What Works for Women and Girls

formula feeding increases the risk of the infant dying of diarrheal disease. Women livingwith HIV also face pressures from their partners, families and communities to breastfeed. Inmany countries, formula feeding is associated with HIV and women who formula feed facestigma. For example, in Botswana, free ARVs and infant formula are widely available, as issafe drinking water; yet, more than half of women in a study did not formula feed their babiesdue to stigma (Shapiro et al., 2003). PMTCT programs may also inadvertently increase stigmaagainst women living with HIV by having separate HIV facilities, home visits for HIV-positivewomen, or providing infant formula (Thorsen et al., 2008). For women living with HIV whohave infants who are HIV-positive, breastfeeding is best, but women are often unable to knowtheir infant’s serostatus prior to deciding whether to breastfeed or not.Further research is urgently needed to clarify what works best in infant feeding to preventperinatal transmission. “Prevention of mother-to-child HIV transmission during breastfeedingremains one of the greatest challenges facing scientists, clinicians and women in the developingworld… While awaiting further studies… promoting exclusive breastfeeding with saferweaning and assuring ART for pregnant and postpartum women with advanced HIV will likelyprevent the majority of needless maternal and infant deaths” (Kuhn et al., 2009a: 90–91).What Works—Safe Motherhood and Prevention of Vertical Transmission: Postpartum1. ARVs, when used for treatment or prophylaxis, and can reduce mother-to-child HIVtransmission to infants.2. Early postpartum visits can result in increased condom use, contraceptive use, HIVtesting and treatment.Promising Strategies:3. Provision of clean water, fuel and formula to HIV-positive mothers who wish to practiceexclusive formula feeding can result in low postnatal rates of HIV transmission toinfants.4. Exclusive breastfeeding results in lower rates of HIV transmission to the infant thanmixed feeding.5. Postnatal home visits by trained lay counselors may reduce mixed feeding.6. Conducting HIV testing and counseling for women who bring their children forimmunization can increase the number of women accessing testing and treatmentservices.7. Community support groups can be highly beneficial for HIV-positive pregnant womenand mothers.WHAT WORKS FOR WOMEN AND GIRLS253