What Works for Women and Girls

An exploratory cross-sectional survey was conducted in 6 PMTCT sites in ruralZimbabwe to assess the acceptability of opt-out HIV testing. Of 520 women sampled,285 (55%) had been HIV tested during their last pregnancy. Among the 235 women notHIV tested in ANC, 79% would accept HIV testing if opt-out testing was introduced.Factors associated with accepting the opt-out approach were being less than 20 yearsold, having secondary education or more, living with a partner, and the existence of aPMTCT service where the untested women delivered. Thirty-seven women of 235 (16%)would decline routine HIV testing, mainly because of their fear of knowing their HIVstatus and the need to have their partner’s consent. Among the 285 women alreadytested in ANC, 97% would accept the opt-out approach (Perez et al., 2006). (Gray V)(PMTCT, HIV testing, antenatal care, Zimbabwe)A study from 2007 to 2008 in Mexico investigated the provision of a validated facilitatedconsent to pregnant women, which considered the emotional impact of potentiallytesting HIV-positive and included counseling before rapid HIV testing, in antenatalcare settings where routine rapid HIV testing is not common. Of the 1,293 HIV testsgiven during the study period, 92% of women stated that the facilitated consent was“clear and sufficient to accept or reject the test” (Ortíz Ibarra et al., 2008). (Abstract)(antenatal care, HIV testing, Mexico)2. Informed and appropriate counseling during ANC can lead to increased discussion betweenpartners and increased protective behaviors such as condom use.A study in Côte d’Ivoire from 2001 to 2005 with 306 HIV-positive, 352 HIV-negative,and 52 pregnant women who refused HIV testing, found that prenatal HIV counselingand testing led to increased discussions between partners regarding STIsand sexual risks, and increased condom use when sexual activity was resumed afterdelivery. After prenatal counseling and testing, HIV-positive women were enrolled ina PMTCT program and were followed for 2 years. Women who tested HIV-negativeand untested women received reproductive health related follow-ups for 2 years. Priorto prenatal counseling and testing, two-thirds of HIV-negative and untested womenreported having had discussions about STIs with male partners, while afterwards over90 percent of women reported discussing STIs, suggesting that their partners be testedfor HIV, and encouraging condom use in extramarital sexual relations. For HIV-positivewomen, discussions about STIs with partners increased from 28 percent to 65 percent,72 percent suggested that their partners be tested for HIV, and 58 percent encouragedcondom use in extramarital relations. Additionally, condom use increased from 36 to59 percent of HIV-negative women, 52 to 57 percent of untested women, and 23 to49 percent of HIV-positive women when sexual activity was resumed after delivery.However, data were collected from women only and therefore actual discussions withpartners may be overrepresented (Desgrées-Du-Loû et al., 2009). (Gray III) (pregnancy,counseling, HIV testing, communication, condom use, Côte d’Ivoire)226 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION