What Works for Women and Girls

A study in Nigeria of 1,138 babies exposed to HIV found that with HAART, PMTCTrates following C-section (3.6%) was not different from vaginal delivery (3.53%) (Sagayet al., 2008). (Gray IV) (PMTCT, HAART, cesarean section, delivery, Nigeria)Because the risk of perinatal transmission of HIV is directly proportional to maternalviral loads, for women who have either very low or undetectable viral loads, there may beno additional benefit to cesarean section delivery. “For those [women] on highly activeantiretroviral therapy who have undetectable or low viral loads, the added benefit ofcesarean delivery is not established and is probably negligible” (Sharma and Spearman,2008: 414). (Gray V) (PMTCT, cesarean section, delivery HAART)Gaps in Programming—Delivery1. Efforts are needed to ensure HIV-positive women have information on birthingoptions and the right to make choices based on that information.2. Interventions are needed to ensure that stigma from health care workers does notdiscourage HIV-positive women from giving birth in safer settings.3. Efforts are needed to to ensure that health care workers protect the confidentiality ofHIV-positive women’s serostatus.4. Interventions are needed to provide HIV testing and counseling during labor anddelivery that respects informed consent.5. Health care providers must have access to personal protective equipment suchas gowns, gloves, needle-less systems and eye protection to decrease the risk ofoccupational exposure.1. Efforts are needed to ensure HIV-positive women have information on birthing optionsand the right to make choices based on that information. Studies found that HIV-positivewomen were not given information on birthing options.Gap noted, for example, in Ukraine and Brazil (Yaremenko et al., 2004).2. Interventions are needed to ensure that stigma from health care workers does notdiscourage HIV-positive women from giving birth in safer settings. [See also Chapter 11F.Strengthening the Enabling Environment: Reducing Stigma and Discrimination] Studies foundthat HIV-positive women experienced discrimination by providers in ANC services or didnot attend ANC services due to fear of mistreatment by health providers.Gap noted, for example, in Thailand (Teeraratkul et al., 2005), Cote d’Ivoire (Painter etal., 2004) and Vietnam (Hong et al., 2004).248 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION