What Works for Women and Girls

counseling tools are needed. Studies found that women reported that providers accusedthem of killing their infants if they breastfed. Women lack access to infant formula buthave been told by providers that it is the only way for their infant to survive. Women weretold that breastfeeding is a mode of HIV transmission and exclusive breastfeeding is amode of prevention. Women fear HIV more than diarrheal disease, even though moredeaths occur from diarrheal disease. Women were not given choices. Women did not giveproviders accurate information on how they were feeding their infant for fear of beingdenied health care. Women lacked autonomy to decide infant feeding, which was decidedby male partners or grandmothers.Gap noted, for example, in Burkina Faso, Cambodia and Cameroon (Desclaux andAlfieri, 2009), Malawi, Kenya and Zambia (Chopra et al., 2009), Malawi (Kerr etal., 2008), Lesotho (Towle and Lende, 2008), Botswana, Kenya, Malawi and Uganda(Chopra and Rollins, 2008 and Coutosidis et al., 2002 cited in Chopra and Rollins,2008), and Cameroon (Kakute et al., 2005).2. Further efforts are needed to identify and treat mastitis in order to reduce HIV transmissionin HIV-positive women who are breastfeeding. Studies found that maternal HIV infectionwas correlated with mastitis and the potential for vertical transmission, but treatmentfor mastitis did not reduce the HIV viral load in breastmilk.Gap noted, for example, in Zambia (Kasonka et al., 2006), Tanzania (Kantarci et al.,2007) and Malawi (Nussenblatt et al., 2006).3. Accurate testing techniques for infants may inform infant feeding. Studies note that rapidscale up of early infant diagnosis is needed in low-resource settings in order to access treatmentand care as soon as possible. [For WHO guidance on HIV testing in infants see: http://www.who.int/hiv/topics/vct/toolkit/additional_resources/children/en]Gap noted, for example, in Tanzania (Finnegan et al., 2009: 216); Kenya (Inwani et al.,2009: 492); South Africa (Rollins et al., 2009:1855); Vietnam (Sohn et al., 2009); WestAfrica (Msellati, 2009:809).4. Stigma reduction interventions are needed so that HIV-positive women can choose replacementfeeding, breastfeeding and weaning schedules. Studies found that HIV-positivewomen feared that if they used infant formula or abruptly weaned, they would be stigmatizedfor their HIV-positive serostatus.Gap noted, for example, in Malawi, (Chinkonde et al., 2009), Ethiopia (Gaga et al.,2008), Malawi (Thorsen et al., 2008 and Banda et al., 2008), and South Africa (Dohertyet al., 2006).5. Additional efforts are needed to provide postpartum women with contraception informationand methods so they may space or prevent their next pregnancy. [See also ChapterWHAT WORKS FOR WOMEN AND GIRLS265