Just starting with a stigma-reduction intervention without knowing exactly what or who you will have to target is not effective. When you realise that there is stigma in the programme you are dealing with, or in the environment that you are working in, you will need to identify first what the source and level are of the stigma.
Exercise 2: Sources of stigma
In this exercise, participants explore sources of stigmatisation. The objective is to create awareness that stigma can be reinforced or initiated by media, laws, doctors, community figures and institutions, among others. See Guide 3 Annex 1: Training exercises and tips for further details.
Examples of the kind of questions you may ask when you try to scope the sources of stigma and their levels in a specific situation
Situation: persons are afraid to disclose their health condition:
Do people in the community hold specific beliefs that prevent an affected person from disclosing his or her condition? Or is it the attitude of the community health workers that is the problem? Or are both and maybe even other factors in play?
Situation: children with a certain health condition face acts of discrimination at school:
Are there teachers who foster stigmatising behaviour towards a child with a specific health condition? Or is it the parents of classmates that influence the discriminating behaviour of their children? Are there discriminating texts in the books used in class that stimulate this behaviour? Are there other possible sources?
Situation: a leprosy-affected person is being divorced by their spouse because of their status:
Does a husband divorce his leprosy-affected wife out of fear? What kind of fear? Or does he want to divorce her because he feels pushed by his family or the community to do so? What ideas and possible consequences are causing this? Or is it maybe because there is a law in place that fosters the idea that leprosy can be a ground for divorce? Could it be a combination of some of these factors?
Situation: persons with an NTD cannot access loans from a credit institution to start a micro-enterprise:
Are there regulations at the credit institutions that prevent persons with an NTD from obtaining a loan? Are the employees at the institution unapproachable and unwilling to assist them? Are their loan applications not honoured because of certain misbeliefs or attitudes? Did persons with the NTD actually approach employees to obtain a loan, or did they not try because they expected employees of the institution to have discriminatory attitudes?
Sometimes there may be one stigma source, but most often there are several for the same situation. It is often not possible to tackle all sources at once, so you may have to prioritise the most important area(s) to intervene.