What Works for Women and Girls

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4F. Prevention for Key Affected Populations:Transgender Women and MenTransgender women and men are at significant risk for HIV. Many transgender women andmen engage in paid sex, have low condom use rates, experience high rates of violence andsuffer discrimination when accessing health services (Mahendra et al., 2008; Cascante, 2008;Riono and Praptoraharjo, 2008; Sanchez et al., 2008; Ospina and Letouze, 2008). No evaluatedinterventions were found that provided services for transgender women and transgendermen. Very little information has been published on HIV and transgender women and menin developing countries, with only recent 2008 International AIDS Conference abstracts andwebsites providing information on this topic. Most of the literature does not specify whetherthose included in the study are transgender men or transgender women, despite the differingneeds of each group. Transgender men, who are biologically women, need sexual and reproductivehealth services such as screening for cervical cancer. Yet accessing needed health andHIV services, which usually operate on strict male/female gender identities, may be extremelydifficult.Transgender women and men in many societies face marginalization. A survey of 50 transgenderpeople (gender identity not specified) from Chennai, India found that more than halfare discriminated against by their own families, 70% were denied jobs, and 64% faced violence(Prabakaran, 2008). Participatory action research with sex workers and outreach workers from13 sex worker projects in Central and Eastern Europe and Central Asia found that of 238 male,female and transgender sex workers from 12 countries, more than 45% reported physicalabuse by police and more than 41% reported sexual abuse (Crago et al., 2008). Fifty-five independentstudies from 19 countries (countries not specified) of 2,233 transgender women sexworkers found a 33% HIV prevalence rate (Friedman et al., 2008). Some organizations, suchas Genderdynamix (www.genderdynamix.org.za) and the Triangle Project (www.triangle.org.za) in South Africa, advocate and provide services for transgender people.While not enough studies were found to include as “what works,” some studies were foundshowing programs with positive impacts for transgender women and men. Non-formal educationand livelihood programs for transgender people may improve safer sex practices. SAATHI,a capacity-building NGO in India, provided non-formal education and livelihood programstogether with existing HIV prevention interventions to members of Santi Seva, a communitybased organization of transgender people. While at the start of the project, 80% had unprotectedsex, safer sex practices improved so that fewer than 35% had unprotected sex (Sakar etal., 2008). Another intervention with a positive impact was training police about the rightsof transgender women, resulting in decreased violence. In Mexico, training for 905 police bytransgender women on how violence affected transgender women and their rights led to agreementswith police authorities to promote the human rights of transgender women and withthe Human Rights Commission to follow-up on complaints of violence (Blass et al., 2008).108 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS
Transgender women and men are often overlooked in HIV prevention planning and treatmentprograms and little evidence is therefore available on what works for transgender womenand men, though there are some promising strategies.What Works—Prevention for Key Affected Populations: Transgender Women and MenPromising Strategies:1. Peer educators can encourage transgender women to increase condom use andtesting.EVIDENCEPromising Strategies:1. Peer educators can encourage transgender women to increase condom use and HIV testing.In India, where transgender women have an HIV prevalence of 20%, paid peer educatorsprovide condoms to other transgender women, resulting in an uptake of condoms(no data given). Peer educators encourage “No condoms, no sex;” teach condom negotiationskills and advise to avoid police where forced sex may occur (Chakrapani et al.,2008). (Abstract) (transgender, peer education, condom use, India)Trained transgender peer educators (no gender identity specified) reached out to transgendersex workers (no gender identity specified) in Mexico, of the 100 reached, 15%then accessed VCT (Flores et al., 2008). (Abstract) (transgender, sex workers, peer education,Mexico)Gaps in Programming—Transgender Women and Men1. HIV prevention interventions and treatment programs are needed for transgenderpeople.2. Health care settings must address the needs of transgender people and reducebarriers to services.3. Efforts are needed to mobilize transgender women and men at a community level tosupport prevention and safety.WHAT WORKS FOR WOMEN AND GIRLS109
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WHAT WORKSFOR WOMEN AND GIRLSEviden
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Authors:Jill Gay, MAKaren Hardee, P
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Jose Esparza, MD, Ph.D.Senior Advis
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Shyam Kottilil, MD, Ph.D.Staff Clin
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Larry Slutsker, MD, MPHChief, Malar
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Table of ContentsList of Abbreviati
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List of Abbreviations3TCACTAHIANCAP
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PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
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MethodologyMeasuring “what works
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2. Hormonal contraception is safe f
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outcomes has been more difficult to
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2. Promoting contraceptives and fam
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International Political Commitments
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established national action plans o
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Organization of the DocumentThis do
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Table 1.1Countries included in What
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understanding the epidemic in any g
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girls in school, for example. The c
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Within each intervention, studies a
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Chapter 3.Prevention for WomenA. Ma
