Learning Objectives:

• To engage participants in identifying stories and rules that perpetuate stigma
• To support participants in making connections about how these rules/stories affect individual and collective behaviours
• To highlight how stigma leads to social exclusion and suffering

Materials: Pens, Flipchart Paper, Water-based Markers and Masking Tape Worksheet 1.9.1 – Exploring rules and stories about HIV stigma

Time Required: 45 minutes

Activities & Instructions

Setup and participant format:

• Participants sit in a circle; co-facilitators sit across from each other at the open-end of the horseshoe.
• In Part A, each participant works on her/his/their own; in Part B, participants share their internal dialogue and rules. In Part C, the facilitator debriefs the exercise.

Instructions to Participants

Part A: Individual reflection on rules and stories on HIV stigma (10 minutes)

• (Facilitators provide each participant with Worksheet 1.9.1 and a pen.)
• Facilitator says, “The next activity will help us gain more insight on how stigma impacts our individual behavior and impacts how society operates. This activity will be done in 3 steps. First we would like you to work on the worksheets by yourself, then you would share the discussion in small groups, and then we would report back and debrief in a large group. We will take you through the steps one by one.
  • First let us divide ourselves into four small groups, can we count off 1,2,3,4 please. (after people finish counting) Now let’s get into the small groups, the 1’s with the 1s, the 2’s with 2’s and so on. Please do that now.
  • (After people get into their small groups).
    We have just given everyone an activity worksheet. On this worksheet, you will find a list of topics or issues related to HIV stigma. Now we would invite each group to work on the topic that correspond to their group number, that is, group 1 will work on topic 1 and so on.
  • So Group 1 will be working on HIV, sex, dating and relationships; group 2 will work on HIV, family and community; group 3 will work on HIV and faith and religion; and then group 4 will work on HIV criminalization and human rights.“
• Facilitator continues, “First we would like you to work individually on your own for a few minutes to fill out your own thoughts on this topic. Write down what kinds of thoughts come to mind when you hear “HIV stigma” paired with these issues. For example, HIV and family, or HIV and dating, etc..
  • Think about the key messages, stories or rules you have heard from different parts of the society when you were growing up about HIV and this topic area; write down those messages, stories or rules that come immediately to your mind when you think about this topic. These can be something you agree or disagree with, something you believe or do not believe in. There is no right or wrong answer.
  • After you have written those thoughts, we would like you to think about how these thoughts have guided your actions – including what you DO and what you DON’T DO because of it.”
• Facilitator continues, “Similarly, write down how these thoughts may affect others’ actions, or how society reacts and behaves as a result of these thoughts.
  • Let me give you an example. If the thought you wrote down on the left column is that “HIV is a gay disease”, you may write down on the right-hand column how this influences your behaviours, including what you DO, e.g. “I would tell all my gay friends to get tested for HIV”; or “what you WON’T DO, e.g. “I would not educate my heterosexual friends about ways to prevent HIV.”
• Facilitator continues, “For the societal level, you may think or write down that ‘health care providers would not bother testing heterosexual people for HIV’, or ‘people may use this to justify their prejudice against gay people”’. It can also be ‘it motivated communities to mobilize against both homophobia and AIDS phobia’. Is that clear?” (Check if participants are clear)
  • “Now you have 5 minutes to work on your own on this.”

• (Facilitators check with participants after 5 minutes to ensure that each participant has completed their worksheet.)

Part B: Small Group Sharing on Rules and Stories On HIV Stigma (15 minutes)

• Facilitator says, “We now invite you to share with your small group members what you have written down. You have about 12-15 minutes to share with each other your thoughts on the topic; and we would like each group to choose a note-taker and reporter to share the highlights of your discussion with the big group. Each group will have 2 minute to report to the large group.”

Part C: Large Group Report Back and Debriefing (15 minutes)

• Facilitator asks all participants to regroup into one large group, then says, “Let us hear from each of the groups that came up in your discussion.”
• Co-facilitator writes down what participants share on a flipchart using two columns:
  • In Column A, make notes on what the participants share about the thoughts/rules related to the topic/context listed in the worksheet.
  • In Column B, make notes on the participants’ reported behaviours or action related to the different topic/ context as a result of Column A’s thoughts/rules.
• Facilitator leads the debriefing by asking the following questions:
  • “How do our internal rules and stories affect us negatively or positively?
  • “How do these rules and stories also affect others?”
  • “How do you see these stories connect to social justice or injustice?”

Key Summary Points

When participants finish debriefing, facilitator concludes the activity by pointing out the connection between the thoughts (or internal rules) described by the participants and the behaviours or action of the participants:

• “These internalized thoughts and rules contribute to suffering and act as barriers for us to follow our chosen values. These impact how we live our personal lives, how we interact with others, and how we may respond to different forms of stigma and discrimination.”
• “This pattern of rule-following behaviours may apply both at the individual level as well as at the societal level.”
• “There may be interactions between the individual and societal levels. For example, societal rules may have an impact on individual rules, and an individual may follow these rules or react in opposition against it.”
• “Having this awareness is a first step that enables us to develop proactive strategies to challenge these internalized rules and thoughts.”

Source:

• Fung, K. P., & Zurowski, M. (2011). ACT protocols for CHAMP Study. Toronto, ON: Community Alliance for Accessible Treatment.
• Inspired by Exploring Your Rules About Pain in Dahl, J., & Lundgren, T., (2006). Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain. Oakland, CA: New Harbinger Publication, Inc.

Worksheet 1.9.1 – Exploring Rules and Stories about HIV Stigma Exercise

The following is a list of common topics/contexts about HIV stigma:

1. HIV, Dating, Sex, and Relationships
2. HIV, Family and Community
3. HIV, Faith and Religion
4. HIV, Criminalization and Human Rights

First, take a few minutes to do this on your own. Use the worksheet below to explore some of the societal rules or stories about HIV stigma. Do not think too hard about it – just write down any rules/stories that pop into your head for the topic you have been assigned to. These do not have to be rules or stories you personally agree with or believe in. Once you’ve written down your rules/stories in the left-hand column, write what each rule/story leads to in the right-hand column.

After you have done completing this on your own, share your thoughts with others in your small group.