An estimated 2.5 million people became newly infected with HIV in 2011, and while there have been decreases in new HIV infections and deaths due to AIDS-related causes in recent years, there are still 34 million people living with HIV worldwide.

One response to the global epidemic has been to improve access to and quality of Voluntary Counseling and Testing (VCT) services, particularly for vulnerable populations such as female sex workers, young people, and men who have sex with men. These populations face serious stigma and discrimination, which affects the quality of their lives and discourages them from seeking preventative and HIV/AIDS treatment services.

In 2006, IRH collaborated with Population Services International (PSI) and the Pan-American Social Marketing Organization (PASMO) to increase the use of VCT services among vulnerable populations by improving the quality of services across various countries in Latin America.

IRH’s role was to design a strategy to build provider capacity and improve VCT services. The strategy was informed by a needs assessment with health facilities, simulated clients and key stakeholders. Using Save the Children’s Partnership Defined Quality (PDQ) methodology, IRH identified key indicators and service areas that needed improvement in consultation with providers and clients.

The new strategy addressed common barriers to successful capacity building. These barriers included the fact that programs tend not to release healthcare providers to participate in extended training events, training alone is not enough to change behaviors and attitudes, and stigma and discrimination reaches beyond the consultation room to include non-clinical staff. By motivating providers through a certification process, the strategy invited providers to complete three components, including:

  1. Two days of training along with a series of seminars that reinforced teachings from the initial workshop;
  2. Sensitizing all clinic staff on stigma and discrimination with education sessions; and
  3. Supervision visits after 2 and 4 months to assess skills using a structured checklist, reinforce information and keep providers engaged. The checklist was used both as a supervision tool, but also as a tool for self-assessment for providers.

Evaluation of the strategy showed improvement in many areas including privacy and confidentiality, quality of counseling (assessing risky behavior and discussion with clients), HIV knowledge, and counseling skills. The VCT checklist was adopted by several local programs after the intervention.

Working with the Faith Based Community

In addition to working with NGOs and ministries of health, IRH also worked with selected faith-based organizations (FBOs) and churches to strengthen communication strategies to reflect human rights and sexual diversity perspectives in messages about HIV and its prevention to the religious community. Materials to sensitize the religious community on the importance of reducing stigma and discrimination associated with HIV and vulnerable populations were developed, tested, and disseminated among FBO and church groups. A regional workshop was held in Antigua, Guatemala with key FBO representatives and religious leaders to encourage increased participation in HIV prevention and stigma reduction in their communities. Subsequent sensitization workshops were held with church leaders to familiarize them with the tools and resources developed.