What Works for Women and Girls

Pillar 1: Preventing Primary HIV Infection in WomenPrimary prevention of HIV among adults remains critical to any efforts to reduce verticaltransmission. Women who remain HIV-negative cannot transmit HIV to their infants. Further,“children whose mothers have died, regardless of the mother’s HIV status, are less likely tosurvive to their fifth birthday than are children of HIV-infected women who are still alive” (Zabaet al., 2005 cited in Heymann et al., 2007a). The programming in Chapter 3. Prevention forWomen, Chapter 4. Prevention for Key Affected Populations, Chapter 5. Prevention for Young Peopleand Chapter 11. Strengthening the Enabling Environment address this first prong of preventingprimary HIV infection in women.Pillar 2: Preventing Unintended Pregnancy Among Women Living with HIVPreventing unintended pregnancies can have a significant impact on reducing perinatal transmissionof HIV and is a fundamental right for women. Once fully informed of her options, awoman can decide about her reproductive choices and make an informed decision about herfertility. The benefits of family planning include preventing unintended pregnancies; reducingmaternal and infant deaths; and greater educational and economic opportunities for women(Halperin et al., 2009a). A 2006 modeling study found that for the same cost as treatment withantiretroviral drugs to prevent perinatal transmission, contraceptive use can avert nearly 30percent more unintended HIV-positive births (Reynolds et al., 2006a). It is estimated that 22percent of unintended HIV-positive births are already being prevented through current levelsof contraceptive use in sub-Saharan Africa (Reynolds et al., 2006a). “One of the neglected areasin PMTCT globally has been the issue of fertility desires and fertility planning for HIV-positivewomen and their partners” (McIntyre and Lallemont, 2008b: 137). Interventions related to thispillar are included in this chapter as well as in Chapter 8. Meeting the Sexual and ReproductiveHealth Needs of Women Living With HIV.Pillar 3: Preventing Vertical Transmission of HIV During Pregnancy, Delivery andPostpartumWell-functioning maternal health programs are essential for all women, but particularlyfor pregnant women living with HIV. Access to preconception care, HIV testing and counselingthat guarantees confidentiality, HIV treatment options, and evidence-based options indelivery and for postpartum care are critical to meeting the needs of women living with HIVand preventing perinatal transmission. Interventions related to this pillar are included in thischapter.Pillar 4: Family Treatment—Providing Care, Treatment and Support to HIV-PositiveWomen, Their Children and FamiliesFamily treatment (also referred to as PMTCT-Plus) refers to programming that aims to reducevertical transmission as well as to provide services before, during and after pregnancy forwomen living with HIV and to other family or household members. Globally, maternal-childWHAT WORKS FOR WOMEN AND GIRLS207