1.
Applying Stigma Reduction Best Practices to

2.
Objective:
Research best practices in health-
related stigma reduction for
possible application to the problem
of stigma and violence towards
PWA in Tanzania

3.
 Research on issue of stigma and violence
towards PWA in Tanzania.
 Research on stigma and stigma reduction
programs.
 Literature review of best practices in health-
related stigma reduction, particularly
HIV/AIDS and mental illness.
 Interview with NGO working on issue, Under
the Same Sun.

4.
o Population of nearly 43
million people.
o One of the world’s 48 Least
Developed Countries.
o Nearly 70% live below the
international poverty line
$1.25/day.
o Ranked 152 out of 187 on
UNDP’s 2011 Human
Development Index.

5.
What is Albinism?
• Medical condition
• Lack of melanin
• Skin is chalky white
• Eyes are very light
• Hair is fair
• Genetic
• Inherited
• Incurable

6.
Approximately 1 in
1,429 People in
Tanzania have
Albinism

7.
 Health problems: skin
and eyes
 Stigma  Myths
 Discrimination  Misconceptions
 Social exclusion  Misinformation
 Violence  Superstition

8.
 Lack of pigment causes
virtually no protection
from the sun’s harmful
rays.
 Albinism results in extreme
skin sensitivity to the sun

9.
o Burning
o Blistering
o Skin cancer

10.
o More than 98% of
PWA in Tanzania
die from skin
cancer before the
age of 40.
o 50% develop
advanced skin
cancer by age 30.
o100% exhibit skin
damage by age 10.

11.
oSensitivity to sun
and brightness
oLow vision &
additional eye
problems (“cross
eyed”, “lazy eye”,
involuntary eye
movement, near or
far sightedness, and
more)

12.
 Stigma, discrimination,  But starting in 2007, new
social exclusion, and elements were added
even violence have resulting in extreme acts
been experienced by of violence including
PWA in Tanzania for hunting, mutilating,
raping, and killing due to
millennia.
new superstitious beliefs
regarding charms for
wealth/success and a
cure for HIV/AIDS.

13.
The following video provides information about the
violence against people with albinism in Tanzania:
http://www.youtube.com/watch?v=R0XigrdAJKQ

14.
•99 documented
reports of attacks
for body parts in
Tanzania as of
April 2012, 78 of
which resulted in
death.
•The remaining 21
are mutilated and
traumatized, like
Fatuma.

15.
Dehumanizing beliefs:  Fathered by white men or ghosts of
“Ghost”
“Nobody”
colonialists
“Deal”  Contagious
“Money”
“zeru zeru”  Unintelligent
They don’t die, they just  A curse on their family
disappear.
 A cure for HIV/AIDS
Dehumanization
Objectification  A charm to bring wealth and success
Commodification
 All within a deep-rooted context of
traditional beliefs & superstitions

16.
Due to a lack of understanding of albinism as
a health condition, many people with
albinism in Tanzania experience stigma –
which can lead to marginalization in all
aspects of life:
o education
o employment
o relationships
o emotional and mental health
o safety

17.
 Name-calling
 Taunting
 Limiting educational & employment
opportunities
 Limiting social relationships
 Social exclusion
 Grave robbing
 Violence: mutilation, murder, rape

18.
With the
current dangers
facing people
with albinism,
many,
especially
children, are
fleeing their
villages.

19.
 Stigma “…  “It is vitally important to
exist(s) where recognize that stigma arises
any two of the
and stigmatization takes shape
three
circumstances
in specific contexts of culture
intersect: and power.”
- Parker & Aggleton
low value,
exclusion, and
disadvantage”
- Royal Tropical Institute

20.
Stigma
Discrimination
Human Rights Violations

21.
 Traditional Healers (not all)
 Buyers
 Hunters
 Those who let it happen

22.
 Hired hands, earning relatively little money
for attacking PWA and taking their body
parts.
 Sometimes relatives or neighbors, either
directly or indirectly.

23.
 Miners
 Fishermen
 Businessmen
 Politicians
 Those with money
Why? – To improve their fortunes, gain wealth
and success, a copious catch, find gold,
secure a business deal or win an election.

