Case study: Tackling Stigma and Discrimination in El Salvador: The Vida Digna (Life with Dignity) Programme

The Vida Digna (Life with Dignity) programme in Central America addresses the high levels of stigma, discrimination, and violence faced by key populations affected by HIV and AIDS. This approach to tackling stigma and discrimination in Mexico, designed by Colectivo Sol, the Alliance Linking Organisation in Mexico, and by ViiV Healthcare’s Positive Action programme, has been adapted for El Salvador. The project is being implemented by Alliance Linking Organisation Atlacatl, a Salvadoran organisation run for and by people living with HIV, and four partner organisations.

As reported here:"In concentrated epidemics, engaging key populations is essential to an effective HIV response. In El Salvador this includes gay men and other men who have sex with men, people living with HIV, sex workers and transgender women. In El Salvador the HIV prevalence rate in transgender women is estimated to be 23%, compared to 0.45% in the general population."

The Vida Digna programme has been engaging with service providers: working to reduce stigma and discrimination; strengthening key population organisations; and working to help make the HIV response more sustainable, by the following kinds of actions:

• The programme uses participatory community assessment: "Participatory Community Assessment (PCA) activities encourage participants to examine stigma and discrimination at all levels, from individual through to national. They help participants make the connection with human rights, and give them tools to tackle these issues through official channels." PCA is used as a needs assessment with key populations, a tool for developing advocacy and work plans for partner organisations, and an awareness raising activity with the general population.For example, facilitated by a leader, "[p]articipants recall a time when they were discriminated against, how they felt, what they did and how it changed them. Then they recall another time when they discriminated against someone....Participants rate the cost, quality and user-friendliness of services they use, such as medical care, insurance and legal services. They analyse how well these services are meeting their needs, and whether or not they are discriminated against."
• Partners are working in advocacy as influencers at the national level: "Partner organisations are gaining greater visibility as a result of their participation in the Vida Digna programme and association with Atlacatl. This visibility is helping key populations to advocate and lobby; one of the ways they are making their voices heard at the national level. For example, two Vida Digna partner organisations participated in the drafting of a new law on sexual and reproductive health rights to ensure that the rights of transgender women were addressed...."
• Service provider training is another tool of Vida Digna: "Partner organisations are carrying out training to reduce stigma and discrimination with those service providers they have identified as discriminating against them. For example, in 2011 sex workers ran workshops for health care providers and police officers; gay men worked with their peers; and transgender women trained prison officers and civil servants. More than 8,000 people were reached as a result. The benefits are immediate. Since running workshops for health care providers, sex workers know where they can access stigma-free services."
• Capacity building among key populations organisations is aimed to ensure stronger and more sustainable representation of their voices in the HIV response.

The Vida Digna programme is expanding across Central America via two regional networks (Redtrasex for sex workers, and Redlactrans for transgender women), with support from Positive Action and the Alliance.