What Works for Women and Girls

as gender norms that promote health seeking behavior among women (when they are notignoring their own health to care for others) but not among men. A study in Burkina Faso, forexample, confirmed the low presence of seropositive men not only in the consultation roomsof physicians but also for services that provide food, medicine or school supplies. Few menparticipated in health care facility orientations or support groups for people living with HIV,despite the fact that the 2003 DHS survey of Burkina Faso found that among ages 15 to 49,1.9% of women are HIV-positive and 1.8% of men are HIV-positive. “Even when seropositivemen consent to follow-up, it is widespread practice for women to stand in for their husband,who has stood apart…if his presence is essential….especially in cases of drug, food or other aiddistribution” (Bila and Egrot, 2009:857). Women say they do this both to conceal the man’sshame and to avoid widowhood.Treatment Alone Will Not Be EnoughWith the advent of treatment, insufficient research has been conducted in recent years on“what works” in care and support. It was assumed that “if many more of those who are sickwith AIDS were able to access the necessary drugs and adhere to the drug regimen, then thecrises around caregiving would be reduced” (Urdang, 2006: 169). In reality, “while access toanti-retroviral therapy has been expanding (in 2007 an estimated 3 million people globallyreceived access to ART)” that figure represented only one-third of those in need of treatment(United Nations, 2008b:3). Furthermore, people on ART have palliative care needs. A studyin Tanzania found that palliative care intervention was indicated for 378 (51.7%) patients. Themajority was female (70.9%). Morphine was being prescribed to 21 patients (2.8%) and ARTwas being prescribed to 434 (59.4%). In the field of African HIV care where mortality is high,palliative care has been shown to be largely lacking though it continues to be an important partof HIV programs even in the presence of ARV treatment (Collins and Harding, 2007).While remarkable improvements have been made for both patients and caregivers withaccess to HAART, caregiving is still needed. For example, “when it comes to actions aimed atcombating the HIV/AIDS–food insecurity nexus, the empirical base is still thin” (Gillespie,2006 cited in World Bank, 2007: IV, A). A 2008 UNAIDS review of caregiving in the contextof HIV/AIDS concluded that “caregiving must be addressed through a mix of strategies anddevelopment lenses, adapted to different social and economic contexts, in order to address theeconomic, social and psychological burden of caregiving on individuals, families, communitiesand economies” (United Nations, 2008b: 9). Inputs from governments, as well as NGOs andcommunities, are needed. The UNAIDS review calls for investment in operational researchto “better understand caregiving in the context of HIV and AIDS and to generate strategicinformation to inform programming” (United Nations, 2008b: 13). A review by the Horizonsproject called for situational analyses of HCBC programs to assess the “scope, content andquality of services offered in different communities (Horizons, 2005). Further research oncost-effectiveness of HCBC programs is needed to analyze the cost and benefit of participationto households, and referral systems to care and support programs must be strengthened(Horizons, 2005).346 CHAPTER 12 CARE AND SUPPORT