What Works for Women and Girls

use was positively associated with disclosure of HIV-positive serostatus and partnerbeing HIV-negative, as well as being married (Allen et al., 2008). (Gray V) (condom use,Caribbean)6. Providing antiretroviral treatment to people living with HIV can increase HIV preventionbehaviors, including condom use. [See Chapter 7C. Treatment: Reducing Transmission]Promising Strategies:7. Cervical cancer screening and treatment can be integrated into HIV care to reduce morbidityand mortality in women living with HIV.A program for cervical cancer for both HIV-positive and negative women in Lusaka,Zambia has screened over 20,000 women in 15 primary care clinics and has linkedcervical cancer prevention services with HIV care and treatment services. Due to lack ofresources to establish a patient recall system, emphasis was on high population coveragerather than frequency of exams. Cervical cancer using visual inspection with acetic acid(VIA) provided on-the-spot results, which was then linked with same visit cryotherapy.Community randomized trials have documented the safety, acceptability and effectivenessof single visit “see and treat” methodology based on VIA and same visit cryotherapyof eligible lesions (Sankaranarayan et al., 2007; Goldie et al., 2005; Denny et al.,2005 cited in Mwanahamuntu et al., 2008). Peer educators as health promotion advocatesand patient navigators reduced loss to follow-up. Community women were trainedon conducting community-based cervical health promotion talk. Women who wantedmore information were directed to the cervical cancer prevention clinics. Women whoattended cervical cancer prevention clinics who had not been tested for HIV were counseledon HPV and HIV testing. HIV-positive women were escorted to nearby HIVcare treatment clinics for further evaluation. To minimize stigma, screening clinicswere co-located in government-operated public health clinics near to but not directlywithin the HIV clinic (Mwanahamuntu et al., 2008). (Gray V) (cervical cancer, treatment,Zambia)A 2007 overview states that cervical cancer screening of HIV-positive women in lowresourcecountries could be integrated with ARV treatments, which have establishedthe regular observation, infrastructure and services to support cervical cancer screenings.The overview explains that a new, rapid HPV test is underway and may be the bestoption considering the difficulties associated with Pap smears, visual inspection andHPV tests in low-resource countries. Pap smears require high standards of implementation,which work in high-resource countries, but may be deficient in low-resourcesettings. Visual inspection relies heavily upon the training of the health provider, thoughit is a low-cost option giving immediate results (Franceschi and Jaffe, 2007). (Gray V)(cervical cancer, treatment, Pap smears)198 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV