418 J Health Popul Nutr Dec 2006 about the inadequacy of emergency services for post- abortion care, especially in rural areas of the country. They were also concerned about reports of abandoned babies and infanticide by women who could not cope with children resulting from unwanted pregnancies. Even in South Africa, which permits termination of pregnancy for various reasons, the HIV-positive re- spondents remarked that women are dissuaded from accessing this legal medical procedure and may suf- fer abuse when they are able to obtain an abortion. Women spoke of being afraid to ask for an abortion at clinics and fearing that they would receive poor-quality care: “If we do access the services we are treated poorly—no respect, healthcare workers are judgmen- tal and often cruel….” One of the worst cases of abuse reported to the project team was of a woman living with HIV who said that she was given the foetus to take home after the procedure. The nurses told her that it was her decision, so she must deal with the foetus be- cause they would have nightmares if they had to do it. Women further reported being told that they would be given an abortion only if they agreed to be sterilized. The issue of forced sterilization was reportedly much worse in rural areas. Adoptive parenting At least some respondents in Kenya, Lesotho, and Swaziland said that they knew of HIV-positive peo- ple who had adopted children; it was unclear whether those children were also HIV-positive. In Poland, one NGO was actively mediating such adoptions, although it seemed that only HIV-positive children were placed with HIV-positive adults. In Mexico, PECAC found that governmental regulations prohibit adoption by persons living with HIV. Stigma and discrimination in the healthcare sector While some respondents and field-study researchers knew of health facilities that provide high-quality care to HIV-positive women, all the projects reported that stigma and discrimination against women living with HIV and AIDS persist within the healthcare sector. Par- ticularly troubling was the fact that discrimination was often reported regarding obstetric and gynaecological care. The extent to which this still takes place may be much greater than is often assumed. For example, the HIV-positive researchers in South Africa were surprised at the examples of abuse given, stating that: “At the onset of the research, we were realistic about the state of the healthcare system and based on our own experi- ences, and that of women and girls we knew, we were aware of the negative treatment women suffered at the hands of the healthcare worker. However, the realities Bruyn M of what we heard and saw were far worse than we ima- gined…. As researchers, women and activists, we felt sad, depressed and deeply concerned about the experiences of women living with HIV and AIDS. We found it dif- ficult to deal with the depths of grief and pain experi- enced by women, their lack of knowledge and access to any rights….” The types of discrimination reported were remark- ably similar across countries and regions. HIV-positive women in Africa, Europe, and Latin America are fac- ing denial of treatment and care, humiliating and stigma- tizing attitudes, and breaches of confidentiality. This is particularly the case when they encounter health profes- sionals who are not specialized in HIV/AIDS care. The South African team also noted new types of discrimina- tion that are taking place. Some healthcare providers require women to participate in clinic-based antiretrovi- ral therapy support groups as a precondition for grant- ing them treatment. Women who had participated in antiretroviral treatment literacy programmes and who requested particular types of treatment reported hav- ing been insulted for knowing and understanding their needs. They observed that healthcare workers often do not have adequate information themselves and then feel threatened by a treatment-literate patient. DISCUSSION Although we have passed the 20-year mark for the world- wide HIV/AIDS pandemic, it is apparent that considerable numbers of healthcare professionals still have insuffi- cient information about HIV/AIDS and their generally low risks of occupational exposure to HIV infection. This is contributing to fear among healthcare provid- ers, who subsequently stigmatize and discriminate against patients and clients who are living with HIV in different countries (68,69). In reaction to the persistence of stigma and dis- crimination against people living with HIV/AIDS, national and international non-governmental and multi- lateral organizations have begun speaking out more of- ten about the need for a human rights-based approach in HIV/AIDS-related policies and programmes. For example, in 2003, the Pan American Health Organi- zation examined how violations of human rights are related to stigma and discrimination against HIV-posi- tive persons, and they recommended that the interna- tional human-rights standards and norms protecting HIV-positive people be widely disseminated (70). In August 2005, UNAIDS convened a meeting to further the development of an index to measure observance of rights of HIV-positive persons and the stigma and discrimination they face (71).