What Works for Women and Girls

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outcomes has been more difficult to measure. Strengthening women’s NGOs and womenleaders who can mobilize in-country efforts in the interests of women and girls who are affectedby HIV is also critical.What works for strengthening the enabling environment for women:Transforming Gender Norms:1. Training, peer and partner discussions, and community-based education about changinggender norms can increase HIV protective behaviors.2. Mass media campaigns concerning gender equality as part of comprehensive and integratedservices can increase HIV protective behaviors.Addressing Violence Against Women:1. Community-based participatory learning approaches involving men and women cancreate more gender-equitable relationships, thereby decreasing violence.2. Establishing comprehensive post-rape care protocols, which include PEP, can improveservices for women.3. Microfinance programs can lead to reduction in gender-based violence when integratedwith participatory training on HIV, gender, and violence.Transforming Legal Norms to Empower Women, including Marriage, Inheritance and Property Rights:1. Enforcing laws that allow widows to take control of remaining property can increasetheir ability to cope with HIV.Promoting Women’s Employment, Income and Livelihood Opportunities:1. Increased employment opportunities, microfinance, or small-scale income-generatingactivities can reduce behavior that increases HIV risk, particularly among young people.Advancing Education:1. Increasing educational attainment can help reduce HIV risk among girls.2. Abolishing school fees enables girls to attend (or stay in) school.3. Providing life skills-based education can complement formal education in buildingknowledge and skills to prevent HIV.Reducing Stigma and Discrimination:1. Community-based interventions that provide accurate information about HIV transmission(especially that casual contact cannot transmit the virus) can significantly reduceHIV stigma and discrimination.2. Training for providers can reduce discrimination against people with HIV/AIDS.24 EXECUTIVE SUMMARY
Care and SupportUnder care and support programs the bulk of care is provided—mostly unpaid—by women.Few home-based care programs specifically address the needs of women. HIV/AIDS continuesto take a huge financial toll on households. While scaling up universal access to treatmentis critical, treatment alone will not solve all care and support needs. The studies included inthis chapter outline interventions that work in caring for and supporting women and girls ingeneral, both with respect to their own needs in illness and the burden of caring for others whoare ill, as well as the care and support of orphans and vulnerable children.What works in care and support for women, girls, and vulnerable children:Women and Girls:1. Continued counseling (either group or individual) for those who are HIV-positive andthose who are caregivers can relieve psychological distress.2. Peer support groups can be highly beneficial to women living with HIV.Orphans and Vulnerable Children:1. Accelerating treatment access for adults with children can reduce the number oforphans, reduce pediatric deaths and improve social well-being.2. Programs that promote the strength of families and offer family-centered integratedeconomic, health and social support result in improved health and education outcomesfor orphans.3. ARV treatment with good nutritional intake and regular medical care can improvehealth and survival of HIV-positive children in resource-poor settings.4. Psychological counseling and mentoring for orphans and vulnerable children improvestheir psychological well-being.5. Programs that provide microenterprise opportunities, old age pensions or other targetedfinancial and livelihood assistance can be effective in supporting orphans.Structuring Health Services to Meet Women’s NeedsThe manner in which health services are structured has an impact on HIV prevention, treatmentand care for women and girls. Women often need multiple services, including reproductivehealth and family planning services in addition to HIV prevention, treatment and care, butmost health care facilities are not structured to provide integrated services. Importantly, healthcare providers must practice in a respectful, non-discriminatory manner.What works for women in structuring health services includes:1. Integrating HIV testing and services with family planning, maternal health care orwithin primary care facilities can increase uptake of HIV testing and other reproductivehealth services.WHAT WORKS FOR WOMEN AND GIRLS25
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 24 and 25: 2. Hormonal contraception is safe f
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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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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References 1Aaron, E. and S. Crinit
Page 399 and 400:
Akabaysh, H. and G. Psacharopoulos.
Page 401 and 402:
Andia, I., A. Kaida, M. Maier, D. G
Page 403 and 404:
Auvert, B., D. Taljaard, E. Lagarde
Page 405 and 406:
Barker, P., C. McCanno, N. Mehta, C
Page 407 and 408:
Berer, M. 2008b. “Male Circumcisi
Page 409 and 410:
Bong, C-N., S. Chen, Y-J. Jong, T-S
Page 411 and 412:
Brou, H., G. Djohan, R. Becquet, G.
Page 413 and 414:
Campbell, L. and M. Lambey. 2002.
Page 415 and 416:
Chama, C., W. Gashau and S. Oguche.
