What Works for Women and Girls

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Available GuidelinesA number of sexual and reproductive health guidelines are available to program managersand policymakers. Guidance regarding which contraceptive options are best for women livingwith HIV is available from WHO, 2008a: http://www.who.int/reproductivehealth/publications/family_planning/9789241563888/en/Acounseling tool is also available at: http://www.engenderhealth.org/pubs/hiv-aids-sti/srh-hiv-positive-women-girls.php. Strategic considerationson linking family planning and HIV services can be found at http://www.fhi.org/en/RH/Pubs/booksReports/FP-HIV_Strategic_Considerations.htm. EngenderHealth also hastraining guidelines for program managers and health workers to provide comprehensive SRHcare for women and girls living with HIV: http://www.engenderhealth.org/pubs/hiv-aidssti/index.php.Recent Global Fund guidelines have called for integration of the sexual andreproductive health needs of HIV-positive women into national AIDS plans, with successfulexamples of Global Fund proposals (Hardee et al. 2009a, http://www.populationaction.org/Publications/Reports/A_Practical_Guide_to_IntegratingReproductive_Health_HIV-AIDS/Summary.shtml).The following represents recent evidence as to what works in meeting the sexual and reproductivehealth needs of women living with HIV. [See also Chapter 3D. Prevention for Women:Treating Sexually Transmitted Infections]188 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV
What Works—Meeting the Sexual and Reproductive Health Needs of Women Livingwith HIV1. Promoting contraceptives and family planning counseling as part of routine HIVservices (and vice versa) can increase condom use, contraceptive use, and dualmethod use, thus averting unintended pregnancies among women living with HIV.2. Hormonal contraception is safe for women living with HIV and does not seem toaffect HIV acquisition or HIV progression.3. Women with HIV can use IUDs if they have access to medical services in case of IUDexpulsion.4. Providing information and skills-building support to HIV-positive people can reduceunprotected sex.5. Interventions to support disclosure can increase condom use in discordant couples.6. Providing antiretroviral treatment to people living with HIV can increase HIVprevention behaviors, including condom use.Promising Strategies:7. Cervical cancer screening and treatment can be integrated into HIV care to reducemorbidity and mortality in women living with HIV.8. Promoting condom use for contraception may make condom use more acceptableand easier to negotiate.9. Early postpartum visits can result in increased condom use, contraceptive use, HIVtesting and treatment.EVIDENCE1. Promoting contraceptives and family planning counseling as part of routine HIV services(and vice versa) may increase condom use, contraceptive use, and dual method use, thusaverting unintended pregnancies among women living with HIV. [See also Chapter 13.Structuring Health Services to Meet Women’s Needs]A three-armed randomized controlled trial at a VCT clinic in Lusaka, Zambia with 251couples found a threefold higher contraceptive initiation rate where family planningeducation and offer of contraceptives were available on site rather than by referral to anoutside clinic. All couples received a presentation on family planning methods and theWHAT WORKS FOR WOMEN AND GIRLS189
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WHAT WORKSFOR WOMEN AND GIRLSEviden
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Authors:Jill Gay, MAKaren Hardee, P
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Jose Esparza, MD, Ph.D.Senior Advis
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Shyam Kottilil, MD, Ph.D.Staff Clin
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Larry Slutsker, MD, MPHChief, Malar
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Table of ContentsList of Abbreviati
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List of Abbreviations3TCACTAHIANCAP
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PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
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MethodologyMeasuring “what works
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2. Hormonal contraception is safe f
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outcomes has been more difficult to
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2. Promoting contraceptives and fam
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International Political Commitments
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established national action plans o
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Organization of the DocumentThis do
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Table 1.1Countries included in What
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understanding the epidemic in any g
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girls in school, for example. The c
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Within each intervention, studies a
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Chapter 3.Prevention for WomenA. Ma
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Special Risks for WomenStill, despi
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AIDS cases reported from 1982 to 20
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experience observed in clinical tri
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Female Condoms Are the Only Female-
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condom if it gives them more pleasu
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Correct use of the female condom ha
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A two month prospective study from
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A study of trends from Demographic
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8. Peer education for women can inc
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3B. Prevention for Women: Partner R
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matic focus on partner reduction, y
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of HIV acquisition, but were either
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four visits, each participant was i
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What Works—Prevention for Women:
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vention immediately following the b
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Chapter 4.Prevention for Key Affect
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2010). Transgender men and women al
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confidentiality—violate human rig
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there were major socio-demographic
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and post-intervention were used to
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tent condom use and 1.5 times more
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to their peers, distribute condoms
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Gaps in Programming—Female Sex Wo
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of a sexual relationship with a pri
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than were naltrexone or placebo. HI
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attributed to …swift introduction
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Promising Strategies:5. Sex-segrega
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9. Programming to prevent initiatio
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D’Ivoire, Cuba, Estonia, Indonesi
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Gaps in Programming—Women Prisone
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EVIDENCEPromising Strategies:1. Vol
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In fact, as of September 2008, 66 o
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Transgender women and men are often
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2009). “The invisibility and marg
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especially young women, have their
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negotiation skills and other critic
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to be reached with sex and HIV educ
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What Works—Prevention for Young P
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44% and 100% of participants (Kirby
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tudes, self-efficacy, intentions, a
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as young people in this area had li
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ical validity of the findings that
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study reported having received info
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nancy. Almost 87% of men and 89% of
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last sex, having ever used a condom
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Gap noted, for example, in South Af
