What Works for Women and Girls

Gap noted, for example, generally (WHO, 2006 cited in USAID, 2008a; USAID,2008a). Increased recognition of sexual harassment by students was found in Ghana,but no HIV related outcomes were studied (USAID, 2008a).11F. Strengthening the Enabling Environment:Reducing Stigma and DiscriminationStigma and discrimination have been identified as tremendous barriers to addressing HIV/AIDS (Mann, 1999; Paxton et al., 2004a and b). Stigma was defined by Goffman (1963) as adiscrediting attribute about an individual or group that serves to devalue that person or groupin the eyes of society. Parker and Aggleton (2002) suggest that stigmatization and discriminationare manifest in a number of contexts, including within families, communities, schools,employment, travel/migration opportunities, health care settings, and HIV/AIDS programs.Hardee et al. (2009b) found remarkably consistent views related to people living with HIV andAIDS in a national survey in China, suggesting that stigma and discrimination can be pervasivein societies. Internalized stigma is the shame, guilt or fear that results from discriminationand can also affect family members and health providers. Internalized stigma may deterpeople from accessing needed HIV services (Brouard and Willis, 2006).Stigma Affects Prevention BehaviorsIn a review of interventions to reduce HIV/AIDS stigma, Brown et al., (2003) noted that stigmaaffects prevention behaviors, test-seeking, care-seeking, quality of care provided to HIV-positiveclients, and perceptions and treatment of people living with HIV and AIDS by communitiesand families. They and others, including Parker et al. (2002), contend that HIV/AIDS-relatedstigma is often layered upon other stigma, for example, thatHIV is associated with engaging in illegal behavior such as“No matter where I go,there’s always someone whowill reject me.”—HIV-positive woman, Cuba(Castro et al., 2007: S52)sex work and drug use. A study in China with 10 AIDS healthprofessionals and 21 adults living with HIV found that theChinese public assumes that any woman who has HIV is asex worker (Zhou, 2008). Women are often considered toface the double stigma and discrimination associated withHIV and their inferior status to men in society (Armisteadet al., 2008). [See also 11A. Transforming Gender Norms] Astudy of 2,369 men and women in India at high risk for HIV found that women reportedhigher perceived community HIV/AIDS stigma than men (Zelaya et al., 2008). Findings froma qualitative research study conducted in 2003 in Vietnam found that “women living with HIVand AIDS tend to be more highly stigmatized than men...While women tend to be ‘blamed’for acquiring HIV and AIDS, men are often forgiven by family and society. The consequencesof stigma are also more severe for women, who are more frequently sent away from their328 CHAPTER 11 STRENGTHENING THE ENABLING ENVIRONMENT