What Works for Women and Girls

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2. Hormonal contraception is safe for women living with HIV and does not seem to affectHIV acquisition or HIV progression.3. Women with HIV can use IUDs if they have access to medical services in case of IUDexpulsion.4. Providing information and skills-building support to HIV-positive people can reduceunprotected sex.5. Interventions to support disclosure can increase condom use in discordant couples.Safe Motherhood and Prevention of Vertical TransmissionOf the 136 million women who gave birth each year globally between 2005–2010, an estimated60 million gave birth at home and may not have had access to prevention of mother-to-childtransmission (PMTCT) services. PMTCT programs will only be effective if maternal healthprograms are strengthened and provided to all women because so many women only learntheir HIV status during pregnancy. Improving health systems and providing evidence-basedinterventions to ensure safe motherhood is critical for all women, and especially so for womenliving with HIV. The evidence for what works in preventing perinatal transmission is organizedaccording to the way women access health services, particularly maternal health services:prevention of unintended pregnancies; preconception planning; antenatal care (testing andcounseling, treatment); delivery; and postpartum. Some promising strategies exist for preconceptionplanning and delivery, however further evidence is needed. The science surroundingbreastfeeding and the risk of vertical transmission is still unresolved.What works for women and mothers:Preventing Unintended Pregnancies:1. Preventing unintended pregnancies can reduce perinatal transmission.Antenatal Care–Testing and Counseling:1. Routinely offered testing that is voluntary and accompanied by counseling is acceptable tomost women.2. Informed and appropriate counseling during antenatal care can lead to increased discussionbetween partners and increased protective behaviors such as condom use.3. Involving partners, with women’s consent, can result in increased testing and disclosure.Antenatal Care–Treatment:1. Antiretroviral treatment regimens for pregnant women living with HIV can improvethe health of the mother when used as treatment and can reduce the risk of mother-tochildtransmission when used as prophylaxis.22 EXECUTIVE SUMMARY
2. For women who are pregnant and not eligible for HAART for their own health, shortcourseARV therapy used for prophylaxis can reduce nevirapine resistance.3. Extending an HIV-positive woman’s life increases the long-term survival of her infant.4. National scale-up of HAART in pregnancy improves maternal and infant outcomes.Postpartum:1. ARVs, when used for treatment or prophylaxis, can reduce HIV transmission frommothers to infants.2. Early postpartum visits can result in increased condom use, contraceptive use, HIVtesting and treatment.Preventing, Detecting and Treating Critical Co-infectionsCertain infections, when combined with HIV, can be significantly more severe and lead toearly death for people living with HIV. Tuberculosis has become the leading cause of deathfor those living with HIV. HIV/TB co-infection is particularly deadly to women during theirchildbearing years. Malaria can have serious impacts on pregnant women and HIV/hepatitisco-infection can limit the effectiveness of both HIV and hepatitis treatments. Little evidenceis available on HIV/hepatitis co-infection for women in resource-poor settings. More effectivediagnostics, treatment and treatment literacy programs are needed for hepatitis C. Evidencefor what works for women in TB/HIV and malaria/HIV co-infection is limited.What works for women in preventing TB and malaria co-infection:Tuberculosis:1. Intermittent Preventive Therapy (IPT), as well as HAART, can reduce the incidence ofTB.Malaria:1. Co-trimoxazole prophylaxis, antiretroviral therapy and insecticide treated nets canreduce the incidence of malaria in women living with HIV by 95%.2. Monthly doses of IPT with sulfadoxine-pyrimethamine (SP) is effective in preventingmalaria among pregnant HIV-positive women (but should not be combined withco-trimoxazole).Strengthening the Enabling EnvironmentAddressing structural factors and the enabling environment, such as gender norms; violenceagainst women; legal norms; women’s employment, income and livelihood; advancing education;reducing stigma and discrimination and promoting women’s leadership are criticalto effective HIV/AIDS interventions for women and girls. However, direct impact on HIVWHAT WORKS FOR WOMEN AND GIRLS23
Page 1: WHAT WORKSFOR WOMEN AND GIRLSEviden
Page 4: Authors:Jill Gay, MAKaren Hardee, P
Page 7 and 8: Jose Esparza, MD, Ph.D.Senior Advis
Page 9 and 10: Shyam Kottilil, MD, Ph.D.Staff Clin
Page 11 and 12: Larry Slutsker, MD, MPHChief, Malar
Page 13 and 14: Table of ContentsList of Abbreviati
Page 15 and 16: List of Abbreviations3TCACTAHIANCAP
Page 17: PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
Page 20 and 21: MethodologyMeasuring “what works
Page 26 and 27: outcomes has been more difficult to
Page 28 and 29: 2. Promoting contraceptives and fam
Page 30 and 31: International Political Commitments
Page 32 and 33: established national action plans o
Page 34 and 35: Organization of the DocumentThis do
Page 36 and 37: Table 1.1Countries included in What
Page 38 and 39: understanding the epidemic in any g
Page 40 and 41: girls in school, for example. The c
Page 42 and 43: Within each intervention, studies a
Page 45 and 46: Chapter 3.Prevention for WomenA. Ma
Page 47 and 48: Special Risks for WomenStill, despi
Page 49 and 50: AIDS cases reported from 1982 to 20
Page 51 and 52: experience observed in clinical tri
Page 53 and 54: Female Condoms Are the Only Female-
Page 55 and 56: condom if it gives them more pleasu
Page 57 and 58: Correct use of the female condom ha
Page 59 and 60: A two month prospective study from
Page 61 and 62: A study of trends from Demographic
Page 63 and 64: 8. Peer education for women can inc
Page 65 and 66: 3B. Prevention for Women: Partner R
Page 67 and 68: matic focus on partner reduction, y
Page 69 and 70: of HIV acquisition, but were either
Page 71 and 72: four visits, each participant was i
Page 73 and 74:
What Works—Prevention for Women:
Page 75 and 76:
vention immediately following the b
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Chapter 4.Prevention for Key Affect
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2010). Transgender men and women al
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confidentiality—violate human rig
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there were major socio-demographic
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and post-intervention were used to
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tent condom use and 1.5 times more
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to their peers, distribute condoms
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Gaps in Programming—Female Sex Wo
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of a sexual relationship with a pri
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than were naltrexone or placebo. HI
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attributed to …swift introduction
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Promising Strategies:5. Sex-segrega
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9. Programming to prevent initiatio
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D’Ivoire, Cuba, Estonia, Indonesi
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Gaps in Programming—Women Prisone
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EVIDENCEPromising Strategies:1. Vol
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In fact, as of September 2008, 66 o
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Transgender women and men are often
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2009). “The invisibility and marg
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especially young women, have their
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negotiation skills and other critic
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to be reached with sex and HIV educ
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What Works—Prevention for Young P
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44% and 100% of participants (Kirby
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tudes, self-efficacy, intentions, a
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as young people in this area had li
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ical validity of the findings that
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study reported having received info
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nancy. Almost 87% of men and 89% of
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last sex, having ever used a condom
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Gap noted, for example, in South Af
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Disaggregated Data Is NeededEffecti
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were also effective in increasing u
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Chapter 6.HIV Testing and Counselin
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Equitable Access to Testing and Cou
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they would come for HIV testing, re
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their jobs (Human Rights Watch, 200
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What Works—HIV Testing and Counse
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women. Of all married HIV-positive
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A study in Ethiopia found that inco
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At a provincial hospital in Mombasa
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Between June and December 2007, mob
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Promising Strategies:6. Encouraging
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10. Counseling may reduce risk beha
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women learned violence prevention s
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Chapter 7.TreatmentA. Provision and
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Treatment Has Been Successfully Adm
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HIV Prevention Is Needed as well as
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Gaps in Programming—Provision and
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These practices and tools are usefu
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Non-judgmental, non-stigmatizing in
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percent among ART-experienced patie
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(Donnell et al., 2010). (Abstract)
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The sexual health of women is an im
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[ for women living with HIV]: impro
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Available GuidelinesA number of sex
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advantages of dual method use, alon
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contraception: 57% used hormonal co
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different; and progression to WHO c
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HIV-related behavioral or biologic
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use was positively associated with
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Gaps in Programming—Meeting the S
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Interactions between ARVs and oral
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Chapter 9.Safe Motherhood and Preve
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Pillar 1: Preventing Primary HIV In
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mission of HIV. HIV testing and cou
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EVIDENCE1. Preventing unintended pr
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Gaps in Programming—Reducing Unin
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9B. Safe Motherhood and Preventiono
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EVIDENCEPromising Strategies:1. Dis
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Gaps in Programming—Pre-Conceptio
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9C-1. Safe Motherhood and Preventio
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tion (Kershaw et al., 2006). “…
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outine tests. Fifty percent of the
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An evaluation of UNICEF-funded PMTC
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and syphilis (by rapid plasma regai
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2. Additional efforts are needed to
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for their own disease” (ITPC, 200
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own health needs has never been eva
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dine and lamivudine during pregnanc
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chose elective cesarean section to
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their current pregnancy or a past p
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Promising Strategies:5. Integrating
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Gaps in Programming—Treatment1. I
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cesarean, and 221 were non-elective
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3. Efforts are needed to ensure tha
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“There is no doubt that there are
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formula feeding increases the risk
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of age. For breastfed infants, the
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weeks of gestation and continued un
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A study in Côte d’Ivoire with 54
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during breastfeeding compared with
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3 times higher for infants who were
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counseling tools are needed. Studie
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Chapter 10.Preventing, Detecting an
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latent infection. Some immunocompro
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concurrent active TB and HIV infect
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mortality of HIV-positive people re
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in a 65% decline in mortality and t
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1. Efforts are needed to reduce TB-
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al., 2004 cited in Slutsker and Mar
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stillbirths by 33%. Three cluster-r
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Gaps in Programming—Malaria1. Fur
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dose global coverage was just 27% i
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Chapter 11.Strengthening the Enabli
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combining microfinance and training
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pants meeting once per week for thr
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the men believed that they should n
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in the intervention village were si
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positive impacts. The quasi-experim
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Samoa, Serbia and Montenegro, Thail
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factor associated with sexual assau
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What Works—Strengthening the Enab
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worked with women’s groups, radio
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of school in addressing gender-base
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11C. Strengthening the Enabling Env
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also widely used worldwide and part
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ecognize women’s property rights
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Promising Strategies:2. Community o
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11D. Strengthening the Enabling Env
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Page 323 and 324:
more likely to report having used a
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likely than illiterate women to kno
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of the women surveyed were HIV-posi
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countries extending the fee aboliti
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families and separated from their c
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used the resource “Understanding
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6. Support groups for people living
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11G. Strengthening the Enabling Env
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EVIDENCEPromising Strategies:1. Inv
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Chapter 12.Care and SupportA. Women
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ical care provided by family member
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dealing with their sorrow, grief, a
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What Works—Care and Support: Wome
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2. Peer support groups can be highl
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discriminated unjustly against them
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6. Home-based antiretroviral therap
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12B. Care and Support: Orphans and
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(Thurman et al., 2007). As of 2008,
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care and services were provided, wh
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for treatment can be safely monitor
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A study done in Kenya (year not giv
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ather than a narrowly defined HIV/A
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7. Further interventions to provide
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ning providers, antenatal care and
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What Works—Structuring Health Ser
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counts available at primary health
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Pregnant women reported feeling out
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Before implementation of the PMTCT
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accessing PMTCT. An evaluation of 3
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A mathematical model based on TB tr
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1. Improved integration is needed b
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15. Additional efforts are needed t
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Community-based Care is holistic ca
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Microfinance is often defined as fi
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Sexuality is a central aspect of be
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“What Works compiles a wealth of
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