What Works for Women and Girls

Gaps in Programming—Treatment1. Interventions are needed to increase knowledge of PMTCT-Plus programs amongwomen and the community and to reduce stigma and discrimination directed towardHIV-positive mothers.2. Interventions are needed to inform women IDUs of harm reduction early in pregnancy.3. Well functioning laboratory systems are needed to measure viral load via PCR toassess effectiveness of treatment.4. Interventions are needed to address gender inequity related to uptake and adherenceof ART and ARV prophylaxis.1. Interventions are needed to increase community knowledge of PMTCT-Plus programs andto reduce stigma and discrimination directed toward HIV-positive mothers. [See also Chapter11F. Strengthening the Enabling Environment: Reducing Stigma and Discrimination] Studiesfound that single dose nevirapine for HIV-positive mothers to prevent vertical transmissionwhich is currently contraindicated by WHO is still widely used. Studies found thatproviders do not expect pregnant women living with HIV to be sexually active and do nothave adequate training or counseling skills. Providers and community members blamedwomen for being HIV-positive and for becoming pregnant.Gap noted, for example, in South Africa (Sprague, 2009), Botswana (Kebaabetswe,2007) and Zimbabwe (Feldman and Masophere, 2003).2. Interventions are needed to inform women injection drug users of harm reduction early inpregnancy. [See also Chapter 4B. Prevention for Key Affected Populations: Women Drug Usersand Female Partners of Male IDUs] A study of PMTCT programs found that women IDUswere the least likely to receive treatment and only to be tested for HIV during labor. Nolinkages were found between PMTCT programs and harm reduction programs. WomenIDUs fear accessing health services for fear of losing custody of their children. Anotherstudy found that continuous methadone treatment for female IDUs during pregnancy isassociated with earlier antenatal care and improved neonatal outcomes.Gap noted, for example, in Ukraine (Thorne et al., 2009); Australia (Burns et al., 2006);and for female IDUs in numerous countries (Pinkham and Malinowska-Sempruch,2008; HRW, 2005 cited in Pinkham and Malinowska-Sempruch, 2008).3. Well functioning laboratory systems are needed to measure viral load via PCR to assesseffectiveness of treatment. A study noted “In Africa, access to viral load assessment isextremely limited, and patients must wait until immunologic or clinical deterioration isWHAT WORKS FOR WOMEN AND GIRLS245