What Works for Women and Girls

Treatment Has Been Successfully Administered in a Range of Situations andPopulationsTreatment has been successfully administered with good adherence (95% in 92% of patients)in internally displaced camps in Uganda (Kiboneka et al., 2008b). In the United States, treatmenthas also been successful in postmenopausal women (Patterson et al., 2009). Youthfriendlytreatment services, such as the “girls-only day” at a youth program in Kenya, canincrease the numbers of HIV-positive youth—especially girls—accessing treatment (Otieno etal., 2008). Further, accelerating treatment access for adults with young children can reduce thenumbers of orphans, and improve pediatric mortality and social wellbeing. [See Chapter 12B.Care and Support: Orphans and Vulnerable Children]Access to Treatment Must Be EquitableTo date, more women than men have accessed treatment. “Women are often more likely thanmen to attend health services because of dedicated provision of reproductive and child healthclinics” (Braitstein et al., 2008b: 53). Data disaggregated by sex show that adult women areslightly advantaged over adult men in access to antiretroviral therapy in low- and middleincomecountries. About 60% of adults receiving antiretroviral therapy in reporting countrieswere women, who represent 55% of the people in need (UNAIDS, 2009e).Gender norms may make it less likely for men to seek health care as well. More attentionneeds to be paid to ensuring that HIV-positive men know their serostatus, have access tocondoms and understand the need for consistent and correct condom use, and have equitableaccess to treatment. However, it is unclear whether access for women is higher simply becausePMTCT programs facilitate HIV testing and treatment or whether HIV-positive women who donot want or are unable to get pregnant still have more access than men to treatment (Eyakuzeet al., 2008). Still, “the need for increased and equitable access to AIDS treatment cannot beoverstated” (UNAIDS and WHO, 2004 cited in UNAIDS et al., 2004a).Furthermore, some studies have found that women are more likely than men to be asymptomaticwhen accessing treatment for the first time (Makwiza et al., 2009). A study with 65,000patients at 18 sites in Kenya found that men were more likely to be WHO stage 3/4 with lowerCD4 counts and less likely to have disclosed their serostatus. Men were 34% more likely tobe lost to follow-up, defined as being absent from the clinic for more than three months if onARVs and more than six months if not on ARVs, even with adjusting for CD4 count and otherfactors (Ochieng et al., 2008). A study in Uganda with 20,900 clients, of whom 9,387 were inWHO stage 3 at the time clients sought treatment, found that women are less likely than mento be in WHO stage four (with the lowest CD4 counts) (Sebuliba et al., 2008). A cross-sectionalstudy of clinic data from 86 facilities in Uganda, along with exit interviews with 2,285 clientsand 389 service providers found that women comprised 1.4 times more clients than men andwomen were more likely to adhere to ARVs (Kirungi et al., 2008a).Other studies have found that equity in access differs by age group: In Malawi, 10,000people are on treatment, with proportionately more females accessing treatment than men.WHAT WORKS FOR WOMEN AND GIRLS169