What Works for Women and Girls

1. HIV prevention interventions and treatment programs are needed for transgender people.Studies found that despite high rates of HIV, few prevention interventions are for transgenderpeople.Gap noted, for example, in Indonesia (Riono and Praptoraharjo, 2008); India (Mahendraet al., 2008); Dominican Republic (Cascante, 2008); Colombia (Sanchez et al., 2008);Mexico (Ospina and Letouze, 2008).2. Health care settings must address the needs of transgender people and reduce barriers toservices. One study found that transgender women reported stigma, discrimination andviolations of confidentiality by providers.Gap noted, for example, in India (Saravanamurthy et al., 2008).3. Efforts are needed to mobilize transgender women and men at a community level tosupport prevention and safety. One study found that in order to assure prevention andsafety, community mobilization of transgender people is needed.Gap noted, for example, in Botswana, Namibia and South Africa (Arnott and Crago,2009).4G. Prevention for Key Affected Populations:Women Who Have Sex with Women (WSW)According to a report by the International Gay and Lesbian Human Rights Commission,African lesbians have lower HIV prevalence rates than heterosexual women: same-sex practicingSouth African women self-report HIV prevalence between nine and fifteen percent, withno targeted HIV prevention, treatment or care services (IGLHRC, 2007). Lesbian, bisexual andwomen who have sex with women have rarely been the focus of programs or research effortswith an understanding of the complexities of lesbian sex and sexuality. In India, decriminalizationof same sex activity due to a recent court ruling makes it more likely that HIV servicesreach those at risk (Misra, 2009).While the risk of HIV transmission is low in sex between females and HIV risk from sharedsex toys is minimal (Helena et al., 2003 cited in IGLHRC, 2007), providers and programmersshould not make assumptions about women’s vulnerability based on sexual orientation. InKyrgyzstan, for example, 20% of WSW reported having sex with a man during the previoussix months with only half using condoms (Alisheva et al., 2007). WSW may be at risk of HIVacquisition through rape, even if they have no male partners or injecting drug use. WSW wantand do have children and have needs for sexual and reproductive health services.Additional consideration should be given to the effects of homophobia. Recent reportsdocument violence and rape against WSW in South Africa for being lesbian (Martin et al.,110 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS