What Works for Women and Girls

3. Efforts are needed to ensure that health care workers protect the confidentiality ofHIV-positive women’s serostatus. A study found that health workers violated women’sconfidentiality.Gap noted, for example, in Ukraine (Yaremenko et al., 2004).4. Interventions are needed to provide HIV testing and counseling during labor and deliverythat respects informed consent. [See Chapter 6. HIV Testing and Counseling for Women and9C-1. Testing and Counseling]5. Health care providers must have access to gowns, gloves, needle-less systems and eyeprotection to decrease the risk of occupational exposure to HIV. [See Chapter 13. StructuringHealth Services to Meet Women’s Needs]9E. Safe Motherhood and Preventionof Vertical Transmission: PostpartumPostpartum interventions to prevent vertical transmission of HIV include protecting the healthof the mother with ARV treatment and providing ARV prophylaxis to the mother and/or thebaby to reduce HIV transmission via breastfeeding. Contraception counseling for women inorder to space their next pregnancy or prevent an unintended pregnancy is also a critical—though often overlooked—component of postpartumintervention planning in PMTCT for HIV-positive women(Wilcher et al. 2008).The benefits of ARV treatment for women living withHIV have been previously discussed. ARV treatment forinfants and children can also provide excellent prospectsfor survival into adulthood. However, without antiretroviraltreatment, approximately half of children with perinatalinfection die before two years of age (Newell et al., 2004,cited in Abrams, 2007). “International approaches forpreventing MTCT of HIV now focus on child survival, notjust HIV transmission, as the appropriate outcome to measure success of PMTCT programs.Ultimately, the goal is a live and healthy, HIV-negative child and an alive and healthy motherto care for that child” (Jackson et al., 2009: 226).Four Interventions to Reduce Postnatal Transmission“Scientifi c messages…need to beclarifi ed. Women are told boththat ‘Breastfeeding is a mode ofHIV transmission’ and ‘Exclusivebreastfeeding is a mode ofprevention’”(Desclaux and Alfi eri, 2009: 825).What works best to prevent postnatal transmission via breastfeeding has been the subject ofmuch scrutiny. A 2009 Cochrane review, based on six randomized control trials and one interventioncohort study (data from 1980–2008) found four interventions effective in reducingWHAT WORKS FOR WOMEN AND GIRLS249