What Works for Women and Girls

were more likely to discuss family planning with their partners than those attendingclinics at the control sites, 84% compared to 64%, and intervention couples were alsomore likely to report making reproductive health related decisions together, as a couple,than were control couples, 91% versus 71% (Varkey et al., 2004). (Gray II) (antenatalcare, counseling, condoms, STIs, India)A PMTCT program that included active community education and outreach toencourage couple counseling and testing was implemented in two antenatal clinics inLusaka, Zambia. A subset of HIV-positive women was asked to report their experienceof adverse social events 6 months after delivery. Nine percent (868) of 9,409 womencounseled antenatally were counseled with their husband. Couple-counseled womenwere more likely to accept HIV testing (96%) than women counseled alone (79%).However uptake of nevirapine was not improved. Six months after delivery, 28% of324 HIV-positive women reported at least one adverse social event (including physicalviolence, verbal abuse, divorce or separation). There were no significant differencesin reported adverse social events between couple- and individual-counseled women(Semrau et al., 2005). (Gray III) (PMTCT, couples, counseling, Zambia)Promising Strategies:4. Integrating testing and treatment for syphilis with HIV testing for pregnant women willreduce congenital syphilis and may reduce perinatal transmission HIV. 3A study from 2003 to 2005 in the Ukraine with 521 mother infant pairs with knowninfant HIV-positive serostatus found an association between maternal syphilis and perinataltransmission. Overall, 3.5% of pregnant women had serological test results thatwere positive for syphilis. The overall HIV perinatal transmission rate was 5.8% andwas statistically significantly higher among women who were seropositive for syphilis.Having antenatal serological test results that were positive for syphilis was associatedwith a five-fold increased risk of MTCT univariably and a nearly 4.5-fold increasedrisk adjusting for ARV prophylaxis, premature delivery and elective cesarean delivery(Thorne et al., 2008). (Gray III) (syphilis, PMTCT, Ukraine)A study to determine the association between maternal syphilis and HIV motherto-childtransmission in a prospective cohort study of pregnant women admitted atQueen Elizabeth Central Hospital in Malawi found that maternal syphilis was associatedwith in utero and intrapartum and postpartum perinatal transmission of HIV.Women admitted in late third trimester were screened for HIV (by HIV rapid tests)3 Note: While co-infection with syphilis is associated with increased risk of vertical transmission of HIV, it wouldbe unethical to conduct any study that denied known treatment for syphilis to assess whether giving or withholdingtreatment increased risk of vertical transmission of HIV.228 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION