SRH & HIV service Integration and Stigma: A Step by Step guide

Integrating SRH and HIV services can reduce stigma, but only when deliberate steps are taken to ensure confidentiality in an integrated service delivery setting.

The latest guide in the Steps to Integration series examines the complex issue of stigma and SRHR and HIV service integration. The Integra Initiative sought to explore the experience of stigma of clients living with HIV in a variety of settings, both service-based (when seeking family planning, antenatal, and postnatal care services) and facility-based (when seeking services in different facility types).

There is a complex relationship between stigma and service integration. In some cases, integration has been shown to reduce stigma by providing HIV service clients the anonymity of attending a facility that offers a range of services, but in other circumstances, clients attending HIV services at integrated or partially integrated clinics have perceived an increase in stigma.

The relationship is further complicated by the relative nature of stigma; what is experienced by one group of people in one setting is likely to be felt differently in a different setting, or by a different group of people. Evidence from the Integra Initiative reveals how complex and delicate the issue of stigma is, as it relates to providing integrated HIV and SRH services.

This newly published guide asks how the stigma-reduction gains of integration can be maintained (the confidentiality gained by blending in with other services) but reduce the factors that can lead to increased stigma in integrated service delivery settings.

Following studies in Swaziland and Kenya, 6 key recommendations emerged:

1. Fear of stigma is highly influential to women’s health seeking practices, so it is critical to create practices that protect women’s confidentiality.

2. Ensure confidentiality policies are put in place and there is skilled management of the integration process, so that perceived or enacted stigma is not increased.

3. The psychosocial support provided in stand-alone facilities is a valuable service that should be included in integrated programme design

4. Provider training on interacting with clients living with HIV needs to be improved.

5. Client records, ARV cards, and food distribution for nutritional support needs to be subtly labeled to eliminate the risk of accidental disclosure of HIV status.

6. Frequently changing providers at an integrated facility increases perceived stigma or fear of stigma. Therefore, either limit the providers who offer integrated services, or improve confidential record keeping to reduce the number of times a client has to explain their condition.

The Integra Initiative was a research project on the benefits and costs of a range of models for delivering integrated HIV and SRH services in high and medium HIV prevalence settings, to reduce HIV infection (and associated stigma) and unintended pregnancies. It was managed by the International Planned Parenthood Federation (IPPF) in partnership with the London School of Hygiene & Tropical Medicine (LSHTM) and the Population Council.

For more information and to the view Integra Research findings, visit the project page.