What Works for Women and Girls

their children to be immunized, 94% had not had an HIV test during antenatal careor delivery. When offered HIV testing at the clinic where their child was immunized,80% accepted, of whom 5% were HIV-positive. All HIV-positive women and their childrenwere enrolled in HIV care to receive antiretroviral treatment (Melaku et al., 2008).(Gray IV) (HIV testing, health facilities, immunization, Ethiopia)In a project in South Africa, maternal CD4 cell count was determined every six monthsduring the infant’s immunization visit, with rapid referral for HAART for mothers withCD4 cell counts of less than 200/mm 3 (Barker et al., 2007a). (Gray V) (treatment, healthfacilities, immunization, HAART, South Africa)7. Community support groups can be highly beneficial for HIV-positive pregnant women andmothers. [See Chapter 12A. Care and Support: Women and Girls]Gaps in Programming—Postpartum1. HIV-positive mothers, fathers, grandmother and the larger community need clear,consistent, non-contradictory and nonjudgmental counseling on infant feedingpractices. Health care providers need training based on accurate information.2. Further efforts are needed to identify and treat mastitis in order to reduce HIVtransmission in HIV-positive women who are breastfeeding.3. Accurate testing techniques for infants may inform infant feeding.4. Stigma reduction interventions are needed so that HIV-positive women can choosereplacement feeding, breastfeeding and weaning schedules.5. Additional efforts are needed to provide postpartum women with contraceptioninformation and methods so they may space or prevent their next pregnancy.6. Further efforts are needed to educate families about HIV transmission so that infantsare not abandoned.7. WHO/UNICEF recommendations on the meaning of “acceptable, sustainable, safeand feasible” should be clarified so it can be translated effectively in programmaticsettings.1. HIV-positive mothers, fathers, grandmothers and the larger community need clear, consistent,non-contradictory and nonjudgmental counseling on infant feeding practices. Healthcare providers need training based on accurate information. Studies found that health careproviders gave HIV-positive women conflicting information and that simplified structured264 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION