What Works for Women and Girls

aging, access to these treatments remains limited even for those individuals in resource-richsettings… Teaching couples about ovulation and intercourse timed to fertile periods offers ameans for decreasing the number of unprotected sexual encounters” (Mathews and Mukherjee,2009: S7).Increasingly, services will be needed to provide counseling and support for perinatallyinfected adolescents who will want to know their options for pregnancy, birth and infantfeeding to minimize the probability of transmission to the infant and yet protect their ownhealth (Birungi, 2009a,b). Maternal health providers often lack the knowledge needed toguide women living with HIV through a safe pregnancy process and may discriminate againstwomen living with HIV. Training is needed to ensure that providers will support women’schoices in reproductive health. [See also Chapter 8. Meeting the Sexual and Reproductive HealthNeeds of Women Living With HIV]Focus groups in South Africa found men and women to be very careful in weighing thechoice to have a child and acutely mindful of the long-term consequences for themselves, theirpartners and their future child (London et al., 2008); however studies have found that womenand men living with HIV do not always seek pre-conception counseling due to fear of stigmatizationby health care providers. This obstacle must be overcome in order to minimize the riskof perinatal transmission at the earliest possible point.What Works—Safe Motherhood and Prevention of Vertical Transmission: Pre-ConceptionPromising Strategies:1. Discussing mother-to-child transmission risk with providers and/or other HIVpositivewomen with seronegative children can increase women’s confidence aboutpreventing mother-to-child transmission of HIV.2. When the woman is HIV-positive, or both male and female partners are HIV-positiveand wish to conceive, having an undetectable viral load due to HAART may result inthe lowest risk of perinatal transmission.3. Self-insemination can minimize the risk of transmission to partner and infant when awoman is HIV-positive and her partner is seronegative.4. Sperm washing may be used for an HIV-negative woman wishing to become pregnantwith an HIV-positive male partner without acquiring HIV herself.216 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION