What Works for Women and Girls

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Chapter 6. HIV Testing and Counseling for Women 143Chapter 7. Treatment 167A. Provision and Access 168B. Adherence and Support 173C. Reducing Transmission 175Chapter 8. Meeting the Sexual and Reproductive Health Needs of WomenLiving with HIV 183Chapter 9. Safe Motherhood and Prevention of Vertical Transmission 205A. Preventing Unintended Pregnancies 210B. Pre-Conception 215C. Antenatal Care 2201. Testing and Counseling 2212. Treatment 232D. Delivery 246E. Postpartum 249Chapter 10. Preventing, Detecting and Treating Critical Co-Infections 267A. Tuberculosis 268B. Malaria 277C. Hepatitis 284Chapter 11. Strengthening the Enabling Environment 287A. Transforming Gender Norms 289B. Addressing Violence Against Women 298C. Transforming Legal Norms to Empower Women, including Marriage,Inheritance and Property Rights 309D. Promoting Women’s Employment, Income and Livelihood Opportunities 317E. Advancing Education 322F. Reducing Stigma and Discrimination 328G. Promoting Women’s Leadership 337Chapter 12. Care and Support 341A. Women and Girls 342B. Orphans and Vulnerable Children 355Chapter 13. Structuring Health Services to Meet Women’s Needs 369Glossary of Terms 387References 39512 TABLE OF CONTENTS
List of Abbreviations3TCACTAHIANCAPN+ARTARVASRHAYAAZTcARTCBOCDCCEDAWC-sectiond4T/3TC/NVPDDLDHSDMPADOTDOTS-SCDRCEFVFC2FPFSWGAAGBV2’, 3’-dideoxy-3’-thiacytidine (Lamivudine)Artemisinin Combination TherapiesAcute HIV InfectionAntenatal ClinicsAsia Pacific Network of People Living with HIV/AIDSAntiretroviral TherapyAnti-retroviralAdolescent Sexual and Reproductive HealthAfrican Youth AllianceAzido-deoxythymidineCombination Antiretroviral TherapyCommunity Based OrganizationsCenters for Disease ControlCommittee on the Elimination of Discrimination against WomenCesarean SectionStavudine, Lamivudine and NevirapineDidanosineDemographic and Health SurveysDepot-medroxyprogesterone AcetateDirectly Observed TherapyDirectly Observed Therapy Short CourseDemocratic Republic of the CongoEfavirenzFemale CondomFamily PlanningFemale Sex WorkersGlobal AIDS AllianceGender-Based Violence13
Page 1: WHAT WORKSFOR WOMEN AND GIRLSEviden
Page 4: Authors:Jill Gay, MAKaren Hardee, P
Page 7 and 8: Jose Esparza, MD, Ph.D.Senior Advis
Page 9 and 10: Shyam Kottilil, MD, Ph.D.Staff Clin
Page 11 and 12: Larry Slutsker, MD, MPHChief, Malar
Page 13: Table of ContentsList of Abbreviati
Page 17: PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
Page 20 and 21: MethodologyMeasuring “what works
Page 24 and 25: 2. Hormonal contraception is safe f
Page 26 and 27: outcomes has been more difficult to
Page 28 and 29: 2. Promoting contraceptives and fam
Page 30 and 31: International Political Commitments
Page 32 and 33: established national action plans o
Page 34 and 35: Organization of the DocumentThis do
Page 36 and 37: Table 1.1Countries included in What
Page 38 and 39: understanding the epidemic in any g
Page 40 and 41: girls in school, for example. The c
Page 42 and 43: Within each intervention, studies a
Page 45 and 46: Chapter 3.Prevention for WomenA. Ma
Page 47 and 48: Special Risks for WomenStill, despi
Page 49 and 50: AIDS cases reported from 1982 to 20
Page 51 and 52: experience observed in clinical tri
Page 53 and 54: Female Condoms Are the Only Female-
Page 55 and 56: condom if it gives them more pleasu
Page 57 and 58: 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
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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
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four visits, each participant was i
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What Works—Prevention for Women:
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vention immediately following the b
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Chapter 4.Prevention for Key Affect
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2010). Transgender men and women al
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confidentiality—violate human rig
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there were major socio-demographic
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and post-intervention were used to
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tent condom use and 1.5 times more
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to their peers, distribute condoms
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Gaps in Programming—Female Sex Wo
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of a sexual relationship with a pri
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than were naltrexone or placebo. HI
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attributed to …swift introduction
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Promising Strategies:5. Sex-segrega
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9. Programming to prevent initiatio
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D’Ivoire, Cuba, Estonia, Indonesi
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Gaps in Programming—Women Prisone
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EVIDENCEPromising Strategies:1. Vol
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In fact, as of September 2008, 66 o
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Transgender women and men are often
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2009). “The invisibility and marg
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especially young women, have their