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Special Risks for WomenStill, despi
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AIDS cases reported from 1982 to 20
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experience observed in clinical tri
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Female Condoms Are the Only Female-
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condom if it gives them more pleasu
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Correct use of the female condom ha
Page 59 and 60: A two month prospective study from
Page 61 and 62: A study of trends from Demographic
Page 63 and 64: 8. Peer education for women can inc
Page 65 and 66: 3B. Prevention for Women: Partner R
Page 67 and 68: matic focus on partner reduction, y
Page 69 and 70: of HIV acquisition, but were either
Page 71 and 72: four visits, each participant was i
Page 73 and 74: What Works—Prevention for Women:
Page 75 and 76: vention immediately following the b
Page 77 and 78: Chapter 4.Prevention for Key Affect
Page 79 and 80: 2010). Transgender men and women al
Page 81 and 82: confidentiality—violate human rig
Page 83 and 84: there were major socio-demographic
Page 85 and 86: and post-intervention were used to
Page 87 and 88: tent condom use and 1.5 times more
Page 89 and 90: to their peers, distribute condoms
Page 91 and 92: Gaps in Programming—Female Sex Wo
Page 93 and 94: of a sexual relationship with a pri
Page 95 and 96: than were naltrexone or placebo. HI
Page 97 and 98: attributed to …swift introduction
Page 99 and 100: Promising Strategies:5. Sex-segrega
Page 101 and 102: 9. Programming to prevent initiatio
Page 103 and 104: D’Ivoire, Cuba, Estonia, Indonesi
Page 105 and 106: Gaps in Programming—Women Prisone
Page 107 and 108: EVIDENCEPromising Strategies:1. Vol
Page 109: In fact, as of September 2008, 66 o
Page 113: 2009). “The invisibility and marg
Page 116 and 117: especially young women, have their
Page 118 and 119: negotiation skills and other critic
Page 120 and 121: to be reached with sex and HIV educ
Page 122 and 123: What Works—Prevention for Young P
Page 124 and 125: 44% and 100% of participants (Kirby
Page 126 and 127: tudes, self-efficacy, intentions, a
Page 128 and 129: as young people in this area had li
Page 130 and 131: ical validity of the findings that
Page 132 and 133: study reported having received info
Page 134 and 135: nancy. Almost 87% of men and 89% of
Page 136 and 137: last sex, having ever used a condom
Page 138 and 139: Gap noted, for example, in South Af
Page 140 and 141: Disaggregated Data Is NeededEffecti
Page 142 and 143: were also effective in increasing u
Page 145 and 146: Chapter 6.HIV Testing and Counselin
Page 147 and 148: Equitable Access to Testing and Cou
Page 149 and 150: they would come for HIV testing, re
Page 151 and 152: their jobs (Human Rights Watch, 200
Page 153 and 154: What Works—HIV Testing and Counse
Page 155 and 156: women. Of all married HIV-positive
Page 157 and 158: A study in Ethiopia found that inco
Page 159 and 160: At a provincial hospital in Mombasa
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Between June and December 2007, mob
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Promising Strategies:6. Encouraging
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10. Counseling may reduce risk beha
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women learned violence prevention s
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Chapter 7.TreatmentA. Provision and
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Treatment Has Been Successfully Adm
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HIV Prevention Is Needed as well as
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Gaps in Programming—Provision and
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These practices and tools are usefu
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Non-judgmental, non-stigmatizing in
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percent among ART-experienced patie
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(Donnell et al., 2010). (Abstract)
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The sexual health of women is an im
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[ for women living with HIV]: impro
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Available GuidelinesA number of sex
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advantages of dual method use, alon
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contraception: 57% used hormonal co
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different; and progression to WHO c
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HIV-related behavioral or biologic
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use was positively associated with
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Gaps in Programming—Meeting the S
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Interactions between ARVs and oral
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Chapter 9.Safe Motherhood and Preve
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Pillar 1: Preventing Primary HIV In
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mission of HIV. HIV testing and cou
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EVIDENCE1. Preventing unintended pr
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Gaps in Programming—Reducing Unin
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9B. Safe Motherhood and Preventiono
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EVIDENCEPromising Strategies:1. Dis
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Gaps in Programming—Pre-Conceptio
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9C-1. Safe Motherhood and Preventio
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tion (Kershaw et al., 2006). “…
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outine tests. Fifty percent of the
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An evaluation of UNICEF-funded PMTC
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and syphilis (by rapid plasma regai
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2. Additional efforts are needed to
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for their own disease” (ITPC, 200
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own health needs has never been eva
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dine and lamivudine during pregnanc
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chose elective cesarean section to
