What Works for Women and Girls

The sexual health of women is an important component of SRH services and is oftenoverlooked, particularly for women living with HIV. Discussions of SRH services for womenliving with HIV often revolve around controlling fertility and ignore HIV-positive women’sneeds for services that include attention to safe and healthy sexuality and a desire for children.Because women living with HIV are more vulnerable to rights abuses, for example forcedcontraception or coerced sterilization, ensuring that their sexual and reproductive health needsare met is critical (Wilcher and Cates, 2009). [See Chapter 13: Structuring Health Services to MeetWomen’s Needs]Fertility Planning Is Important for All Women, Regardlessof SerostatusWomen living with HIV have similar reproductive patterns as women without HIV (Stanwoodet al., 2007; Hoffman et al., 2008a; Rochat et al., 2006 cited in Reynolds et al., 2008). Somewomen living with HIV want to start or continue having children and others do not. Worldwidemore than 215 million women say they would prefer to avoid a pregnancy, but are not using anyform of contraception, or they are using traditional methods, which are less effective meansof contraception (Singh et al., 2009c). Among those 215 million women are women who maynot know their HIV status.Because many people still do not know their HIV status, and because negotiating condomuse is not always possible, expanding access to contraceptives for all women who need and wantthem through rights-based, voluntary services, is an important component of HIV programmingand is cost-effective (Adair, 2009; Halperin et al., 2009a). A 2008 modeling study inthe 15 PEPFAR countries estimates that the annual number of unintended HIV-positive birthscurrently averted by contraception use is over 220,000 (Reynolds et al., 2008). A study by theU.S. CDC in Uganda found that unwanted pregnancies may account for almost a quarter of allHIV-positive infants in Uganda (Hladik et al., 2008a; Hladik et al., 2009).As for all women, a wide range of contraceptive options provided with quality counselingis required (WHO/RHR and CCP, 2007). “For women who do not currently desire pregnancy,the dual method approach—combining condoms for HIV/sexually transmitted disease (STD)prevention with longer-acting, more effective contraceptives for added protection againstpregnancy—simultaneously prevents both heterosexual and perinatal HIV transmission.Prevention of unplanned pregnancies remains a cost-effective and economically feasible wayto prevent pediatric HIV disease in most of Africa. This approach also reduces the numberof AIDS orphans….” (Mark et al., 2007: 1201). The female condom also offers an importantdual protection option for women (Welbourn, 2006). [See also Chapter 3. Prevention for Womenand Chapter 9. Safe Motherhood and Prevention of Vertical Transmission] Women living with andwithout HIV report greater success in negotiating condom use if it is also presented to theirpartner as contraception.184 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV