Stigma & Service Delivery: OST Report

This 45-page report aims to summarise findings from the Open Space Technology (OST) conference held in South Africa, in February 2005. It covers some of the problems and suggested solutions for helping combat stigma in respect to service delivery.

OST is a method for participation at conferences and is described as bringing together a group of people with a common concern and having them contribute to the dialogue in a way where they create the contents and outcomes. Thus the participants are considered the "experts" since they are the ones with the experience of the problem.

As a result of the conference, the authors describe ways that media is used to inflate stigma, for instance "in pictures of suffering e.g. orphans, stick thin people wasting away..." The words used to describe HIV/AIDS are "suffering" or "dying." They point out that journalists, for instance, may wish to push a story into a campaign, and donors or pharmaceuticals may be behind the journalism, so a story may be censored according to their issues.

The authors describe some of the challenges in measuring the reduction of stigma. Difficult questions come up such as, how does one evaluate attitude change - or how is HIV stigma different from other kinds of stigma? The authors offer a number of suggestions such as set of generic indicators or specialty indicators that can be tailored to a specific environment: community, workplace, health sector, church, etc.

The authors suggest combating stigma through methods of communications such as: having people who working in HIV/AIDs try to put themselves in the positions of their patients to create empathy; seeking to find out how the individual is feeling about his or her illness and try to find answers from them; creating
an enabling environment where these issues could be discussed in a more harmonious (non-stigmatising) atmosphere, for instance a barbeque.

In respect to recommended changes on the part of the media, the authors make a number of suggestions. Several key ones include: media workers should be trained in HIV so that they can become more informed and report more competently; more ‘live’ interviews should occur without donors interceding; articles should be screened before they are published to make sure that the media is representing the issue correctly; HIV/AIDs issues should be integrated into general wellness so that the issue is not isolated; media staff could help individuals prepare for public disclosures so that are handled well.

The authors state, "the solution will always involve communication and connection versus isolation and separation." They go on to provide an example of a young man who was living with HIV. "He was healthy, and an active member of the community, promoting AIDS awareness and spreading positive living information. One day he didn’t appear, and after several weeks of absence his supervisor went to his house to see what was wrong. She found him sick and depressed. She recognized that he had TB and took him for treatment. He thought he had full-blown AIDS, and that he would be seen as a fraud, a failure, and rejected by his community, and that he would die. He was filled with self-judgment and had forgotten what he knew about TB. When he recovered he had
a vivid memory of what happens when you self-stigmatize."