What Works for Women and Girls

al., 2004 cited in Slutsker and Marston, 2007). “Unfortunately, the link between the currentprevention and control programs for HIV is weak… All those involved in control activities formalaria and HIV… should approach the control of these two diseases in a more integratedway” (Van geertruyden and D’Alessandro, 2007: 467).Bednets and Indoor Spraying Can Dramatically Reduce Malaria TransmissionEffective interventions exist which can dramatically reduce the prevalence and incidence ofmalaria among both women living with HIV and women who are HIV-negative. A criticalintervention is insecticide-treated bednets (ITNs). To be effective, ITNs should be distributedto whole communities in order to achieve area-wide reductions in malaria transmission. Asof 2006, the number of ITNs produced was sufficient to protect just 26% of the population atrisk in Africa (WHO, 2008b). Long-lasting insecticidal nets have been developed in responseto low re-treatment rates of conventional ITNs. These are pre-treated nets that require nofurther re-treatment during their expected lifespan of three to five years. Use of long-lastinginsecticidal nets reduces both human exposure—most of the insecticide is hidden in the netand not bioavailable—and the risk of environmental contamination (Yartey, 2006).The method and timing of providing bednets should be considered. ITNs distributedthrough outpatient HIV care programs can result in greater use. A rural community-basedoutpatient HIV care program in Uganda found that among 131 people who stated they receivedat least one net, 98% stated they still had the program-provided net and 91% reported havingslept under the ITN the night prior to the survey and 88% reported sleeping under the ITNseven days a week (Cohee et al., 2008). However, ITNs distributed only to people living withHIV may become stigmatizing. In addition, because approximately 65% of African women donot present for antenatal care until the second or third trimester, distributing ITNs throughantenatal care programs may not be effective, as malaria parasites may be well established bythe time the woman presents for antenatal care (Brentlinger et al., 2006).Indoor residual spraying is another vector control option that involves the application ofa liquid insecticide. Insects absorb a lethal dose when they come in contact with the sprayedsurfaces. The effectiveness of indoor residual spraying depends on coverage in the communityand the level of acceptance. The World Health Organization recommends 12 insecticides forthe use of indoor residual spraying, including DDT. DDT is one of the most widely used pesticidesas it is the most affordable (Robson, 2009). However, resistance is developing to DDTand new pesticides are needed for indoor residual spraying (Feacham, 2009; Robson, 2009).In addition, a review of 494 peer reviewed studies from 2005 to 2008 on the health impactsof DDT found that “…exposure to DDT and its breakdown product DDE may be associatedwith adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneousabortion and impaired neurodevelopment in children” (Eskenazi et al., 2009). A recentstudy of DDT and breast cancer found that pre-pubertal and pubertal years are critical periodsof exposure to DDT that may result in increased risk for breast cancer, requiring longitudinalstudies of many years (Cohn et al., 2007 cited in Eskanazi et al, 2009). Studies found thatindoor residual spraying results in high DDT exposure in humans, including pregnant womenand fetuses (Eskanazi et al., 2009). However, no data were found on use of indoor residualWHAT WORKS FOR WOMEN AND GIRLS279