What Works for Women and Girls

Interactions between ARVs and oral contraceptives may alter the effectiveness or sideeffects of oral contraceptives.Gap noted, for example, in Delvaux and Nöstlinger, 2007; Stuart, 2009: 412; Andersonet al, 2005; Chu et al., 2005; Aweeka et al., 2006 cited in Stuart, 2009.8. Efforts are needed to capitalize on opportunities to integrate family planning and HIVservices. Studies found that both men and women wanted greater integration of services.Gap noted, for example, in Ethiopia (Wilson-Clark, 2008); South Africa (Mantell et al.,2008b); Mexico (Gonzalez, 2008).9. Policy guidelines need to specify how contraception should be addressed in HIV prevention,treatment and care. Studies found that many guidelines did not explicitly addressfamily planning in VCT and PMTCT guidelines and that providers and policymakers feltthey had insufficient knowledge.Gap noted, for example, in South Africa (Harries et al., 2007); 16 high-HIV prevalencecountries (Strachan et al., 2004).10. Additional efforts are needed to reduce the contextual barriers that influence the behavioror decisions of people living with HIV to engage in unsafe sex. Studies found that factorssuch as difficulties negotiating condoms, partner refusal, high unemployment, alcoholuse, financial dependency, expectations of childbearing, fear of disclosure, etc., influencedprotective behavior.Gap noted, for example, in South Africa (MacDonald et al., 2008, Eisele et al., 2008);Uganda (King et al., 2009; Bakeera-Kitaka et al., 2008); Cameroon (Abega et al., 2008).11. Providers need additional skills and resources to provide non-judgmental, confidential safersex counseling to people living with HIV. [See also Chapter 13. Structuring Health Servicesto Meet Women’s Needs] Studies found that providers faced barriers in providing effectivecounseling including too few staff, limited time, discomfort discussing sex, etc.Gap noted, for example, in South Africa (Cornman et al., 2008); Russian Federation(Davidson et al., 2008).12. Further interventions providing disclosure support are needed, particularly for womenfacing abandonment, violence, or other adverse events. [See also Chapter 9C-1. SafeMotherhood and Prevention of Vertical Transmission: Testing and Counseling, Chapter 6. HIVTesting and Counseling for Women and Chapter 11F. Strengthening the Enabling Environment:Reducing Stigma and Discrimination] Studies found many women faced abuse and abandonmentupon disclosing their status.Gap noted, for example, in Malawi (Chinkonde et al., 2009); South Africa, Malawi,Swaziland, Lesotho and Tanzania (Greeff et al., 2008).202 CHAPTER 8 MEETING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV