What Works for Women and Girls

percent among ART-experienced patients with uninfected partners or with partners theydid not previously know, and from 58 to 74 percent among ART-experienced patientswith HIV-positive partners. In individual counseling sessions, participants developedpersonal sexual behavior plans. Free condoms were provided. The available evidenceindicates a significant reduction in risk behavior associated with ART in developingcountries. However, there are few existing studies and the rigor of these studies is weak(Kennedy et al., 2007). (Gray III) (treatment, risk behavior, Côte d’Ivoire, Uganda)A study of longitudinal data from 2,993 HIV-discordant couples in Rwanda and Zambiafrom 2002 to 2008 found that couples where the HIV-positive partner was on ARTwere less likely to have self-reported vaginal sex not protected by condoms, presence ofsperm on a vaginal smear or pregnancy than where the HIV-positive partner was not onART (Sullivan et al., 2009). (Gray IV) (treatment, condoms, pregnancy, Rwanda, Zambia)An analysis of survey data from a cross-sectional study with 85 HIV-positive womenfrom Uganda; 50 HIV-positive women in South Africa; and 44 HIV-positive womenin Brazil found that HAART users were significantly (3.64 times) more likely to usecondoms. Of the 179 HIV-positive women, 83 women reporting recent sexual intercourse,with 63% using condoms and 76% using contraceptive methods. Of the 179HIV-positive women, 65% reported currently using HAART (Kaida et al., 2008). (GrayIV) (treatment, condom use, contraception, Uganda, South Africa, Brazil)A survey of 277 participants attending an HIV care clinic from their initiation to treatmentstarting in October 2004 until May 2006 in Mozambique found that followingART, more participants used condoms for sexual intercourse. Interviewer administeredsurveys were conducted at ART initiation and one year later. Of 277 participants, 48%reported sexual activity three months prior to ART initiation, whereas over 63% reportedsexual activity one year later. After one year of ART, more participants reported sexualactivity, however, 77% were more likely to report correct and consistent condom usecompared to 33% prior to ART initiation. Following ART initiation, 77% had disclosedtheir HIV-positive serostatus to their sexual partners compared to 58% prior to ARTinitiation. Prior to ART initiation, only 22.6% used condoms with HIV-negative orunknown status partners as compared to over 33.9% following ART initiation (Pearsonet al., 2008). (Gray IV) (treatment, condom use, sex behavior, disclosure, Mozambique)Promising Strategies:2. ARV therapy reduces (but does not eliminate) the risk of HIV transmission and may be anadditional prevention strategy.A review of publications from 1996 to 2009 with 11 cohorts reporting on 5,021 heterosexualcouples and 461 HIV transmission events found that studies of heterosexualdiscordant couples observed no transmission in patients treated with ART and withWHAT WORKS FOR WOMEN AND GIRLS179