Opinion: Why Corporate Philanthropy Must Stand Against Stigma
By Manika Lall
Almost two generations have passed since the first AIDS cases were reported and, despite innovation in treatment and care, the HIV epidemic persists. As another global pandemic takes up most of the world’s attention, World AIDS Day is an important reminder that the fight to end AIDS requires not only renewed energy and additional resources, but also careful strategy to ensure investment has an enduring effect on health outcomes.
Tackling HIV-related stigma is a big part of this.
Research has made clear that people from stigmatized groups, often living on the margins of society, are bearing the brunt of new HIV infections. For example, laws that criminalize same-sex sexual behavior are correlated with lower rates of HIV testing and higher HIV prevalence among gay and bisexual men.
When a person is then diagnosed with HIV, the levels of stigma and discrimination they face can be high. UNAIDS reports that in 25 of 36 countries with recent data, more than half of adults hold discriminatory attitudes toward people living with HIV.
As a philanthropy professional at Gilead Sciences, a company that has been an integral part of the fight against HIV/AIDS, I feel a deep sense of responsibility to help guide resources toward people working to reverse inequities.
While as a company, we have unsurprisingly always taken a clear stance against stigma, Gilead has prioritized its grant-making to support organizations working at the community level in recent years. This is because they are uniquely positioned to design and implement interventions that disrupt HIV-related stigma and help marginalized populations access prevention and care.
For example, the Balochistan Rural Development Program is a Pakistani nonprofit organization working to prevent HIV among people who inject drugs. In recent years, the province of Balochistan has seen rising rates of injection drug use and HIV, and BRDP works to educate people on HIV prevention, screen people who inject drugs, and link those individuals who test positive to care.
The program helps to dispel stigma by normalizing testing and treatment, and demonstrating to policymakers that people who inject drugs and people living with HIV are real people; they are mothers, fathers, sons, and daughters. They are friends and co-workers.
BRDP also provides primary health care services to other stigmatized groups in the province — including prisoners — and has demonstrated success in reaching patients and improving health.
Private sector organizations like ours must take stances to support sustainable, community-driven projects, such as BRDP’s initiatives, that target those left behind and are forced to endure stigmatization.
The value of community-based work in tackling HIV/AIDS
Community-based groups have the obvious advantage of proximity to the people we would like to connect with when working to tackle HIV. They have an in-depth understanding of the local context and are therefore best placed to implement approaches that can reduce stigma-related barriers to care within that community. The stigma often stems from distrust and misinformation, and community-based groups have insight on the best ways to tackle those challenges and the ways in which people prefer to connect.
In my experience, local leadership is able to identify and overcome community-level obstacles to success much better than a donor organization ever could.
One example of how Gilead has tapped into this deep understanding of local preferences is a project in South Africa. Large numbers of South African men with HIV do not engage in timely care for HIV, so Gilead is supporting local organization Praekelt Foundation to develop a mobile platform that reminds men to seek HIV services — all in the palms of their hands.
MenConnect is an innovative adaptation of a widely accepted platform in South Africa, WhatsApp, which is being used to support men through their HIV treatment journey, promoting retention and adherence to treatment. The aim of the platform is to sidestep HIV stigma and nurture autonomy in a private and confidential way, removing the potential for judgment by others. The app provides access to around-the-clock resources and fits nicely into the larger effort to support South Africa in ending AIDS as a public health threat.
An additional benefit of supporting community-based organizations is that they can have built-in local ownership, acceptability, and sustainability. With local community members invested in the success of these programs, implementers are committed to adapting programs to evolving needs over the long term.
That’s not to say, however, that corporate giving should focus only on community-based groups. Donations to a blend of both large multilateral organizations, as well as local nonprofits, is essential to establishing wide-reaching programs that enrich communities by building capacity and awareness of disease risk and prevention.
In fact, Gilead’s support for MenConnect is part of a broader initiative called the MenStar Coalition, a partnership among several corporate and non-profit entities led by the U.S. President’s Emergency Plan for AIDS Relief. MenStar is successfully improving health services for men in sub-Saharan Africa at each stage of the HIV treatment cascade.
By meeting men where they are, the MenStar Coalition has brought nearly 2.2 million men into treatment and 94% of these men have become virally suppressed. The MenStar Coalition continues to develop innovations that normalize HIV testing and treatment through self-testing, equipping health care practitioners to support patients’ mental health, and empowering men to stay on treatment — addressing, in turn, HIV-related stigma among several key groups including policymakers, providers, and communities affected by HIV.
Stigma against HIV is unfortunately unlikely to go away anytime soon. However, fighting stigma is critical to fighting the HIV epidemic. This is why I urge fellow philanthropists, colleagues, and other companies to make a concerted effort to support locally-embedded nonprofits and groups — advocates, youth groups, faith-based organizations, and community health workers, among others — that can take a stand against stigma. Only in ending stigma can we improve equitable access to HIV education, prevention, and care.
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