What Works for Women and Girls

3 times higher for infants who were non-exclusively breastfed compared to those whoreceived only breast milk. A maternal CD4 count of below 350 was a strong predictorof HIV transmission before 4 months of age, but a significant reduction in HIV transmissionrelated to exclusive breastfeeding remained after controlling for CD4 count.For exclusively breastfed infants, the risk of acquiring HIV was greatest in the first 4months and then declined thereafter. The rate of HIV transmission for non-exclusivelybreastfed infants was 2.4 percent per month compared to less than 1 percent per monthfor exclusively breastfed infants (Kuhn et al., 2007). (Gray III) (PMTCT, breastfeeding,infant feeding, Zambia)5. Postnatal home visits by trained lay counselors may reduce mixed feeding.A 2001–2003 study that followed HIV-positive and HIV-negative pregnant womenattending antenatal clinics in South Africa found that postnatal home visits offeringinfant feeding counseling significantly improved adherence to either exclusive breastfeedingor exclusive replacement feeding. The study followed 1,253 HIV-positive and1,238 HIV-negative pregnant women who attended nine different clinics. Adherencewas significantly associated with the number of antenatal feeding counseling homevisits for both options. A breastfeeding counselor performed one antenatal home visitfor every woman to discuss feeding options and three additional visits were available tothose who chose to breastfeed. For women who chose to replacement feed, a specialistvisited the home to teach methods of safe replacement feeding. The study also collecteddata on access to clean water, a refrigerator, fuel for boiling water and regular income forthe mother, and found that only 3% of HIV-positive pregnant women had access to allfour resources and 32.1% had access to all but regular income. “Of those who intendedto replacement feed…few had the necessary resources to prepare infant formula safely”(Bland et al., 2007: 292). Infant formula became available in 2002 for HIV-positivepregnant women (Bland et al., 2007). (Gray II) (breastfeeding, formula feeding, counseling,South Africa)6. Conducting HIV testing and counseling for women who bring their children for immunizationcan increase the number of women accessing testing and treatment services. [Seealso Chapter 6. HIV Testing and Counseling for Women and Chapter 13. Structuring HealthServices to Meet Women’s Needs]A study from 1999 to 2000 that provided VCT for women attending maternal and childhealth clinics for their first postpartum or well-baby visit in Botswana found that 937 or54% of 1,735 postpartum women accepted VCT. 30% of those who accepted VCT wereHIV-positive (Thior et al. 2007). (Gray III) (HIV testing, health facilities, immunization,Botswana)In Ethiopia, while low numbers of women have institutional deliveries, more than70% of children are immunized. A study found that of 1,430 women who broughtWHAT WORKS FOR WOMEN AND GIRLS263