Page 417 and 418:
Chimwaza, A., J. Chimango, C. Kapon
Page 419 and 420:
Cluver L. and F. Gardner. 2007. “
Page 421 and 422:
Coovadia, H. 2004. “Antiretrovira
Page 423 and 424:
De Bruyn, M. 2006a. There’s Nothi
Page 425 and 426:
Dharmadhikari, A., J Gupta, M. Deck
Page 427 and 428:
Druce, N. and A. Nolan. 2007. “Se
Page 429 and 430:
Epstein H. 2009. “Universal volun
Page 431 and 432:
Farrell, B. and N. Rajani. 2007.
Page 433 and 434:
Ford, N., D. Wilsono, P. Cawthorne,
Page 435 and 436:
Galvez-Buccollini, J., S. DeLea, P.
Page 437 and 438:
Gillespie, D., H. Bradley, M. Wolde
Page 439 and 440:
Gogna, M., M. Pechny, I. Ibarlucia,
Page 441 and 442:
Grimes, D., J. Benson, S. Singh, M.
Page 443 and 444:
Haddock, S., K. Hardee, J. Gay, P.
Page 445 and 446:
Harries, A., R. Chimizi and R. Zach
Page 447 and 448:
Hillemans, P., T. Ellerbrock, S. Mc
Page 449 and 450:
Hope, R. 2007. Addressing Cross-Gen
Page 451 and 452:
Innes, C, S Charalambous, M Felix,
Page 453 and 454:
Islander, F. 2006. Plenary Presenta
Page 455 and 456:
Jewkes, R. 2007. “Comprehensive R
Page 457 and 458:
Kadando, R., J. Lyavala and M. Mulo
Page 459 and 460:
Karnell, A.P., P.K. Cupp, R.S. Zimm
Page 461 and 462:
Maharashtra, India.” Abstract THP
Page 463 and 464:
Kim, Y., A. Kols, R. Nyakauru, C. M
Page 465 and 466:
Knerr, W., McEachran, J. and Philpo
Page 467 and 468:
Laga, M., M. Alary, N. Nzila, A. Ma
Page 469 and 470:
Leonard, L., I. Ndiaye, A. Kapadia,
Page 471 and 472:
Luke, N. and K. Kurz. 2002. Cross-g
Page 473 and 474:
Mahendra, V., R. Verma, S. Singh, S
Page 475 and 476:
Prevent HIV Mother-to-Child Transmi
Page 477 and 478:
McIntyre, J. and M. Lallemont. 2008
Page 479 and 480:
Minaya, J., A. Owen-Simth and J. He
Page 481 and 482:
Morrison, C. 2009. “Hormonal Cont
Page 483 and 484:
Musaba, E., C. Morrison, M. Sunkutu
Page 485 and 486:
Nelson, K., D. Celentano, S. Euimtr
Page 487 and 488:
Nyamukapa A., S. Gregson, B. Lopman
Page 489 and 490:
Olaleye, A., D. Polsy, D. Atamawanl
Page 491 and 492:
Paiva, V., E. Felipe, N. Santos, T.
Page 493 and 494:
Peacock, D. 2009. “Working with M
Page 495 and 496:
Pillai, S., M. Seshu and M. Shivdas
Page 497 and 498:
Puntos de Encuentro. 2008. Final Ev
Page 499 and 500:
Reniers, G., T. Araya, G.Davey, N.
Page 501 and 502:
Ross, D., J. Changalucha, A. Obasi,
Page 503 and 504:
an Operations Research Study in Zam
Page 505 and 506:
Sekirime, W. and J. Lule. 2009. “
Page 507 and 508:
Shuey, D., B. Baishangire, S. Omiat
Page 509 and 510:
Smith D. 2007. “Modern Marriage,
Page 511 and 512:
Stanwood N., S. Cohn, J. Heiser and
Page 513 and 514:
Stuikyte, R. S. Schonning and S. Me
Page 515 and 516:
Taylor, E. A. Pettifor, B. Mupenda,
Page 517 and 518:
Todd, J., D. Maher, I. Kasamba, E.
Page 519 and 520:
UNAIDS. 2007b. “The Positive Part
Page 521 and 522:
UNIFEM. 2008. http://www.genderanda
Page 523 and 524:
Verhoeff, F. B. Brabin, C. Hart, L.
Page 525 and 526:
Wang, X. and Z. Wu. 2007. “Factor
Page 527 and 528:
Wilcher, R., T. Petruney, H. Reynol
Page 529 and 530:
World Health Organization (WHO). 20
Page 531 and 532:
Yankah, E., J. Ayres, S. Arruda and
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“What Works compiles a wealth of
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