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negotiation skills and other critic
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to be reached with sex and HIV educ
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What Works—Prevention for Young P
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44% and 100% of participants (Kirby
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tudes, self-efficacy, intentions, a
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as young people in this area had li
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ical validity of the findings that
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study reported having received info
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nancy. Almost 87% of men and 89% of
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last sex, having ever used a condom
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Gap noted, for example, in South Af
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Disaggregated Data Is NeededEffecti
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were also effective in increasing u
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Chapter 6.HIV Testing and Counselin
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Equitable Access to Testing and Cou
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they would come for HIV testing, re
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their jobs (Human Rights Watch, 200
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What Works—HIV Testing and Counse
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women. Of all married HIV-positive
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A study in Ethiopia found that inco
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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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Page 323 and 324:
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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References 1Aaron, E. and S. Crinit
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Akabaysh, H. and G. Psacharopoulos.
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Andia, I., A. Kaida, M. Maier, D. G
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Auvert, B., D. Taljaard, E. Lagarde
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Barker, P., C. McCanno, N. Mehta, C
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Berer, M. 2008b. “Male Circumcisi
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Bong, C-N., S. Chen, Y-J. Jong, T-S
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Brou, H., G. Djohan, R. Becquet, G.
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Campbell, L. and M. Lambey. 2002.
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Chama, C., W. Gashau and S. Oguche.
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Chimwaza, A., J. Chimango, C. Kapon
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Cluver L. and F. Gardner. 2007. “
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Coovadia, H. 2004. “Antiretrovira
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De Bruyn, M. 2006a. There’s Nothi
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Dharmadhikari, A., J Gupta, M. Deck
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Druce, N. and A. Nolan. 2007. “Se
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Epstein H. 2009. “Universal volun
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Farrell, B. and N. Rajani. 2007.
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Ford, N., D. Wilsono, P. Cawthorne,
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Galvez-Buccollini, J., S. DeLea, P.
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Gillespie, D., H. Bradley, M. Wolde
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Gogna, M., M. Pechny, I. Ibarlucia,
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Grimes, D., J. Benson, S. Singh, M.
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Haddock, S., K. Hardee, J. Gay, P.
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Harries, A., R. Chimizi and R. Zach
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Hillemans, P., T. Ellerbrock, S. Mc
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Hope, R. 2007. Addressing Cross-Gen
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Innes, C, S Charalambous, M Felix,
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Karnell, A.P., P.K. Cupp, R.S. Zimm
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Kim, Y., A. Kols, R. Nyakauru, C. M
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Luke, N. and K. Kurz. 2002. Cross-g
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Mahendra, V., R. Verma, S. Singh, S
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Prevent HIV Mother-to-Child Transmi
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McIntyre, J. and M. Lallemont. 2008
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Minaya, J., A. Owen-Simth and J. He
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Morrison, C. 2009. “Hormonal Cont
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Nelson, K., D. Celentano, S. Euimtr
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Nyamukapa A., S. Gregson, B. Lopman
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Peacock, D. 2009. “Working with M
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an Operations Research Study in Zam
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“What Works compiles a wealth of
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