What Works for Women and Girls

[ for women living with HIV]: improved information about, and access to…unbiased, legal, safeand confidential pregnancy, childbirth, and/or abortion services... [and] better training andawareness raising for health workers to reduce the frequency of forced abortion and forcedsterilization of HIV-positive women” (ICW, 2008: 2). Based on the human rights underpinningof HIV and AIDS programming, “HIV-positive women should not be pressured not tohave children, but should be given full information and be able to make their own informeddecision” (Paxton et al., 2004a: 15). Health services should affirm a woman’s ability to makedecisions about when and whether she wants children and forbid coercion in making familyplanning and reproductive health decisions (Eckman and Hersted, 2006). Women need tobe asked on a regular basis: is pregnancy desired? If the answer is yes, preconception counselingis warranted along with support for a healthy and safe pregnancy. [See Chapter 9B. SafeMotherhood and Prevention of Vertical Transmission: Pre-Conception] If the answer is no, contraceptiveoptions should be discussed and if an unintended pregnancy occurs, abortion, wherelegal, or, if necessary, post-abortion care services should be offered by providers (Wilcher andCates, 2009).Studies assessing the desire for children by women living with HIV rarely stratify results bytime of diagnosis. Understanding how reproductive health choices change for women livingwith HIV is warranted. Studies have found that fertility desires of HIV-positive individualschanges over time (Chen et al., 2001 cited in Myer et al., 2010). The desire to limit birthswas higher among recently tested HIV-positive women in Zambia and Zimbabwe (Johnsonet al., 2009). Some studies have found that knowing that one is HIV-positive may increasecontraceptive use to prevent unintended pregnancies. A study of 227 women living with HIVin Malawi found that prior to receiving their HIV test results, 33 percent reported a desire tohave future children; this declined to 15 percent one week later and remained constant forthe following year. Contraceptive use increased from 38 percent prior to HIV testing to 46percent after 12 months. The pregnancy incidence among women who reported that they didnot want future children after HIV testing was less than half of the incidence among womenwho reported they did want future children (Hoffman et al., 2008b).A growing amount of evidence exists on integratingsexual and reproductive health programs and services with“My HIV status does not takeaway my sexuality.”—Grace Sedio,ICW Representative fromBotswana, 2008HIV prevention, treatment and care, but more evaluatedstudies to demonstrate what works for women are needed(Wilcher and Cates, 2009; Spaulding et al., 2009). [SeeChapter 13. Structuring Health Services to Meet Women’s Needs]Combining family planning information with HIV preventionmessages may be a good way to prevent HIV amongwomen but is often a missed opportunity. For example,in Ethiopia, community health workers have visited morethan 42% of women aged 15–19 years old throughout the country with family planning information,referral and services, but not HIV prevention (Wilson-Clark, 2008). Studies haveshown that health care workers can provide counseling on sexuality, family planning, HIV/186 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV