What Works for Women and Girls

Non-judgmental, non-stigmatizing interventions to reduce HIV transmission to sexualpartners are urgently needed (Collins et al., 2008). Other interventions both within the healthsector and outside the health sector, for example, those that transform norms, reduce violenceagainst women, promote legal rights, etc, also need to be implemented in order to supportsafer sexual behavior once someone knows his/her positive serostatus. [See also Chapter 11.Strengthening the Enabling Environment] Transmission can also occur in the attempt to becomepregnant: “In the absence of artificial insemination technologies, effectively unavailable in mostlow- or low-to-middle income countries, conception requires unprotected sexual intercourse;this means risk of either HIV transmission (in serodiscordant couples) or HIV super-infection(in couples where both couples are positive” (London et al., 2008: 14). [See also Chapter 9. SafeMotherhood and Prevention of Vertical Transmission]“Treatment cannot replace the use of condoms. The proper use of condoms remains areliable means of enabling everyone, without knowing the serologic status of their partners,to keep control on protecting themselves and others during sexual intercourse…. Treatmentshould be thought of as a tool providing regular condom users valuable extra safety. Moreover,condoms remain the only way to protect oneself against other STIs” (Bourdillon et al.,2008: 11).Further research is critical to assess “what works” in reducing transmission. Randomizedevaluations of different behavioral intervention models, including clinician-initiated communicationare needed (Bunnell et al., 2006b). “When discussions of ongoing STD-related riskbehavior do occur, they are infrequent and often initiated at the patient’s request. At best,the lack of these discussion in HIV-related care settings is unfortunate; at worst, it indirectlycontributes to escalating rates of STDs among HIV-infected persons and of new HIV acquisitionamong others at risk” (Hall and Marrazzo, 2007: 518.)What Works—Treatment: Reducing Transmission1. Providing antiretroviral treatment to people living with HIV can increase HIVprevention behaviors, including condom use.Promising Strategies:2. ARV therapy reduces (but does not eliminate) the risk of HIV transmission and maybe an additional prevention strategy.WHAT WORKS FOR WOMEN AND GIRLS177