What Works for Women and Girls

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Gaps in Programming—Transforming Legal Norms to Empower Women, includingMarriage, Inheritance and Property Rights1. Interventions are needed to increase the knowledge of HIV-positive people—especiallywomen—regarding their rights and provide resources to fight for these rights.2. Legislation that allows women the right to refuse forced marriage and penalizes maritaland non-marital rape may reduce coercive sex and the risk of HIV transmission.3. Laws prohibiting young age at marriage need to be enacted.4. Interventions are needed to assist parents dying of AIDS with planning for the futurewell-being of their children.1. Interventions are needed to increase the knowledge of HIV-positive people—especiallywomen—regarding their rights and provide resources to fight for these rights. Studiesfound that women had insufficient knowledge of their legal rights and no resources to fightfor their legal rights.Gap noted, for example, in India (Devasahayam et al., 2008); Uganda (Mabumba et al.,2007); Kenya (WambuiWaweru, 2004); and Zambia, Namibia and Uganda (Steinzor,2003, Manchester, 2004).2. Legislation that allows women the right to refuse forced marriage and penalizes maritaland non-marital rape may reduce coercive sex and the risk of HIV transmission. Studiesfound that in some countries, legislation penalizing marital rape does not exist.Gap noted, for example, in sub-Saharan Africa (Kilonzo et al., 2009b; HRW, 2003a).3. Laws prohibiting young age at marriage need to be enacted. Field reports and studies foundthat child marriage for girls is still common in some countries.Gap noted globally (CHANGE, 2009, Ezer et al., 2006)4. Interventions are needed to assist parents dying of AIDS with planning for the future wellbeingof their children. [See Chapter 12B. Care and Support: Orphans and Vulnerable Children]316 CHAPTER 11 STRENGTHENING THE ENABLING ENVIRONMENT
11D. Strengthening the Enabling Environment:Promoting Women’s Employment, Income andLivelihood OpportunitiesWomen’s economic dependence on men and unequal access to resources, including land andincome-generating opportunities, increases the likelihood of women and girls engaging in avariety of unsafe sexual behaviors including transactional sex, coerced sex, earlier sexual debut,and multiple sexual partners, and thus increases their risk of becoming infected with HIV(Gillespie and Kadiyala, 2005).A Woman’s Economic Stability Can Enhance Her Ability to Insist on Safer SexMarried women and women in partnerships often accept risky behavior by their partnersdue to the need for economic security. A study in Vietnam in 2004 and 2005, consistingof interviews with 23 husbands and 23 wives, along with 15 key informant interviews foundthat because women needed the economic benefits of marriage, women acquiesced to theirhusband’s multiple partnerships or purchasing sex with sex workers. Independent sources ofincome and employment for women may allow women to insist on safe sex (Phinney, 2008).Similarly, a qualitative study in Brazil among women with children enrolled in a day carecenter found that financial dependence is the factor that most contributes to accepting a man’smultiple sexual partnerships. As one woman put it: “She accepts his infidelity because ...she’sthinking...How will I care for the children? How will I find a job?” (Hebling and Guimaraes,2004: 1215). The authors point out: “The results show that although women know how theyshould prevent...AIDS—by using condoms—they feelpowerless to do so, since they feel that this depends on theman’s wishes. They admitted that they don’t have the realdecision power...where ‘the man always has the final word.’Fear of separation was associated with loss of financial…stability” (Hebling and Guimaraes, 2004: 1216). A study inSouth Africa found that the women interviewed claimedthat if they had jobs, they would be able to refuse sex to menwho refused to wear condoms. The women said, “Povertymakes prostitutes of us” (Susser and Stein, 2000: 1044).In certain circumstances, providing microfinancefor women can reduce unsafe sex (Pronyk et al., 2008).Although there is a need for better indicators to measurethe HIV/AIDS-related impact of economic empowerment“The owners of the fi sh nets aremen. The woman comes to thisman who says ‘You want somefi sh, give me sex.’ The womanhas to feed her family, so shecan’t say no.”—Malawian man (Kathewera-Banda et al., 2006: 655)on women and girls, studies have consistently shown that increasing women’s access to information,skills, technologies, services, social support, and income increased their ability toprotect themselves from HIV (Weiss et al., 1996 cited in Weiss and Gupta, 1998; Kaufman etal., 2002).WHAT WORKS FOR WOMEN AND GIRLS317
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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
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9B. Safe Motherhood and Preventiono
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EVIDENCEPromising Strategies:1. Dis
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Gaps in Programming—Pre-Conceptio
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9C-1. Safe Motherhood and Preventio
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tion (Kershaw et al., 2006). “…
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outine tests. Fifty percent of the
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An evaluation of UNICEF-funded PMTC
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and syphilis (by rapid plasma regai
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2. Additional efforts are needed to
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for their own disease” (ITPC, 200
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own health needs has never been eva
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dine and lamivudine during pregnanc
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chose elective cesarean section to
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their current pregnancy or a past p
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Promising Strategies:5. Integrating
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Gaps in Programming—Treatment1. I
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cesarean, and 221 were non-elective
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3. Efforts are needed to ensure tha
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“There is no doubt that there are
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formula feeding increases the risk
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of age. For breastfed infants, the
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weeks of gestation and continued un
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A study in Côte d’Ivoire with 54
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during breastfeeding compared with
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3 times higher for infants who were
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Page 269 and 270: Chapter 10.Preventing, Detecting an
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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
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Page 289 and 290: Chapter 11.Strengthening the Enabli
Page 291 and 292: combining microfinance and training
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Page 305 and 306: What Works—Strengthening the Enab
Page 307 and 308: worked with women’s groups, radio
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Page 311 and 312: 11C. Strengthening the Enabling Env
Page 313 and 314: also widely used worldwide and part
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Page 317: Promising Strategies:2. Community o
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Page 329 and 330: countries extending the fee aboliti
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Page 337 and 338: 6. Support groups for people living
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Page 341 and 342: EVIDENCEPromising Strategies:1. Inv
Page 343 and 344: Chapter 12.Care and SupportA. Women
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Page 351 and 352: 2. Peer support groups can be highl
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Page 355 and 356: 6. Home-based antiretroviral therap
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Page 359 and 360: (Thurman et al., 2007). As of 2008,
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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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“What Works compiles a wealth of
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