What Works for Women and Girls

dose global coverage was just 27% in 2007 (Wiersma, 2009). Key countries where infants arenot vaccinated are India, Nigeria, China, Indonesia, Ethiopia and Pakistan.HIV-positive infants, children and adults can also be vaccinated for hepatitis B, butHIV-positive individuals are less likely to respond to vaccination against hepatitis B (Kottilil etal., 2005). A study from 2003 to 2005 in Thailand with 1,535 IDUs (90% male), of whom 24were HIV-positive found that IDUs with HIV were more than six times as likely to not respondto the hepatitis B vaccine, with only 14 responding to the three dose vaccine (Sunthornchart etal., 2008).It is also critical that all blood is screened for hepatitis B as well as HIV. Once a person hasthe chronic form of hepatitis B, they can be treated but not cured. Treatment for both HIV andhepatitis B reduces the risk of transmission of both hepatitis B and HIV. Importantly, treatmentfor hepatitis B is less effective in those who are co-infected with HIV (Kottilil, 2009).Hepatitis B can be transmitted through sharing needles or sexual contact with a person withhepatitis B. Hepatitis B can also be transmitted through perinatal transmission, with theseinfants being particularly hard to treat.Hepatitis C and HIV Co-Infection can Limit Treatment OptionsInfection with hepatitis C virus causes liver inflammation and scarring. HIV co-infectionleads to worsening of liver disease associated with hepatitis C. Many medications used in ARVtherapy are cleared through the liver. Thus, co-infection with hepatitis C can complicate ARVtherapy for people living with HIV.Hepatitis C can be averted by using condoms, by never sharing needles and by safe injectionpractices, including both in illicit drug use as well as injections in medical settings such aswhen infants are immunized. No preventive vaccine exists for hepatitis C. Globally, more than90% of new hepatitis C infections are attributed to injection drug use, but few IDUs receivetreatment (Hoover, 2009). Many people with hepatitis C, particularly IDUs, who are traditionallymarginalized and underserved, are unaware that they are infected. Hepatitis C can be sexuallytransmitted, although transmission between heterosexual couples is rare. Hepatitis C canalso be transmitted through unsterilized medical, dental, tattoo equipment and the sharingof razors (Hoover, 2009). The mother-to-infant transmission of hepatitis C is about 4–7%.Maternal co-infection with HIV increases the rate of hepatitis C transmission 4–5 fold, but theactual time and mode of transmission are not known (Roberts and Yeung, 2002). An electiveC-section is only recommended for women with hepatitis C/HIV co-infection (Kottilil, 2010).Treatment literacy on hepatitis C and hepatitis C/HIV co-infection is needed both for thoseat high risk and health providers (Hoover, 2009). A 2000 to 2002 pilot study in China ofneedle exchange programs indicated that scaling up needle exchange programs can lowerrates of hepatitis C and HIV. Participants in the intervention communities were almost threetimes less likely to have shared needles in the past month than those in the control communities,with significantly lower rates of infection both for HIV and hepatitis C. The results of thetrials were used to develop national policy guidelines in 2002 and needle exchange programswere included in the second five-year action plan. The needle exchange program was scaled upin 2006 from 93 sites to 729 by the end of the year (Wu et al., 2007c).WHAT WORKS FOR WOMEN AND GIRLS285