What Works for Women and Girls

(Auvert et al., 2005; Bailey et al., 2007; and Gray et al., 2007). (Gray I) (male circumcision,transmission)“…Circumcision prior to sexual debut [of male adolescents] will render the greatest lifetimeprotection” (Eaton and Kalichman, 2009:191). (Gray V) (male circumcision)Gaps in Programming—Testing and Counseling1. Further interventions are needed to incorporate violence prevention, screening andcounseling services into PMTCT testing and counseling.2. Additional efforts are needed to improve information and counseling about HIVduring ANC to ensure that pregnant woman and their sexual partners have adequateinformation.3. Additional efforts are needed to ensure confidentiality in testing.4. Increased support is needed for HIV serostatus disclosure, particularly at key timessuch as delivery, infant weaning, and at the resumption of sexual activity.5. Further interventions are needed to provide couples counseling and testing to reduceseroconversion during pregnancy.6. Multiple strategies are needed to promote male involvement in ways that meetpregnant women’s needs.7. Further interventions are needed to reduce barriers to HIV testing.8. Improved record keeping on HIV counseling, serostatus, and treatment is needed toimprove referrals and linkages with other health care services.9. HIV testing must be linked to access to treatment.1. Further interventions are needed to incorporate violence prevention, screening and counselingservices into PMTCT testing and counseling. [See also Chapter 11B. Strengtheningthe Enabling Environment: Addressing Violence Against Women] Studies found high rates ofviolence, sexual coercion and abuse among HIV-positive pregnant women, particularlywhen accessing HIV testing or during disclosure.Gap noted, for example, in Nigeria (Ezechi et al., 2009); Zimbabwe (Shetty et al.,2008a); Malawi (Bobrow et al., 2008); Kenya (Kiarie et al., 2006; Gaillard et al., 2002:)and South Africa (Dunkle et al., 2004).230 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION