What Works for Women and Girls

Gaps in Programming—Provision and Access1. Initiatives that provide for early diagnosis and appropriate longitudinal careprior to treatment eligibility are needed to reduce mortality rates among adultsaccessing treatment.1. Initiatives that provide for early diagnosis and appropriate longitudinal care prior to treatmenteligibility are needed to reduce mortality rates among adults accessing treatment.A review found that early mortality among adults accessing antiretroviral therapy can beattributed to late diagnosis of HIV.Gap noted, for example, in a review of 18 published cohort studies in Africa (Lawn et al.,2008).7B. Treatment: Adherence and SupportAccess alone does not ensure that women will adhere to treatment. “The regimens are oftencomplicated, can require dietary restrictions and may lead to adverse effects,” such as changesin body fat that can negatively impact body image (Mills et al., 2006: 2; Holstad et al., 2006).A systematic review of 84 studies examining barriers to treatment adherence found “fearof disclosure, forgetfulness, a lack of understanding of treatment benefits, complicated regimens,and being away from medications were consistent barriers to adherence in developedand developing nations. More common to developing settings were issues of access, includingfinancial constraints and a disruption in access to medications” (Mills et al., 2006: 18).There Are Gender Differences in Treatment AdherenceMen and women have similar adherence rates, and women are able to follow complicated regimensas well as men. But there are gender differences in predictors of adherence. Women mayneed family support, including redistribution of household responsibilities, to enable them toadhere to treatment. Even if drugs are free or subsidized, women may not be able to afford thetime or money required to travel to a clinic. Women may also have difficulty navigating treatmentwhen it conflicts with other activities for survival. One South African sex worker pointsout the struggles she faces: “If you don’t pay off the police, they take you to jail…you can’t takeantiretroviral drugs or any medication you need” (Arnott and Crago, 2009: 10).It is also critical for treatment programs to assess not just how many people who needtreatment gain access to treatment but who gains access, how, and if it is accompanied by careand support. Does the program address adherence? Do patients receive adherence support?Do patients receive good quality counseling? Are patients satisfied with their quality of care?WHAT WORKS FOR WOMEN AND GIRLS173