
  HIV status.




PMTCT Generic Training Package                        Module 4, Slide 84
                                 Key Points   (Continued)




 As a result of HIV-related stigma and discrimination,
  women may avoid:
       Accessing antenatal care services
       Receiving HIV testing
       Disclosing their HIV test results
       Accepting PMTCT interventions
       Accepting referrals to care, treatment and support services
       Using recommended PMTCT safer infant feeding practices


PMTCT Generic Training Package                              Module 4, Slide 85
                                 Key Points   (Continued)




 Stigma must be addressed at all levels including global,
  national, community, programme and individual. It is
  essential that PMTCT programmes collaborate with
  community leaders to address HIV-related stigma and
  discrimination that affects uptake of PMTCT services.
 HCWs are role models. PMTCT staff should treat
  PLHIV as they would clients assumed to be HIV-
  negative.



PMTCT Generic Training Package                              Module 4, Slide 86
                                 Key Points   (Continued)




 PLHIV can become involved in PMTCT services in any
  number of ways, as volunteers or paid staff, depending
  on their skill level and interests.
 PMTCT staff should promote partner participation in
  PMTCT interventions and community support of PLHIV
  and their families.




PMTCT Generic Training Package                              Module 4, Slide 87

								
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