QI and Stigma Reduction

HIV-related stigma and discrimination (S+D) in healthcare settings remains a major barrier to the achievement of UNAIDS’ 95-95-95 targets and optimal outcomes for PLWH. In healthcare settings, HIV-related stigma can manifest in the form of negative attitudes or beliefs among healthcare workers, refusals to provide care, provision of suboptimal care, and practicing excessive or unnecessary infection control and isolation measures. HIV-related S+D has been shown to discourage engagement across the HIV prevention and treatment continuum, hindering PLWH and key populations from accessing essential medical services, underscoring a crucial need to develop and implement S+D reduction interventions at scale.

Globally validated tools and evidence-informed interventions exist to measure and reduce S+D, yet their incorporation into routine national and subnational HIV programming remains limited. Moreover, while routine measurement of HIV-related S+D is feasible, little work has been done to apply QI methods to the implementation of stigma reduction policies and interventions. Reasons for poor uptake of stigma-reduction activities reflect the inherent difficulty of scaling pilot projects to generate population-level impact.

Applying QI to Stigma Reduction in Healthcare

The Southeast Asia Stigma Reduction QI Learning Network (QIS+D) was launched in 2017 by HEALTHQUAL with support from PEPFAR and has been continued with support from Gilead Sciences and ViiV Healthcare. QIS+D aims to accelerate the integration of S+D reduction activities into routine HIV quality management programming through cycles of continuous measurement, implementing improvements, and peer-to-peer exchange. To support Ministries of Health and the implementation of S+D reduction activities, HEALTHQUAL provides expert consultation related to performance measurement, QI capacity-building, scale-up, and coaching strategies. QIS+D convenes Ministries of Health from Cambodia, Lao PDR, Thailand, Vietnam, Malaysia, and the Philippines.

Key outcomes of Network activities include:

  • Measurement of HIV-related S+D among providers and PLWH in health facilities using validated survey tools
  • Assessment of patient experience and health literacy
  • Application of quality improvement methods to the reduction of S+D
  • Inclusion of PLWH in implementation of S+D reduction activities
  • Sharing of implementation successes, effective interventions, and policy innovations among Ministries of Health in Southeast Asia


Implementation of Network activities is led by HEALTHQUAL and designed in partnership with Dr. Laura Nyblade and the Research Institute for Health Sciences, Chiang Mai University, and generous support through Gilead Sciences and ViiV Healthcare. For more information on the Southeast Asia Stigma Reduction QI Learning Network, please contact Richard E. Birchard, MS, Deputy Director.

Network Resources

Country Resources






Bruce Agins, MD, MPH

Richard E. Birchard, MS
Deputy Director, HEALTHQUAL

Charlie Ferrusi, MPH
Program Manager, HEALTHQUAL


Laura Nyblade, PhD
Senior Technical Advisor, RTI International

Kriengkrai Srithanaviboonchai, MD, MPH
Associate Professor, Research Institute for Health Sciences, Chiang Mai University

Chanane Wanapirak, MD
Associate Professor, Research Institute for Health Sciences, Chiang Mai University

Jarun Chueayen
Data Manager, Research Institute for Health Sciences, Chiang Mai University