What Works for Women and Girls

promote stigmatizing attitudes towards individuals living with HIV” (Nyblade et al., 2009:4). The Commission on AIDS in Asia reviewed over 5,000 papers; commissioned 30 papers;surveyed 600 members of civil society; conducted five country missions and held two subregionalworkshops and concluded that it is crucial to “avoid programmes that accentuateAIDS-related sigma...Such programs may include ‘crack-downs’ on red-light areas and arrestsex workers, large-scale arrests of young drug users under the ‘war on drugs’ programs andmandatory testing for HIV” (Report of the Commission on AIDS in Asia, 2008: 17). A 2008review of published literature on stigma in the HIV/AIDS epidemic that included 390 articles,of which 176 were either global in scope or were in a developing country context, foundthat “there are only a small number of published studies on interventions and programmesdesigned to reduce HIV/AIDS stigma” (Mahajan et al., 2008: S74). An earlier review in 2003found that among 22 relevant studies, “No study looked at different messages that could betailored to men and women, nor were there any efforts to compare differential impact of maleversus female contacts for different gendered audiences” (Brown et al., 2003: 66).With the introduction and expansion of antiretroviral treatment, there was hope that stigmaand discrimination would decline, however, “despite ongoing research, there is not yet conclusiveevidence to support this hope” (Gruskin et al., 2007b: 12). A household probability sampleof individuals ages 18–32 with 14,657 participants from Thailand, Zimbabwe, Tanzania, andSouth Africa found that lack of knowledge of antiretroviral therapy was significantly associatedwith increased personal endorsement of stigma towards people living with HIV in allsites (Genberg et al., 2008). What is clear is that reducing stigma improves quality of life forwomen living with HIV, especially in the realms of employment and schooling, in addition toimproving quality of life within families and communities.[See also Chapter 8. Meeting the Sexual and Reproductive Health Needs of Women Livingwith HIV, Chapter 9. Safe Motherhood and Prevention of Vertical Transmission, and Chapter 13.Structuring Health Services to Meet Women’s Needs for further discussion of stigma as it relatesto those topics.]330 CHAPTER 11 STRENGTHENING THE ENABLING ENVIRONMENT