Feature story

Community groups are reducing stigma in health-care settings in Asia

26 May 2017

Dy Sokha has a ready smile and calls out friendly greetings to doctors, nurses and patients as she walks through the bustling hallways of the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia. She is brightly dressed in a peach pink shirt and is a full-time counsellor with the ARV Users Association (AUA), a community-based organization providing services to people living with HIV.

“Sometimes at the beginning of a counselling session, the client won’t look at my face,” said Dy Sokha. “They put their face down; they scratch their fingernails. They are so shy. For these difficult cases, I must open up about myself.”

Dy Sokha was diagnosed with HIV about 20 years ago and began taking antiretroviral medicine in 2004. The HIV treatment improved her health significantly and now gives her the strength to lead a busy life as a counsellor.

“I have become a role model for my clients, as they can see I am successful and they understand that just because you have HIV, it does not mean you have to disappear from society,” she said.

AUA, which is active in seven hospitals in two provinces, is one of a few community-based HIV organizations in Cambodia whose staff work directly alongside health-care providers. While the organization provides a range of services, such as counselling on treatment adherence and HIV prevention, it places a particular focus on preventing stigma and discrimination in the hospitals in which it works.

Eighty-five per cent of AUA’s 40 staff members are people living with HIV and so they know first-hand how discrimination can lead to social isolation and negatively affect a person’s health and well-being. The group facilitates connections between clients and health-care providers and holds regular meetings with hospital staff to provide feedback.

“We coordinate with different stakeholders to meet and encourage communication between people living with HIV, service providers and civil society,” said Sienghorn Han, Executive Director of AUA.

In 2015, AUA was trained by Asia Catalyst to document human rights violations in health-care settings. The cooperation was part of a study that Asia Catalyst conducted in four countries in Asia, which found discrimination evident in many areas, from denial of services and segregation to arbitrary additional fees for health services.

When AUA receives a discrimination case, it acts as a mediator, trying to find a solution that is acceptable to both health-care workers and clients.

“We keep good contact with all levels of the hospital,” said Dy Sokha. “The staff and I sit together—the doctor, the client and myself—to understand the problem in order to help the doctor do his or her best.”

AUA also holds counselling sessions with clients that aim to give them accurate information, as well as empower them to advocate for their rights and negotiate with health-care providers.

Bopha, who prefers to use a pseudonym and is living with HIV, found that AUA was especially helpful when she became pregnant in 2013. “AUA explained everything, especially how to take care of my pregnancy and how to disclose my HIV status to my doctor so that I could access antiretroviral medicines to prevent the transmission of HIV to my daughter,” she said.

Cambodian health officials acknowledge that AUA provides services that help busy health-care workers. Ngauv Bora, Deputy Chief, Technical Bureau of the National Centre for HIV/AIDS, Dermatology and STDs, said, “For clients, AUA staff are like friends and they trust them more than the hospital counsellors. AUA is helping to create an enabling environment.”

The organization is one of more than a dozen community groups that, along with health officials and international experts from 12 countries, participated in the first Asia Regional Consultation on Addressing HIV-Related Stigma and Discrimination in Healthcare, which took place on 25 and 26 May in Bangkok, Thailand.

The regional consultation provided a platform for countries to achieve tangible objectives, with technical assistance from partners. Community organizations were recognized as crucial partners in the drive to eliminate stigma and discrimination.

UNAIDS is working with countries to empower people living with, at risk of and affected by HIV to know their rights and to access justice and legal services to prevent and challenge violations of human rights.