What Works for Women and Girls

they would come for HIV testing, regardless of the women’s serostatus. Partner violence wasa serious problem among many female VCT clients, with more that 25% of women agreeingwith the statement “violence is a major problem in my life.” Of the 245 women, one-third wereHIV-positive and were 2.68 times more likely than HIV-negative women to have experienced aviolent episode with a current partner. Young HIV-positive women ages 18–29 were ten timesmore likely to report partner violence than young HIV-negative women. If a woman underwenttesting on her own without informing her partner, she risked being blamed as the source ofinfection (Maman et al., 2001a). [See also Chapter 11B. Strengthening the Enabling Environment:Addressing Violence Against Women]Serodiscordance in a relationship can result in violence and other adverse outcomes forwomen. Focus groups with 18 women, 11 HIV counselors and 16 men in Tanzania found thatdivorce and abandonment were outcomes of serodiscordant test results within couples (Milayet al., 2008). A study with interviews of 26 women in Uganda who experienced violence andwere in a serodiscordant relationship found that violence increased in their relationship afterknowledge of HIV serostatus. None reported their experience to law enforcement authorities.Women who tested seronegative with a husband who tested HIV-positive reported that theirhusband deliberately tried to infect them with HIV by raping them in order to accuse thewoman of having infected him, a more acceptable scenario for the man. Women who testedHIV-positive and had a seronegative husband were told to leave their homes (Emusu et al.,2009). Counseling concerning violence in pre- and post-HIV testing is very much needed.A review of the published scientific literature from 1990 to 2008 on couple-oriented HIVcounseling and testing found that in five African countries, at least two-thirds of couples withat least one HIV-positive partner were HIV serodiscordant. HIV counseling has largely beenorganized on an individual and sex-specific basis. Interventions are needed to promote continuouslong-term condom use within long-term serodiscordant partnerships with education andinformation on serodiscordance (Desgrées-Du-Loû and Orne-Gliemann, 2008).Providers need the training, skills, and tools to enable them to identify women at riskof violence or other negative consequences. Program planners also need to develop linksbetween HIV testing services and programs that address gender-based violence and servicesthat support survivors of violence, and develop strategies to reach women who do not cometo clinics because of violence. Women living with HIV have been found to be 2.7 times morelikely to have experienced a violent episode from a current partner than HIV-negative women,and this rate is even higher among younger women (Maman et al., 2001a). However, somecouples want to test together and should be able to do so. In five African countries, at least twothirdsof couples with at least one HIV-positive partner were serodiscordant; in half of them,the woman was the HIV-positive partner. To date, such couples are not among the ‘key populations’to whom prevention interventions are targeted. Couple-centered initiatives for HIVtesting have not been scaled up (Desgrées-Du-Loû and Orne-Gliemann, 2008). Some siteshave had success in increasing couples HTC, such as the AIDS Information Center in Uganda,with over 700,000 clients serviced since 1990, with an increase of 9% of clients coming withtheir partner for HTC in 1992 rising to 28% of clients by 2000, of whom 18% were serodiscordant(Malamba et al., 2005).WHAT WORKS FOR WOMEN AND GIRLS147