What Works for Women and Girls

Gaps in Programming—Pre-Conception1. Women and their sexual partners need access to comprehensive pre-conception care sothey can make informed decisions about pregnancy before conception.2. Interventions are needed to support the autonomous decision-making of HIV-positivewomen who are caught between the contradictory pressures of family, community andhealth care providers.3. Some HIV-positive men and women would consider adoption.4. Women and their sexual partners need to know and understand how seroconversioncan occur during pregnancy.1. Women and their sexual partners need access to comprehensive pre-conception care sothey can make informed decisions about pregnancy before conception. Studies found thatHIV-positive women could not access pre-conception advice on safer pregnancy options, ashealth providers discouraged pregnancy. Studies found that significant numbers of pregnantwomen did not know any way to prevent vertical transmission.Gap noted, for example, in South Africa (London et al., 2008); China (Luo and He,2008); globally (Hirsch, 2007; Delvaux & Nöstlinger, 2007).2. Interventions are needed to support the autonomous decision-making of HIV-positivewomen who are caught between the contradictory pressures of family, community andhealth care providers. Studies found that HIV-positive women and men need informationand social support to make decisions that reflect their own preferences in the face of pressureto bear children. A review of the published literature from 1990 to 2008 found thatthe refusal of health workers to discuss reproductive options in a non-biased way negativelyimpacts HIV-positive women. Studies also found that HIV-positive men lacked informationon preconception and felt they could not request this information from health providers.Gap noted, for example, in Vietnam (Oosterjoff et al., 2008), Brazil (Paiva et al., 2003),and South Africa (Nduna and Farlane, 2009).3. Some HIV-positive men and women would consider adoption. A study found thatHIV-positive men and women would consider adopting a child as an alternative to havinga biological child.Gap noted, for example, in South Africa (Cooper et al., 2009).4. Women and their sexual partners need to know and understand how seroconversion canoccur during pregnancy. [See 9C-1. Testing and Counseling]WHAT WORKS FOR WOMEN AND GIRLS219