What Works for Women and Girls

These practices and tools are useful for both men and women, however further research isneeded regarding the best ways to overcome a number treatment adherence barriers specific towomen such as fear of disclosure, stigma, violence, body image issues related to fat redistribution(a side effect of some medications), among others.Gaps in Programming—Adherence and Support1. In addition to treatment access, interventions are needed to reduce barriers totreatment adherence for women.1. In addition to treatment access, interventions are needed to reduce barriers to treatmentadherence for women. Studies found that women face a number of barriers that impacttreatment adherence, such as violence, stigma, cost, and changes in body image.Gap noted, for example, in a systematic review (Mills et al., 2006); Sierra Leone (Vandiet al., 2008); Uganda (Weiser et al., 2008); Nigeria (Oloriegbel and Adirieje, 2008);Argentina (Pecheny and Manzelli, 2008); Tanzania and Zambia (Moyer et al., 2008);Zambia (Murray et al., 2009); China (Sabin et al., 2008); Uganda, Tanzania andBotswana (Hardon et al., 2007).7C. Treatment: Reducing TransmissionThe efficiency of HIV transmission is directly proportional to the viral load in the transmittingindividual (Quinn et al., 2000) i.e. the higher the viral load, the easier it is to transmitHIV. Acute HIV infection, lasting weeks or months, mayaccount “for a substantial proportion of HIV-1 transmissionworldwide. Viral burden is particularly high duringthis brief period, resulting in individuals being highlyinfectious” (Powers et al., 2008: 560). Acute HIV infectionusually evolves, in the absence of treatment, into a state ofchronic HIV infection that can remain relatively constantfor years. While this period is associated with a much lowerrisk of transmission compared with that of acute HIV infection,because the period following acute HIV infection canlast a median duration of eight years, the cumulative riskof transmission during these eight years can be substantial(Granich et al., 2009).“Condom issues are diffi cult. Weknow we can prolong our lives ifwe do not infect each other. Onthe other hand, marriage is alsoimportant… We cannot survivewithout men. Who will help usmeet our needs?”—Woman who dropped out of aPMTCT Program, Malawi(Chinkonde et al., 2009: 14)WHAT WORKS FOR WOMEN AND GIRLS175