What Works for Women and Girls

their jobs (Human Rights Watch, 2004a). Studies have found that women in Kenya will givebirth at home rather than at a health facility in order to avoid being forced to take an HIV test,be tested without their informed consent, or have the confidentiality of their HIV tests resultsbreeched (Turan et al., 2008a). Further, a survey of 1,268 respondents in Botswana in 2004found that while most participants reported being in favor of routine testing, 43 percent ofparticipants believed that routine testing would lead people to avoid going to the doctor forfear of testing (Weiser et al., 2006a). In the same study, 14 percent agreed that routine testingleads to more violence against women and that 62 percent of women and 76 percent of menbelieved that they could not refuse an HIV test (PHR, 2007a).Clearly, HIV testing which discourages women from needed health services contraindicatesall public health benefits that could accrue from knowing one’s serostatus. It is possibleto increase access to HIV testing and more likely for women to engage in HIV prevention ifcounseling, confidentiality and consent are inherent to the HIV testing process (WHO andUNAIDS, 2007). Routinely offering and recommending HIV testing and counseling, butrequiring that women specifically agree (“opt-in”) may increase the numbers of those testedwhile respecting human rights (Jurgens, 2007a). Studies are needed to compare routine testingthat includes an “opt-in” component with other approaches to what have been called “opt-out”testing, evaluating outcomes both in terms of respect for human rights and increasing thenumbers of those who want to get an HIV test. The “opt-in” aspect of routine testing wouldmean that providers explain the benefits of HIV tests and recommend an HIV test. Additionalresearch is needed to assess how to streamline but keep essential elements of pre- and posttestcounseling (Jurgens, 2007a; Chersich and Temmerman, 2008). A study in Zimbabwe of5,775 people based on survey data between 1998 and 2000, followed by a repeat survey in 2003found that women who had had pre-test counseling were significantly more likely to return fortheir test results than those with no pre-test counseling (Sherr et al., 2007). For those who testHIV-negative, testing should be seen as part of an ongoing prevention strategy, with encouragementfor those who are HIV-negative or untested to protect themselves and others fromHIV transmission (Bell et al., 2007).Interventions are needed to help those who have tested HIV-positive to prepare for disclosure.Policy documents and reports that strongly advocate for the involvement of people whohave tested positive often do not consider the processes involved, the psychological impact ofdisclosure, and the potential impact on relationships or career prospects (Manchester, 2004).Possible approaches include disclosure plans, disclosure mediated by a friend or counselor,and couple counseling. Voluntary couples counseling can encourage men to reduce negativereactions and promote shared responsibility for reproductive health; however, women’s confidentialitymust be guaranteed, along with support (Cohen and Burger, 2000).WHAT WORKS FOR WOMEN AND GIRLS149