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their current pregnancy or a past p
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Promising Strategies:5. Integrating
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Gaps in Programming—Treatment1. I
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cesarean, and 221 were non-elective
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3. Efforts are needed to ensure tha
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“There is no doubt that there are
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formula feeding increases the risk
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of age. For breastfed infants, the
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weeks of gestation and continued un
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A study in Côte d’Ivoire with 54
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during breastfeeding compared with
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3 times higher for infants who were
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counseling tools are needed. Studie
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Chapter 10.Preventing, Detecting an
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latent infection. Some immunocompro
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concurrent active TB and HIV infect
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mortality of HIV-positive people re
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in a 65% decline in mortality and t
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1. Efforts are needed to reduce TB-
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al., 2004 cited in Slutsker and Mar
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stillbirths by 33%. Three cluster-r
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Gaps in Programming—Malaria1. Fur
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dose global coverage was just 27% i
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Chapter 11.Strengthening the Enabli
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combining microfinance and training
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pants meeting once per week for thr
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the men believed that they should n
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in the intervention village were si
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positive impacts. The quasi-experim
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Samoa, Serbia and Montenegro, Thail
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factor associated with sexual assau
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What Works—Strengthening the Enab
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worked with women’s groups, radio
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of school in addressing gender-base
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11C. Strengthening the Enabling Env
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also widely used worldwide and part
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ecognize women’s property rights
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Promising Strategies:2. Community o
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11D. Strengthening the Enabling Env
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more likely to report having used a
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likely than illiterate women to kno
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of the women surveyed were HIV-posi
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countries extending the fee aboliti
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families and separated from their c
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used the resource “Understanding
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6. Support groups for people living
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11G. Strengthening the Enabling Env
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EVIDENCEPromising Strategies:1. Inv
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Chapter 12.Care and SupportA. Women
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ical care provided by family member
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dealing with their sorrow, grief, a
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What Works—Care and Support: Wome
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2. Peer support groups can be highl
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discriminated unjustly against them
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6. Home-based antiretroviral therap
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12B. Care and Support: Orphans and
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(Thurman et al., 2007). As of 2008,
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care and services were provided, wh
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for treatment can be safely monitor
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A study done in Kenya (year not giv
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ather than a narrowly defined HIV/A
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7. Further interventions to provide
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ning providers, antenatal care and
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What Works—Structuring Health Ser
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counts available at primary health
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Pregnant women reported feeling out
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Before implementation of the PMTCT
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accessing PMTCT. An evaluation of 3
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A mathematical model based on TB tr
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1. Improved integration is needed b
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15. Additional efforts are needed t
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Community-based Care is holistic ca
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Microfinance is often defined as fi
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Sexuality is a central aspect of be
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“What Works compiles a wealth of
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