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Tackling structural stigma: a systems perspective
INTRODUCTION: Structural stigma in the global HIV response is a “moving target” that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present f...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9274342/ https://www.ncbi.nlm.nih.gov/pubmed/35818874 http://dx.doi.org/10.1002/jia2.25924 |
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author | Brown, Graham Reeders, Daniel Cogle, Aaron Allan, Brent Howard, Chris Rule, John Chong, Susan Gleeson, Deborah |
author_facet | Brown, Graham Reeders, Daniel Cogle, Aaron Allan, Brent Howard, Chris Rule, John Chong, Susan Gleeson, Deborah |
author_sort | Brown, Graham |
collection | PubMed |
description | INTRODUCTION: Structural stigma in the global HIV response is a “moving target” that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present findings from a study adopting a systems perspective to understand how to tackle structural stigma via the Meaningful Involvement of People with HIV/AIDS (MIPA), while highlighting the challenges in demonstrating peer leadership from people living with HIV (PLHIV). METHODS: Through a long‐term ongoing community‐research collaboration (2015–2023), the study applied systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organizations. We used hypothetical narratives, affinity methods and causal loop diagrams to co‐create system maps that visualize the factors that influence the extent to which peer leadership is expected, respected, sought‐out and funded in the Australian context. We then developed draft indicators of what we should see happening when PLHIV peer leadership and MIPA is enabled to challenge structural stigma. RESULTS: Participants in the collaboration identified the interactions at a system level, which can enable or constrain the quality and influence of PLHIV peer leadership. Participants identified that effective peer leadership is itself affected by structural stigma, and peer leaders and the programmes that support and enable peer leadership must navigate a complex network of causal pathways and strategic pitfalls. Participants identified that indicators for effective PLHIV peer leadership in terms of engagement, alignment, adaptation and influence also required indicators for policy and service organizations to recognize their own system role to value and enable PLHIV peer leadership. Failing to strengthen and incorporate PLHIV leadership within broader systems of policy making and health service provision was identified as an example of structural stigma. CONCLUSIONS: Incorporating PLHIV leadership creates a virtuous cycle, because, as PLHIV voices are heard and trusted, the case for their inclusion only gets stronger. This paper argues that a systems perspective can help to guide the most productive leverage points for intervention to tackle structural stigma and promote effective PLHIV leadership. |
format | Online Article Text |
id | pubmed-9274342 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92743422022-07-15 Tackling structural stigma: a systems perspective Brown, Graham Reeders, Daniel Cogle, Aaron Allan, Brent Howard, Chris Rule, John Chong, Susan Gleeson, Deborah J Int AIDS Soc Article INTRODUCTION: Structural stigma in the global HIV response is a “moving target” that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present findings from a study adopting a systems perspective to understand how to tackle structural stigma via the Meaningful Involvement of People with HIV/AIDS (MIPA), while highlighting the challenges in demonstrating peer leadership from people living with HIV (PLHIV). METHODS: Through a long‐term ongoing community‐research collaboration (2015–2023), the study applied systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organizations. We used hypothetical narratives, affinity methods and causal loop diagrams to co‐create system maps that visualize the factors that influence the extent to which peer leadership is expected, respected, sought‐out and funded in the Australian context. We then developed draft indicators of what we should see happening when PLHIV peer leadership and MIPA is enabled to challenge structural stigma. RESULTS: Participants in the collaboration identified the interactions at a system level, which can enable or constrain the quality and influence of PLHIV peer leadership. Participants identified that effective peer leadership is itself affected by structural stigma, and peer leaders and the programmes that support and enable peer leadership must navigate a complex network of causal pathways and strategic pitfalls. Participants identified that indicators for effective PLHIV peer leadership in terms of engagement, alignment, adaptation and influence also required indicators for policy and service organizations to recognize their own system role to value and enable PLHIV peer leadership. Failing to strengthen and incorporate PLHIV leadership within broader systems of policy making and health service provision was identified as an example of structural stigma. CONCLUSIONS: Incorporating PLHIV leadership creates a virtuous cycle, because, as PLHIV voices are heard and trusted, the case for their inclusion only gets stronger. This paper argues that a systems perspective can help to guide the most productive leverage points for intervention to tackle structural stigma and promote effective PLHIV leadership. John Wiley and Sons Inc. 2022-07-12 /pmc/articles/PMC9274342/ /pubmed/35818874 http://dx.doi.org/10.1002/jia2.25924 Text en © 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Article Brown, Graham Reeders, Daniel Cogle, Aaron Allan, Brent Howard, Chris Rule, John Chong, Susan Gleeson, Deborah Tackling structural stigma: a systems perspective |
title | Tackling structural stigma: a systems perspective |
title_full | Tackling structural stigma: a systems perspective |
title_fullStr | Tackling structural stigma: a systems perspective |
title_full_unstemmed | Tackling structural stigma: a systems perspective |
title_short | Tackling structural stigma: a systems perspective |
title_sort | tackling structural stigma: a systems perspective |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9274342/ https://www.ncbi.nlm.nih.gov/pubmed/35818874 http://dx.doi.org/10.1002/jia2.25924 |
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