What Works for Women and Girls

cesarean, and 221 were non-elective cesarean and the mode of delivery was not associated withviral load increase or CD4 count decrease within 18 months after delivery or progression toAIDS or death within an average of 2.7 years after delivery (Navas-Nacher et al., 2006).Globally many HIV-positive women experience stigma and discrimination during labor anddelivery. Health care providers need training to reduce this stigma and discrimination againstHIV-positive women in the delivery setting. They also need access to appropriate personalprotective equipment (PPE) such as gloves, gowns, needleless systems and eye shields so thatthey can protect their own health as they care for their patients (WHO, 2009f). [See Chapter13. Structuring Health Services to Meet Women’s Needs] Health care providers must ensureHIV-positive women’s confidentiality regarding HIV serostatus. HIV-positive women, as allwomen, need support and information about their choices in childbirth.As previously mentioned in the introduction to the treatment section above, the WHOreleased new guidelines in November 2009 for the use of ARVs in pregnant women thatexpands treatment to women with CD4 counts below 350 cells/mm3, rather than below 200cells/mm3 and provides for earlier ARV prophylaxis at 14 weeks gestation, rather than 28weeks gestation (WHO 2009b). The consequence, once countries choose and scale up theirmedication regimens, is that more women should receive ARV treatment or prophylaxis, whichshould result in lower viral loads at delivery. With adequate training and adequate access toPPE, this should decrease the occupational risk exposure to HIV by health care providers andminimize the stigma and discrimination directed toward HIV-positive women that is rooted inhealth care provider fear of HIV acquisition. At present, research is very limited in this area.Implementing high quality, non-stigmatizing maternal health services may encourage morewomen living with HIV to give birth in safer settings.What Works—Safe Motherhood and Prevention of Vertical Transmission: DeliveryPromising Strategies:1. The use of antiretroviral drug regimens for either treatment of the mother’s health orprophylaxis to prevent mother-to-child transmission of HIV may reduce the advantageof cesarean over vaginal deliveries.EVIDENCEPromising Strategies:1. The use of antiretroviral drug regimens for either treatment of the mother’s health orprophylaxis to prevent mother-to-child transmission of HIV may reduce the advantage ofcesarean over vaginal deliveries.WHAT WORKS FOR WOMEN AND GIRLS247