24.
 According to the Albino Association of
Tanzania, the price for a complete set of
albino body parts – comprising limbs,
genitals, ears, tongue, hair and blood – has
gone up from 75,000 US dollars to 200,000
US dollars within just a few years.

25.
Traditional medicine is
widely practiced in  Powerful, respected, awed,
Tanzania.
influential members of
Long history of allegiance
to traditional medicine, community
combined with limited
access to - and trust of –
 Special connection to spirit
western/biomedical health
care. world, often through ancestral
Ranked 192 out of 192 spirits
countries for physician
density, with a mere 0.008
 Holders of thousands of years of
physicians per 1,000
people. knowledge of spiritual, physical,
magical healing

26.
 Inform and raise awareness
 Include targeted community interventions
 Utilize local opinion leaders as change agents
 Increase contact with members of the stigmatized group
 Integrate members of the stigmatized group into
mainstream community life/society
 Educate and empower members of the stigmatized group
 Ensure strategies and interventions are context-appropriate
 Acknowledge the wider environment

27.
 Disseminate correct information in
compelling ways.
 Close the KAP gap through participatory
methods, such as facilitated discussion.
 Pay attention to the pieces of stigma
reduction program design and how they
influence and support one another.

28.
 Tailor message according to audience.
 Differences between ethnic groups, age
groups, urban and rural populations,
profession, gender, etc.
 Example: Schools – influence the youth as
their opinions are taking shape; “change
takes a generation.”

29.
 Culturally: how do people get their
information, what language and what forms
are most effective?
 Example: Pact Tanzania using music for
stigma reduction towards OVC.

30.
Usimtenge mtoto
PACT TANZANIA - OVC
Don’t discriminate
 3 anti-stigma songs sung by against a child
15 Bongo Flava artists,
launched at rally:
 Tuonyeshe upendo
Show us love
 Usimtenge mtoto
Do not discriminate against a child
 Haki za mtoto
Rights of the child

31.
A short glimpse of some empowerment songs
from children with albinism at an albinism
awareness day for PWA in Tanzania – to
encourage them and counter self-stigma.
These songs can also be used to counter felt
stigma at events for the wider community:
http://www.youtube.com/watch?
v=71MQtAaGxAg
Cue to 7:52

32.
 Trusted members of the community to whom
others look for guidance.
 Can include elders, religious or community
leaders, celebrities (such as musicians).
 Example: Balozi leaders as change agents.

33.
PWA are
PEOPLE, not
ghosts, not
some abstract
“thing.”

34.
 Being separate reinforces “us” and “them”
thinking.
 Integration optimizes contact.
 Example: Children with albinism integrated into
mainstream schools, with modifications to address
their physical needs, resulting in children growing
up alongside each other, playing together, knowing
one another. Must be accompanied by stigma
reduction education and modeled and monitored
by teachers and other school staff.

35.
 To eliminate self-stigma and counter felt
stigma.
 To raise the awareness of PWA re: their
health condition.
 To create opportunities for equality
(education, social inclusion, employment).

36.
 Stigma stems from complex web of socio-
cultural, economic, and political elements.
 Stigma reduction efforts must take the wider
picture into account.
 Collaborate where possible.
 At least, know your role is only part of the
solution.
 Multi-level, multi-channel stigma reduction
programs are more effective.

37.
There are a limited number of NGOs working
on issues related to people with albinism in
Tanzania, including:
o Under the Same Sun
o Red Cross
o Adventist Development and Relief Agency
o Tanzania Albino Society

38.
 Documentary White and Black: Crimes of
Colour
 Screenings in communities with discussion,
on television, radio script version, reached
thousands

39.
 Learn from these (and other) successful best practices.
 A possible intervention point could be at the level of the
traditional healer.
 Precedence for this in HIV/AIDS awareness raising programs.
 A number have spoken out about the practice – that it is a
false belief.
 They are respected members of the community.
 Highlight that it is in their best interest.
 Considering the strength of traditional belief in Tanzanian
culture, this could be the most effective way in the long run to
deal with this.
 Must be done carefully – with the protection of PWA of
utmost importance.