Page 140 and 141: Disaggregated Data Is NeededEffecti
Page 142 and 143: were also effective in increasing u
Page 145 and 146: Chapter 6.HIV Testing and Counselin
Page 147 and 148: Equitable Access to Testing and Cou
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Page 151 and 152: their jobs (Human Rights Watch, 200
Page 153 and 154: What Works—HIV Testing and Counse
Page 155 and 156: women. Of all married HIV-positive
Page 157 and 158: A study in Ethiopia found that inco
Page 159 and 160: At a provincial hospital in Mombasa
Page 161 and 162: Between June and December 2007, mob
Page 163 and 164: Promising Strategies:6. Encouraging
Page 165 and 166: 10. Counseling may reduce risk beha
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Page 169 and 170: Chapter 7.TreatmentA. Provision and
Page 171 and 172: Treatment Has Been Successfully Adm
Page 173 and 174: HIV Prevention Is Needed as well as
Page 175 and 176: Gaps in Programming—Provision and
Page 177 and 178: These practices and tools are usefu
Page 179 and 180: Non-judgmental, non-stigmatizing in
Page 181 and 182: percent among ART-experienced patie
Page 183: (Donnell et al., 2010). (Abstract)
Page 186 and 187: The sexual health of women is an im
Page 188 and 189: [ for women living with HIV]: impro
Page 192 and 193: advantages of dual method use, alon
Page 194 and 195: contraception: 57% used hormonal co
Page 196 and 197: different; and progression to WHO c
Page 198 and 199: HIV-related behavioral or biologic
Page 200 and 201: use was positively associated with
Page 202 and 203: Gaps in Programming—Meeting the S
Page 204 and 205: Interactions between ARVs and oral
Page 207 and 208: Chapter 9.Safe Motherhood and Preve
Page 209 and 210: Pillar 1: Preventing Primary HIV In
Page 211 and 212: mission of HIV. HIV testing and cou
Page 213 and 214: EVIDENCE1. Preventing unintended pr
Page 215 and 216: Gaps in Programming—Reducing Unin
Page 217 and 218: 9B. Safe Motherhood and Preventiono
Page 219 and 220: EVIDENCEPromising Strategies:1. Dis
Page 221 and 222: Gaps in Programming—Pre-Conceptio
Page 223 and 224: 9C-1. Safe Motherhood and Preventio
Page 225 and 226: tion (Kershaw et al., 2006). “…
Page 227 and 228: outine tests. Fifty percent of the
Page 229 and 230: An evaluation of UNICEF-funded PMTC
Page 231 and 232: and syphilis (by rapid plasma regai
Page 233 and 234: 2. Additional efforts are needed to
Page 235 and 236: for their own disease” (ITPC, 200
Page 237 and 238: own health needs has never been eva
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chose elective cesarean section to
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their current pregnancy or a past p
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Promising Strategies:5. Integrating
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Gaps in Programming—Treatment1. I
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cesarean, and 221 were non-elective
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3. Efforts are needed to ensure tha
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“There is no doubt that there are
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formula feeding increases the risk
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of age. For breastfed infants, the
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weeks of gestation and continued un
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A study in Côte d’Ivoire with 54
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during breastfeeding compared with
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3 times higher for infants who were
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counseling tools are needed. Studie
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Chapter 10.Preventing, Detecting an
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latent infection. Some immunocompro
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concurrent active TB and HIV infect
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mortality of HIV-positive people re
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in a 65% decline in mortality and t
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1. Efforts are needed to reduce TB-
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al., 2004 cited in Slutsker and Mar
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stillbirths by 33%. Three cluster-r
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Gaps in Programming—Malaria1. Fur
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dose global coverage was just 27% i
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Chapter 11.Strengthening the Enabli
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combining microfinance and training
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pants meeting once per week for thr
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the men believed that they should n
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in the intervention village were si
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positive impacts. The quasi-experim
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Samoa, Serbia and Montenegro, Thail
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factor associated with sexual assau
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What Works—Strengthening the Enab
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worked with women’s groups, radio
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of school in addressing gender-base
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11C. Strengthening the Enabling Env
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also widely used worldwide and part
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ecognize women’s property rights
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Promising Strategies:2. Community o
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11D. Strengthening the Enabling Env
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more likely to report having used a
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likely than illiterate women to kno
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of the women surveyed were HIV-posi
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countries extending the fee aboliti
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families and separated from their c
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used the resource “Understanding
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6. Support groups for people living
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11G. Strengthening the Enabling Env
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EVIDENCEPromising Strategies:1. Inv
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Chapter 12.Care and SupportA. Women
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ical care provided by family member
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dealing with their sorrow, grief, a
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What Works—Care and Support: Wome
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2. Peer support groups can be highl
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discriminated unjustly against them
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6. Home-based antiretroviral therap
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12B. Care and Support: Orphans and
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(Thurman et al., 2007). As of 2008,
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care and services were provided, wh
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for treatment can be safely monitor
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A study done in Kenya (year not giv
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ather than a narrowly defined HIV/A
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7. Further interventions to provide
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ning providers, antenatal care and
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What Works—Structuring Health Ser
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counts available at primary health
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Pregnant women reported feeling out
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Before implementation of the PMTCT
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accessing PMTCT. An evaluation of 3
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A mathematical model based on TB tr
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1. Improved integration is needed b
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15. Additional efforts are needed t
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Community-based Care is holistic ca
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Microfinance is often defined as fi
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Sexuality is a central aspect of be
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“What Works compiles a wealth of
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