Strengthening VCT services by addressing stigma and discrimination

Different barriers prevent people from seeking Voluntary Counseling and Testing (VCT) services. One important barrier is stigma and discrimination associated with getting tested for HIV, especially among female sex workers (FSW) and men who have sex with men (MSM). Stigma and discrimination toward FSWs and MSM, by health providers and clinic staff affects the quality and demand for VCT services. However, health personnel typically do not receive training aimed at addressing stigma and discrimination. A situational analysis in El Salvador and Nicaragua guided the development of a capacity building strategy designed to address provider issues of stigma and discrimination in order to improve the quality of services. Providers' behavior change is expected to be achieved through participation in a four-month program culminating in certification. In both countries the program involved participation in a two-day training and continuing education sessions; delivering sensitization talks to clinic staff; and supervision visits to assess skills using a checklist, mentor providers and keep them engaged. Data collected before and after strategy implementation include pre and post-tests and analysis of supervision visits with 250 providers, exit interviews with 100 VCT clients and stakeholder interviews. Results show significant improvements in providers' knowledge of VCT protocol and quality of services over time. Results also show that providers value ongoing capacity building/mentoring over one-time trainings and that approaching stigma and discrimination through the lens of human rights and sexual diversity is more effective than focusing on specific vulnerable groups, which may have the unintended effect of further stigmatization.