What Works for Women and Girls

7. Further interventions are needed to reduce barriers to HIV testing. Studies found that fearof partner notification, risk of domestic violence, the unreliability of rapid HIV tests, longwaiting times at the clinic, costs for transport, lack of childcare and the need for partnerconsent were barriers to HIV testing. The impact of rapid testing during labor and deliveryfor HIV-positive women has yet to be assessed.Gap noted, for example, in a global review of PMTCT (Pai and Klein, 2009); and Uganda(Homsy et al., 2007 cited in Pai and Klein, 2009).8. Improved record keeping on HIV counseling, serostatus, and treatment is needed toimprove referrals and linkages with other health care services. A study found that recordkeeping of HIV staging and CD4 counts was inadequate.Gap noted, for example, in a review of maternal care practices in Africa (Rollins andMphatswe, 2008).9. HIV testing must be linked to access to treatment.Gap noted, for example, in Uganda (Dahl et al., 2008).9C-2. Safe Motherhood and Prevention of Vertical Transmission: TreatmentAll women have a right to a safe pregnancy (Freedman et al., 2005), including women livingwith HIV. For pregnant women living with HIV there is no therapy or combination of therapiesor medical procedures that can guarantee an HIV-negative infant (Anderson, 2005).However, there are proven strategies that improve the health of the mother during pregnancyand reduce the risk of mother-to-child transmission of HIV. The most important strategy isfor the woman to access health care services where she can be evaluated for the use of antiretroviraldrugs, either for the treatment of her own health or for prophylaxis to reduce the riskof mother-to-child transmission of HIV during pregnancy. “Antenatal care must include ‘fasttracking’HIV-infected women into programmes providing holistic care, including treatmentwith HAART…[with] HIV care to be integrated into routine antenatal care, and not [maintained]as a separate programme” (Sebitloane and Mhlanga, 2008: 496 and 498). Women whoare on a HAART regimen [ for their own health] have the least risk of perinatal transmission,estimated at 1% (Stek, 2008). In addition, women on HAART [ for their own health] have amuch greater likelihood of an expanded lifespan, which results in a better quality of life forthe woman herself and reduces the likelihood of an intergenerational effect for orphans andvulnerable children. [See also Chapter 12B. Care and Support: Orphans and Vulnerable Children]In 2007, only 12% of pregnant women identified as being HIV-positive during antenatalcare were assessed to determine whether they were eligible to receive antiretroviral therapy fortheir own health, and only 9% of those HIV-positive women who received PMTCT servicesreceived HAART (UNAIDS, 2009e). “The best way to ensure that infants are not born withHIV or acquire it during breastfeeding is to provide HIV-positive women the care they need232 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION