Breaking the barriers to access to care for marginalized communities

The Society for Inclusion and Development in Communities and Care for ALL (SIDC) has been at the forefront of combating stigma and discrimination in Lebanon's health-care settings. The focus of SIDC is on marginalized communities such as people living with HIV, people who use drugs, sex workers and sexual and gender minorities.  

In Lebanon, people living with and affected by HIV face systemic stigma and discrimination within health-care settings, significantly hindering their access to essential medical services. They often encounter legal and social barriers that deter them from seeking care due to fears of exposure and discrimination, as Lebanese laws inadequately protect them in health-care and employment sectors.

Recognizing these challenges, SIDC has launched several initiatives to promote collaboration among health-care professionals, social workers and policymakers to address the root causes of stigma and discrimination and drive systemic change. They have conducted public awareness campaigns, health-care providers’ training, and advocacy for policy change to ensure more inclusive health-care environments.

Everyone needs to be on board!

On 8 June 2024, SIDC, together with professional syndicates, organized a high-level discussion focusing on stigma and discrimination in health care. The event brought together over 50 stakeholders, including representatives from various ministries, national health programmes, syndicates, UN agencies, civil society organizations and media. Discussions centred on implementing patient rights policies, cultural awareness training and monitoring health-care services in marginalized communities.

Dr Nadia Badran, President of the Syndicate of Social Workers in Lebanon and Executive Director of SIDC, opened the meeting with a compelling speech on the deep-seated stigma and discrimination in the health and social sectors, and emphasized the real-life impact on the those affected. Dr Youssef Bakhash, President of the Lebanese Order of Physicians, and Dr Rima Sassine, President of the Order of Nurses in Lebanon, stressed the critical importance of implementing patient rights policies and cultural awareness training to mitigate bias.

"Breaking the stigma in the health-care sector is essential! Patients' rights come first and ensuring access to services for all is a duty," said Dr Youssef Bakhash, President of the Order of Physicians in Lebanon.

"Building a culture that challenges stigma and discrimination starts with awareness and re-evaluating cultural legacies, biases and personal judgments. These inherited beliefs often shape professionals' behaviour, but they can and must be addressed," said Dr Rima Sassine, President of the Order of Nurses in Lebanon.

Judge Sheikh Mohammad Abdullah Abou Zeid, president of the Saida Sunni Sharia court, called for closer monitoring of health-care services in excluded communities and refugee camps, where discrimination is most prevalent. He said, "It is crucial to address the discrimination that occurs in providing services in impoverished areas and refugee camps while ensuring oversight of health-care providers, especially those working outside the formal system, to protect both them and the beneficiaries."

Dr Rima Cheaito, President of Lebanese Order of Midwives, said, “This is an important event and we are honoured to be part of it, fighting stigma in health-care settings is embedded in our code of conduct, and every midwife should be able to deal respecting the dignity for all.”

Following the meeting, SIDC developed a “Guide for providing stigma-free and discrimination-free health and social services in the context of HIV in Lebanon”, which is a comprehensive resource to address stigma and discrimination in health-care and social service settings. It is designed to equip health-care providers, social workers and other professionals with the knowledge and tools necessary to foster inclusive and equitable environments for key populations. The guide is divided into two parts: a scientific guide that provides a foundational understanding of stigma and discrimination in health care, particularly concerning HIV; and a training manual to build the capacity of health-care and social service providers. It offers a structured, step-by-step approach to conducting training sessions, covering best practices for planning, execution and evaluation.

Following development of the guide, SIDC conducted a Training of Trainers on Stigma and Discrimination in Health-care Settings. This training aimed to build and strengthen the capacities of health-care providers in delivering stigma-free and discrimination-free services for key populations and people living with HIV. Held in Beirut over 5 days in December 2024, the training followed a participatory approach, engaging representatives from various governmental, professional and civil society institutions. The program covered 4 core modules: HIV and key populations; the causes and consequences of stigma and discrimination; behaviour change strategies; and training skills. The training resulted in a significant improvement in participants' knowledge, as shown by pre-and post-test assessments, and helped develop a pool of trainers capable of conducting further sessions in their respective institutions. 

SIDC remains dedicated to fostering an inclusive, stigma-free health-care environment in Lebanon through fostering intersectoral collaboration, policy advocacy and sustainable programmes. WHO and SIDC have forged a partnership to combat stigma and discrimination in health-care settings. WHO's global guidelines, including the 2022 Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations, have guided SIDC’s advocacy and intervention strategies in Lebanon. By adopting WHO’s evidence-based recommendations, SIDC has emphasized the critical need to address stigma and discrimination as a fundamental barrier to health-care access. Moreover, SIDC has actively collaborated with WHO in the development of a technical brief aimed at enhancing the quality of health-care services. Achieving equitable health care is ongoing, but with persistent efforts, SIDC demonstrates that meaningful change is achievable.