What Works for Women and Girls

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What Works—Prevention for Young People: Encouraging Behavior Change1. Sex and HIV education with certain characteristics (see introduction to 5A) prior tothe onset of sexual activity may be effective in preventing transmission of HIV byincreasing age at first sex and, for those who are sexually active, increasing condomuse and reducing the number of sexual partners.2. Training for teachers to conduct age-appropriate participatory sexuality and AIDSeducation can improve students’ knowledge and skills.3. Mass media and social marketing campaigns are modestly effective in persuadingboth female and male adolescents to change risky behaviors.4. Communication between adults and young people about reproductive healthinformation can increase protective behaviors.Promising Strategies:5. National efforts to decrease or delay sexual activity, increase condom use and reducethe number of sexual partners can be effective in preventing HIV nationwide.6. Promoting condoms for pregnancy prevention may increase condom use for safe sex.7. Providing HIV prevention education by people living with HIV (who wish toserodisclose) to youth can reinforce messages about protective behavior.8. Comprehensive programs for youth can improve HIV knowledge and encourageprotective behavior.9. Increased employment opportunities, microfinance, or small-scale income generatingactivities can reduce risky behavior—particularly among young women.EVIDENCE1. Sex and HIV education with certain characteristics (see introduction to 5A) prior to theonset of sexual activity may be effective in preventing transmission of HIV by increasingage at first sex and, for those who are sexually active, increasing condom use and reducingthe number of sexual partners.A review by UNESCO of 87 sex and HIV education programs in developing and developedcountries found that 23 studies showed a delayed initiation of sex (40 had nosignificant impact); 16 decreased the number of sexual partners (20 had no significantimpact); 23 increased condom use (35 had no significant impact) and 16 studies reducedsexual risk taking, one increased sexual risk taking and 13 had no significant impact.120 CHAPTER 5 PREVENTION FOR YOUNG PEOPLE
Evaluated programs were curriculum and group-based; focused on sexual behavior;focused on young people; had a experimental or quasi-experimental design; a samplesize of at least 100; measured impact on sexual behaviors for at least three to six monthsand were published after 1990 (UNESCO, 2009). (Gray I) (sex education, sexual partners,condom use, sex behavior)A review evaluating 83 sex and HIV education programs in developing and developedcountries that were based on a written curriculum and were implemented amonggroups of youth in schools, clinics or other community settings found that two-thirdsof the studies found a significant positive impact on one or more sexual behaviors oroutcomes, while only seven percent found a significant negative impact. One-third of theprograms had a positive impact on two or more behaviors or outcomes. The 83 studiesgenerally reported on one or more of six aspects of sexual behavior: initiation of sex,frequency of sex, number of sexual partners, condom use, contraceptive use in general,and composite measures of sexual risk-taking (e.g., frequency of sex without condoms).A few studies reported on pregnancy and STI rates. Initiation of Sex. Of the 52 studiesthat measured impact on this behavior, 22 (42 percent) found that the programs significantlydelayed the initiation of sex among one or more groups for at least six months,29 (55 percent) found no significant impact, and one (in the United States) found theprogram hastened the initiation of sex. Frequency of Sex. Of the 31 studies that measuredimpact on frequency, nine (29 percent) reduced the frequency, 19 (61 percent) found nosignificant change in frequency, and three (all in developed countries) found increasedfrequency among any major groups at any point in time. Number of Sexual Partners.Of 34 studies measuring this factor, 12 (35 percent) found a decrease in the number ofsexual partners, while 21 (62 percent) found no significant impact. Condom Use. Of the54 studies measuring program impact on condom use, almost half (48 percent) showedincreased condom use; none found decreased condom use. Contraceptive Use in General.Of the 15 studies measuring impact, six showed increased contraceptive use, eightshowed no impact, and one (in the United States) showed decreased contraceptive use.Sexual Risk Taking. Some studies (28) developed composite measures of sexual activityand condom use (e.g., frequency of sex without condoms). Half of them found significantlyreduced sexual risk-taking. None of them found increased sexual risk-taking.Pregnancy Rates. Of the 13 studies that measured pregnancy rates, three found significantpositive effects, nine found insignificant effects, and one (in the United States)found significant negative effects. STI Rates. Of the 10 studies that measured impact onSTI rates, two found a positive impact, six found no significant impact, and two founda negative impact. For example, in Tanzania, a sexuality education intervention reducedthe number of sexual partners among boys and increased condom use among both boysand girls. This evaluation used an experimental design and found positive behavioralimpacts over a three-year period (Ross et al., 2003 cited in Kirby et al., 2007). Skillsbased programs were more effective at changing behavior than were the knowledgebasedprograms. In the programs reviewed, female adolescents constituted betweenWHAT WORKS FOR WOMEN AND GIRLS121
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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
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A two month prospective study from
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A study of trends from Demographic
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8. Peer education for women can inc
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3B. Prevention for Women: Partner R
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matic focus on partner reduction, y
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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
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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
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Page 105 and 106: Gaps in Programming—Women Prisone
Page 107 and 108: EVIDENCEPromising Strategies:1. Vol
Page 109 and 110: In fact, as of September 2008, 66 o
Page 111 and 112: Transgender women and men are often
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 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
Page 161 and 162: Between June and December 2007, mob
Page 163 and 164: Promising Strategies:6. Encouraging
Page 165 and 166: 10. Counseling may reduce risk beha
Page 167 and 168: women learned violence prevention s
Page 169 and 170: Chapter 7.TreatmentA. Provision and
Page 171 and 172: 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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