What Works for Women and Girls

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8. Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]Studies found that women were not given contraceptive counseling or contraceptives postpartumand that transport costs restricted their ability to gain access to their contraceptivemethod of choice. Studies also found an unmet need for postpartum contraception amongHIV-positive women. Studies found that sexuality and condom use need to be addressedwhen sexual activity resumes postpartum. Family planning services are most often notprovided postpartum in PMTCT programs.Gap noted, for example, in South Africa (Moodley et al., 2008a), Kenya (Chersich et al.,2008b), Côte d’Ivoire (Brou et al., 2008), Kenya and Zambia (Thea et al., 2006).6. Further efforts are needed to educate families about HIV transmission so that infants arenot abandoned. A study found that families forced HIV-positive women to abandon theirinfants due to erroneous fears that the infants could transmit HIV.Gap noted, for example, in Russia (Zabina et al., 2009).7. WHO/UNICEF recommendations on the meaning of “acceptable, sustainable, safe andfeasible” should be clarified so it can be translated effectively in programmatic settings.A study found that confusing and contradictory advice was given by providers on when tofeed with infant formula.Gap noted, for example, in South Africa, (Doherty et al., 2006).266 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION
Chapter 10.Preventing, Detecting and TreatingCritical Co-InfectionsA. TuberculosisB. MalariaC. HepatitisCertain infections, when combined with HIV, can be significantly more severe and lead toearly death for HIV-positive people. Tuberculosis has become the leading cause of death forthose living with HIV. Malaria can have serious impacts on pregnant women and hepatitis/HIV co-infection can limit the effectiveness of both HIV and hepatitis treatments. These threediseases, when present as co-infections with HIV, warrant further discussion regarding theirprevention, detection and treatment. 11 As noted in Chapter 2. Methodology, this chapter, particularly the section on malaria, was not as thoroughlyreviewed as other topics in the compendium. Consultation with co-infection experts should complement theinformation in this chapter. Some references to groups working on co-infections are provided in this chapter.267
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WHAT WORKSFOR WOMEN AND GIRLSEviden
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Authors:Jill Gay, MAKaren Hardee, P
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Jose Esparza, MD, Ph.D.Senior Advis
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Shyam Kottilil, MD, Ph.D.Staff Clin
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Larry Slutsker, MD, MPHChief, Malar
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Table of ContentsList of Abbreviati
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List of Abbreviations3TCACTAHIANCAP
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PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
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MethodologyMeasuring “what works
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2. Hormonal contraception is safe f
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outcomes has been more difficult to
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2. Promoting contraceptives and fam
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International Political Commitments
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established national action plans o
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Organization of the DocumentThis do
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Table 1.1Countries included in What
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understanding the epidemic in any g
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girls in school, for example. The c
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Within each intervention, studies a
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Chapter 3.Prevention for WomenA. Ma
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Special Risks for WomenStill, despi
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AIDS cases reported from 1982 to 20
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experience observed in clinical tri
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Female Condoms Are the Only Female-
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condom if it gives them more pleasu
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Correct use of the female condom ha
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A two month prospective study from
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A study of trends from Demographic
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8. Peer education for women can inc
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3B. Prevention for Women: Partner R
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matic focus on partner reduction, y
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of HIV acquisition, but were either
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four visits, each participant was i
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What Works—Prevention for Women:
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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
Page 217 and 218: 9B. Safe Motherhood and Preventiono
Page 219 and 220: EVIDENCEPromising Strategies:1. Dis
Page 221 and 222: Gaps in Programming—Pre-Conceptio
Page 223 and 224: 9C-1. Safe Motherhood and Preventio
Page 225 and 226: tion (Kershaw et al., 2006). “…
Page 227 and 228: outine tests. Fifty percent of the
Page 229 and 230: An evaluation of UNICEF-funded PMTC
Page 231 and 232: and syphilis (by rapid plasma regai
Page 233 and 234: 2. Additional efforts are needed to
Page 235 and 236: for their own disease” (ITPC, 200
Page 237 and 238: own health needs has never been eva
Page 239 and 240: dine and lamivudine during pregnanc
Page 241 and 242: chose elective cesarean section to
Page 243 and 244: their current pregnancy or a past p
Page 245 and 246: Promising Strategies:5. Integrating
Page 247 and 248: Gaps in Programming—Treatment1. I
Page 249 and 250: cesarean, and 221 were non-elective
Page 251 and 252: 3. Efforts are needed to ensure tha
Page 253 and 254: “There is no doubt that there are
Page 255 and 256: formula feeding increases the risk
Page 257 and 258: of age. For breastfed infants, the
Page 259 and 260: weeks of gestation and continued un
Page 261 and 262: A study in Côte d’Ivoire with 54
Page 263 and 264: during breastfeeding compared with
Page 265 and 266: 3 times higher for infants who were
Page 267: counseling tools are needed. Studie
Page 271 and 272: latent infection. Some immunocompro
Page 273 and 274: concurrent active TB and HIV infect
Page 275 and 276: mortality of HIV-positive people re
Page 277 and 278: in a 65% decline in mortality and t
Page 279 and 280: 1. Efforts are needed to reduce TB-
Page 281 and 282: al., 2004 cited in Slutsker and Mar
Page 283 and 284: stillbirths by 33%. Three cluster-r
Page 285 and 286: Gaps in Programming—Malaria1. Fur
Page 287 and 288: dose global coverage was just 27% i
Page 289 and 290: Chapter 11.Strengthening the Enabli
Page 291 and 292: combining microfinance and training
Page 293 and 294: pants meeting once per week for thr
Page 295 and 296: the men believed that they should n
Page 297 and 298: in the intervention village were si
Page 299 and 300: positive impacts. The quasi-experim
Page 301 and 302: Samoa, Serbia and Montenegro, Thail
Page 303 and 304: factor associated with sexual assau
Page 305 and 306: What Works—Strengthening the Enab
Page 307 and 308: worked with women’s groups, radio
Page 309 and 310: of school in addressing gender-base
Page 311 and 312: 11C. Strengthening the Enabling Env
Page 313 and 314: also widely used worldwide and part
Page 315 and 316: ecognize women’s property rights
Page 317 and 318: Promising Strategies:2. Community o
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11D. Strengthening the Enabling Env
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What Works—Strengthening the Enab
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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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What Works—Strengthening the Enab
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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
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Akabaysh, H. and G. Psacharopoulos.
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Andia, I., A. Kaida, M. Maier, D. G
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Berer, M. 2008b. “Male Circumcisi
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“What Works compiles a wealth of
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