What Works for Women and Girls

A study in Ethiopia found that incorporating VCT into a reproductive health facilitygreatly increased the numbers of those who accessed VCT, with those accessing VCThaving high HIV prevalence rates. The study used 30,257 VCT client records from FamilyGuidance Association of Ethiopia (FGAE), a non-governmental non-profit providingreproductive health services in clinics. When both VCT and family planning were eitherin the same room or offered by the same counselor, clients were 1.9–7.2 to initiateHIV testing than if VCT and family planning were simply offered in the same healthfacility. Relative to facilities co-locating services in the same compound, those offeringfamily planning and HIV services in the same rooms were 2–13 times more likely toserve atypical family planning client-types than older, ever-married women. Facilitieswhere counselors jointly offered HIV and family planning services and served manyrepeat family planning clients were significantly less likely to serve single clients relativeto older, married women. Younger, single men (78.2%) and older, married women(80.6%) were most likely to self-initiate HIV testing, while the highest HIV prevalencewas seen among older, married men (20.5%) and older, married women (34.2%). FGAEattracts both pregnant women, who are at high risk for HIV, and young, single peoplewho want to initiate VCT (Bradley et al., 2008a). (Gray III) (counseling, HIV testing,family planning, health facilities, Ethiopia)From 1985–2000, the Group Hatien d’Etude du Sarcome de Kaposi et des InfectionsOpportunistes (GHESKIO), an NGO with a VCT center in Haiti increased the integrationof additional health services. The number of new people seeking VCT increasedfrom 142 in 1985 to 8,175 in 1999, a 62-fold increase. Of new adults seeking VCTin 1999, GHESKIO provided AIDS care to 17%, TB treatment to 6%, STI managementto 18%, and 19% became new users of a contraceptive method. Of the 6,709adults coming for VCT in 1999, 36% benefited from at least one service visit. Of the2,013 adults who tested HIV-positive, 56% benefited from at least one service visit and21% referred a sexual partner for VCT. One hundred ten HIV-negative sexual partnersof HIV-positive individuals were identified, and of these, 85 returned for repeat HIVtesting after a median of 18 months, and none of these 85 seroconverted. The prevalenceof HIV among patients served by GHESKIO was 30% or six times the prevalencerate in the general adult Haitian population. On their first visit to GHESKIO,individuals are assisted to develop a personalized HIV risk reduction strategy. Patientsreporting a history of cough for more than 3 weeks are provided on-site, same day TBscreening including clinical exam and sputum smears. Patients with STI symptoms areprovided treatment based on algorithms. All patients are screened for syphilis. Sameday pregnancy tests are conducted. Condoms are provided. All patients are encouragedto obtain family planning. Post-test HIV-negative patients are counseled in groups of 5.All HIV-positive patients are counseled individually, encouraged to refer sexual partnersand offered comprehensive HIV care, including HAART for all adult patients, PMTCT,long-term access to HAART when women give birth, treatment of opportunistic infections,home care, education to family care givers, and nutritional support. Availability ofWHAT WORKS FOR WOMEN AND GIRLS155