What Works for Women and Girls

1. Efforts are needed to reduce TB-related stigma for women. A study found that in Malawi,TB-related stigma was closely linked with HIV; in Colombia women faced work-relatedstigma; and in India and Bangladesh, women were concerned about the impact of TB onmarital prospects and social isolation.Gap noted, for example, in Bangladesh, India, Malawi and Colombia (Somma et al.,2008).2. A combination of infection control strategies may significantly reduce the rate of TB transmission,including drug-resistant TB, in high-risk, low-resourced health care settings. [SeeChapter 13. Structuring Health Services to Meet Women’s Needs]10B. Preventing, Detecting and Treating CriticalCo-Infections: MalariaMalaria and HIV co-infection is a critical public health problem that may fuel the spread ofboth diseases in countries where both diseases are endemic.Malaria seems to be more common and more severe for people living with HIV (Kublinet al., 2005; Hoffman et al., 1999; Mermin et al., 2006; French et al., 2001; Francesconi etal., 2001; Grimwade et al., 2004; and Ladner et al., 2003 cited in Mermin et al., 2006). Menand women living with HIV with CD4 counts below 300have both a higher risk of experiencing early treatmentfailure for malaria and a recurrence of malaria symptomsthan HIV-positive people with CD4 counts over 300 orHIV-negative people (Van geertruyden et al., 2006).Clinical malaria has also been associated with an increasein HIV viral load and a fall in CD4 cell count, potentiallyworsening the clinical outlook for people living with HIV.Repeated and transient increases in HIV viral load resultingfrom co-infection can amplify HIV prevalence, suggestingthat malaria may be an important factor in the rapid spreadof HIV infection in sub-Saharan Africa (Abu-Raddad et. al.,2006 cited in Sepulveda et al., 2007).“Approximately one millionpregnancies per year arecomplicated by co-infectionof malaria and HIV insub-Saharan Africa”(WHO, 2004 cited in Unekeand Ogbonna, 2009).In areas where malaria occurs, malaria prevention should be part of basic HIV care(Whitworth et al., 2005 cited in Mermin et al., 2006).Malaria and HIV Co-Infection is of Special Concern to Pregnant WomenMalaria during pregnancy can result in maternal death, anemia, miscarriage and prematurebirth, as well as other adverse effects for the infant. The first pregnancies are the most critical,as women develop pregnancy-specific immunity against placental parasites over successiveWHAT WORKS FOR WOMEN AND GIRLS277