What Works for Women and Girls

Equitable Access to Testing and Counseling ServicesIs NeededTo ensure universal access, expanding coverage of HIV testing and counseling for womenis needed, both within and outside of antenatal care settings. [See also Chapter 9C-1. SafeMotherhood and Prevention of Vertical Transmission: Testing and Counseling] Most women accessHIV testing within maternal health services. “Pregnant women are disproportionately testedfor HIV since they come into contact with the health system regularly” (Groves et al., 2009:2). One study from India of 800 adult men and 800 recently pregnant women found eventhough women were over 80% less likely than men to be aware of HIV testing facilities or theexistence of HIV testing and counseling, women were more than twice as likely to have hadan HIV test (Khale et al., 2008). A review of literature from 1980 to 2008 on gender-equitableservices in rural India found that “men sought testing out of personal concern, whereas womenutilized testing on the recommendation of, and in some cases reported mandatory testing by,their antenatal provider (Sinha et al., 2009: 200). Analysis of 2005–2006 DHS data fromZimbabwe with 6,997 women and 5,359 men found that HIV testing is higher for women(30%) than men (22%). Women are tested as part of routine counseling in ANC, “whereas formen it is volunteering to be tested” (Sambisa, 2008: i). In South Africa, counseling and testingfor HIV is currently limited to antenatal care settings and a few stand-alone centers (Mullicket al., 2008).The emphasis on counseling and testing for prevention of maternal to child transmission(PMTCT) means that women who are not pregnant are inadequately reached with HIV testingand counseling services. Few HIV testing programs that are not part of PMTCT services aredesigned to meet the needs of women. Health care providersoften only refer women from vulnerable groups, such as sex“Compared to men, despite lowerHIV services awareness, womenhad greater access to HIV testingservices in already highly-utilizedantenatal clinics.”(Khale et al., 2008).workers, or women with HIV-related symptoms to testingand counseling, not recognizing the value of testing andcounseling for all women. More recent data from some sitessuggests that even outside of PMTCT clients, more womenthan men access HIV testing (Greig et al., 2008; Fernandezet al., 2008). One study in South Africa found that by notcounting access to HTC via PMTCT services, females werestill twice as likely as males to use HTC (Snow et al., 2008).“Men’s underutilization of HIV services significantly underminesprevention and treatment efforts” (Peacock et al., 2008: 1). The fact that fewer men gettested than women means that women end up bearing the burden of status disclosure to men,with attendant risk of stigma and abandonment (Greig et al., 2008).WHAT WORKS FOR WOMEN AND GIRLS145