What Works for Women and Girls

However, in the 15 to 19 year age group, more men are proportionately on treatment despitethe fact that HIV prevalence in this age group is higher among women. There were morewomen than men on treatment for ages 30 to 39, yet HIV prevalence in this age group ishigher in men as compared to women.Despite having better access to treatment, a study in Chile that evaluated quality of life for409 people living with HIV in public hospitals, of whom fewer than 19% were women, foundthat women have a worse quality of life (Sgombich Mancilla et al., 2008). One study in ruralIndia found that rural women were 30% less likely than men to initiate antiretroviral medication(Ramchandani et al., 2007 cited in Sinha et al., 2009).Cost is another factor in treatment access. A study of AIDS-related deaths in Addis Ababa,Ethiopia found that following the launch of no-cost antiretroviral therapy in 2005, womendied from AIDS at almost the same rate as men. Prior to no-cost antiretroviral therapy, morewomen than men died of AIDS, possibly due to sex differences in access to resources forfinancing treatment (Reniers et al., 2009). Treatment provided at no cost can substantiallyincrease both women and men’s access to life-saving therapy.Increased Access Must also Include Respect for Human RightsExpanding comprehensive medical services for HIV-positive women and providing multipleentry points for care—including antenatal, family planning and other sexual and reproductivehealth care services and psychosocial support—will be essential to increase women’s access tooptimal ARV treatment. The benefits of treatment access go beyond improvements in healthstatus and can include increasing employment and income for people living with HIV. [SeeChapter 11D. Strengthening the Enabling Environment: Promoting Women’s Employment, Incomeand Livelihood Opportunities] However, fear of stigma and discrimination associated with HIV/AIDS may deter HIV-positive women from seeking ARV therapy as women living with HIVare at increased risk for being blamed as the source of infection and face more severe consequencesof stigma (Hong et al, 2004; Maman et al, 2001a).Regardless of who has better access to treatment, human rights must be respected.Requiring HIV-positive people to disclose their serostatus to sexual partners and/or communitymembers in order to receive treatment, care or support is a human rights violation (Niyirendaet al., 2008). Further, requiring a “treatment buddy” or “medical companion” to access ARVtherapy may place undue burdens on women and their children: a study of 1,453 patients inUganda (71% female) on the impact of requiring patients to disclose their HIV status and havea “treatment buddy” or “medical companion” to access ARV therapy found that of the women,41% chose a child as their medical companion versus 14% of the men (Amuron et al., 2008).Finally, coercing women to accept contraception in order to access treatment violates women’srights to make their own fertility choices. [See Chapter 8. Meeting the Sexual and ReproductiveHealth Needs of Women Living With HIV]170 CHAPTER 7 TREATMENT