What Works for Women and Girls

program in labor and delivery (Kissin et al., 2008; Rahangdale et al., 2007; Sagay et al., 2006cited in Pai and Klein, 2009). The impact of rapid testing during labor and delivery for theHIV-positive woman has yet to be assessed, however (Jurgens et al., 2007a). [See also Chapter6. HIV Testing and Counseling for Women]While routine testing is showing some promising signs of being acceptable and feasible, itis important to ensure that routine testing does not discourage women from seeking neededmedical care or cause unanticipated outcomes for women, such as increased violence. Opt-outtesting, while showing an increase in the number of women who are tested during antenatalcare, raises concerns about whether women living with HIV will avoid antenatal care servicesin order not to be tested (Drucell and Nolan, 2007). Some studies have shown that testing inviolation of human rights standards discourages women from accessing services or may leadto increased violence against women (Turan et al., 2008a; Bwirire et al., 2008; Zabina et al.,2009; Turan et al., 2008b; PHR, 2007a; Center for Reproductive Rights and Federation ofWomen’s Lawyers, Kenya, 2007; HRW, 2003b).“…Coping with HIV-related stigma…is especially challenging during pregnancy and postpartum,when women may be preoccupied not only with the physical and psychological effectsof having HIV, but also with preventing HIV transmission to their infants and/or avoidingdisclosure of their HIV status to their families and communities” (Brickley et al., 2008).However, within the context of HIV testing, counseling is “not simply a human rights imperative:it is a medical intervention that is vital to support pregnant women with preventionefforts, disclosure, living with a life-threatening virus and adherence to treatment” (Gruskin etal., 2008a: 29). Further evaluation of routine and provider-initiated testing is urgently neededto assess whether informed consent and confidentiality is adequately protected (Gruskin et al.,2008a).HIV Counseling for Both Men and Women Is a Critical Component of Antenatal CareCounseling on safer sex during pregnancy should be an important part of HIV testing. “…Parents desire healthy children and are willing to modify their behavior to protect them fromharm” (Tavengwa et al., 2007: 101). Male partners and/or husbands can influence whether awoman accesses HIV testing (Ghanotakis, 2010). It is therefore critical to involve the malepartners of pregnant women—with women’s consent. However, many ANC clinics and maternityhospitals have no place (literally) for men; and health workers in maternal health clinicsrarely have received training in addressing male partners. “In addition, many men believe thattheir wives’ HIV test results would mirror their own. Mass information campaigns shouldaddress this incorrect belief” (Msellati, 2009: 809).For HIV-negative pregnant women, avoiding unsterilized needles, avoiding blood transfusionswhich have not been screened for HIV; and continued condom use and/or mutualmonogamy with one HIV-negative sexual partner are ways remain HIV-negative during thecourse of pregnancy and the postpartum period. However, fear of violence and lack of ability toassert control, such as feeling forced to have sex, may make it even more difficult for pregnantwomen to request condom use, as condoms cannot be talked about in the context of contracep-222 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION