What Works for Women and Girls

and syphilis (by rapid plasma regain test and Treponema pallidum hemagglutinationassay). HIV-positive women and their infants received nevirapine, according to theHIVNET 012 protocol. They were followed up at 6 and 12 weeks postpartum. InfantHIV infection was diagnosed by DNA PCR. Of the 1,155 HIV-positive women enrolled,1147 had syphilis test results, of whom 92 (8.0%) were infected with syphilis. Only 751HIV-positive women delivered live singleton infants who were tested for HIV at birth.Of these, 65 (8.7%) were HIV-infected, suggesting in utero (IU) HIV MTCT. Of the 686infants who were HIV-negative at birth, 507 were successfully followed up. Of these, 89(17.6%) became HIV-positive, suggesting intrapartum/postpartum (IP/PP) HIV transmission.Maternal syphilis was associated with in utero HIV MTCT, after adjusting formaternal HIV-1 viral load and low birth weight (LBW). Furthermore, maternal syphiliswas associated with IP/PP HIV MTCT, after adjusting for recent fever, breast infection,LBW and maternal HIV-1 viral load. Screening and early treatment of maternalsyphilis during pregnancy may reduce pediatric HIV infections (Mwapasa et al., 2006).(Gray III) (PMTCT, HIV testing, syphilis, Malawi)Data from 177 VCT centers in 2006 found that in Haiti, 75,122 pregnant women weretested for both HIV and syphilis. A national scale up of this strategy will reach at least85% of pregnant women. Routine syphilis testing found syphilis in 3,404 pregnantwomen (Severe et al., 2008). (Abstract) (counseling, HIV testing, pregnancy, syphilis,Haiti)5. Where abortion is safe and legal, offering HIV testing to women early in pregnancy mayincrease access to safe abortion.A study in Vietnam based on 38 HIV-positive pregnant women and mothers and 53health workers with routine testing performed at ANC services when women wereseven to eight months pregnant found that all 38 women felt that the timing of the testat ANC services was too late in the pregnancy. As one HIV-positive woman put it: “Iwould not have had a child if I had known that I was positive” (Oosterhoff et al., 2008:656). Three women who accessed VCT rather than routine testing via ANC tested earlyin pregnancy and two opted for abortion when the test was positive (Oosterhoff et al.,2008). (Gray V) (antenatal care, HIV testing, PMTCT, abortion, Vietnam)6. Counseling women during antenatal care regarding circumcision of male infants at birthmay reduce HIV acquisition and transmission when those male infants become sexuallyactive young men. [See also Chapter 3C. Prevention for Women: Male Circumcision]Randomized, controlled trials have determined the level of protective effect of malecircumcision on HIV for men. Male circumcision at birth as part of postnatal care couldreduce, upon the infant’s sexual initiation and for his lifetime, a reduction in the riskof HIV acquisition and transmission. Male circumcision has now been shown in threerandomized clinical trials to reduce the risk of HIV acquisition for men by 50 to 60%WHAT WORKS FOR WOMEN AND GIRLS229