What Works for Women and Girls

uption of therapy, the virus and risk for opportunistic infections increase, even in patientswhere the virus has been suppressed for long periods of time (SMART Study Group, 2006).A recent review found that gender-specific differences in recommendations concerninginitiation of therapy are not warranted (Floridia et al., 2008). An analysis of United States Foodand Drug Administration (FDA) databases also found “no clinically or statistically significantgender differences” in 48-week efficacy of ART in randomized controlled trials between 2000and 2008 (Stubbel et al., 2009).While there may not be a need for different recommendations for initiation of therapy bygender, there are indications that certain interventions can be highly beneficial to women specificallyin treatment provision and access, adherence and support, and reducing transmission.7A. Treatment: Provision and AccessEvidence has repeatedly demonstrated that antiretroviral therapy has been successfully accessedby both men and women with near perfect adherence, good patient retention, and good clinicaloutcomes in resource-poor settings common to many developing countries; results have beensimilar to those achieved in resource-rich countries. A systematic comparison of 4,810 treatment-naïveadult patients (51% female) from 18 HAART treatment programs in Africa, Asiaand South America (low-income settings) with 22,217 treatment-naïveadults (25% female) in 12 HIV cohort studies“I am still on ARVs but myhusband does not know...I hidemedicine. I don’t want to lose mymarriage and I do not want to losemy life. If I am divorced I cannotlook after the children.”—HIV-positive woman, Zambia(Human Rights Watch, 2007: 30)from Europe and North America (high-income settings)found that antiretroviral therapy is feasible and effective inlow-income settings. Mortality was higher in the first fewmonths of treatment for patients in low-income settings.Those in low-income settings started treatment withconsiderably more advanced immunodeficiency than thosefrom industrialized countries, but virological and immunologicalresponse to HAART were similar in both settings(ART-LINC & ART-CC, 2006). A review of nine articlesand 18 abstracts until 2006 from sub-Saharan Africa, with12,116 patients found favorable levels of adherence, with 77% of patients achieving 95% adherenceaccording to patient self-reports. Adherence from studies in sub-Saharan Africa showedthat that more patients were adherent than patients in North America, based on 31 studies with17,537 patients (Mills et al., 2006).168 CHAPTER 7 TREATMENT