What Works for Women and Girls

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Table 1.1Countries included in What Works (N=90)AfricaEast/SouthEast AsiaSouth AsiaLatin Americaand theCaribbeanEastern Europeand Central AsiaNorth Africa/Near EastNorth America/Western andCentral Europeand Oceania30 13 4 16 12 3 12Angola Cambodia Bangladesh Argentina Azerbaijan Egypt AustraliaBenin China India Bahamas Bosnia and IranCanadaHerzegovinaBotswana Hong Kong Nepal Brazil Estonia Turkey FranceBurkina Faso Indonesia Sri Lanka Chile Georgia ItalyCameroon Laos Colombia Kazakhstan New ZealandCôte d’Ivoire Malaysia Cuba Kyrgyzstan Papua NewGuineaDemocraticRepublic ofCongo/ZaireMongoliaDominicanRepublicMoldovaPolandEthiopia Myanmar Ecuador Romania SerbiaGabon Philippines Guyana Russia SpainGhana South Korea Haiti Tajikistan SwitzerlandKenya Taiwan Honduras Ukraine United KingdomLesotho Thailand Jamaica Uzbekistan United StatesLiberia Vietnam MexicoMadagascarNicaraguaMalawiPeruMauritiusTrinidad andTobagoMozambiqueNamibiaNigeriaRepublic ofCongoRwandaSenegalSierra LeoneSouth AfricaSudanSwazilandTanzaniaUgandaZambiaZimbabwe34 CHAPTER 1 INTRODUCTION
Chapter 2.MethodologyOver the past five years, in addition to a wide array ofresearch, advocacy and position papers focusing on theneeds of women and girls, there has been an increase inthe number of strongly evaluated published interventionsthat have proven effective in reaching various groups ofwomen and girls and caring for their particular needs. Thefocus of this document is to gather the evidence of whatprograms have positive outcomes for women in HIV/AIDSprevention, treatment and care. This document reviews theevidence available on interventions and provides a summaryof the evidence, along with the supporting research thatdocuments the effectiveness of interventions designed toaddress the needs of women and girls.The Complexities of MeasuringWhat WorksKey Steps in the Methodology1. Conducted SCOPUS searcheson HIV and women2. Included searches of grayliterature from key websites/organizations3. Reviewed titles/studies forinterventions that hadoutcomes and wereevaluated—focusing on whatworks for women and girls4. Summarized relevant studies5. Used Gray Scale to evaluatestrength of evidence6. Sought extensive reviewby expertsMeasuring “what works” is complicated since the outcomesand impacts of interventions depend on a number of biological and proximate determinants(Boerma and Weir, 2005). Understanding the epidemiology of HIV, how it is spread andwho is at risk is critical for developing and evaluating successful interventions (Chin, 2007).The epidemiological concept of the reproductive number for HIV, R 01is a key component in1 “When, on average, one infected person infects more than one other person, R 0is greater than (>) 1 and the resultwill be epidemic spread of an agent [HIV]. However, when, on average, one infected person does not infectmore than one other person, R 0is less than (
Page 1: WHAT WORKSFOR WOMEN AND GIRLSEviden
Page 4: Authors:Jill Gay, MAKaren Hardee, P
Page 7 and 8: Jose Esparza, MD, Ph.D.Senior Advis
Page 9 and 10: Shyam Kottilil, MD, Ph.D.Staff Clin
Page 11 and 12: Larry Slutsker, MD, MPHChief, Malar
Page 13 and 14: Table of ContentsList of Abbreviati
Page 15 and 16: List of Abbreviations3TCACTAHIANCAP
Page 17: PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
Page 20 and 21: MethodologyMeasuring “what works
Page 24 and 25: 2. Hormonal contraception is safe f
Page 26 and 27: outcomes has been more difficult to
Page 28 and 29: 2. Promoting contraceptives and fam
Page 30 and 31: International Political Commitments
Page 32 and 33: established national action plans o
Page 34 and 35: Organization of the DocumentThis do
Page 38 and 39: understanding the epidemic in any g
Page 40 and 41: girls in school, for example. The c
Page 42 and 43: Within each intervention, studies a
Page 45 and 46: Chapter 3.Prevention for WomenA. Ma
Page 47 and 48: Special Risks for WomenStill, despi
Page 49 and 50: AIDS cases reported from 1982 to 20
Page 51 and 52: experience observed in clinical tri
Page 53 and 54: Female Condoms Are the Only Female-
Page 55 and 56: condom if it gives them more pleasu
Page 57 and 58: Correct use of the female condom ha
Page 59 and 60: A two month prospective study from
Page 61 and 62: A study of trends from Demographic
Page 63 and 64: 8. Peer education for women can inc
Page 65 and 66: 3B. Prevention for Women: Partner R
Page 67 and 68: matic focus on partner reduction, y
Page 69 and 70: of HIV acquisition, but were either
Page 71 and 72: four visits, each participant was i
Page 73 and 74: What Works—Prevention for Women:
Page 75 and 76: vention immediately following the b
Page 77 and 78: Chapter 4.Prevention for Key Affect
Page 79 and 80: 2010). Transgender men and women al
Page 81 and 82: confidentiality—violate human rig
Page 83 and 84: there were major socio-demographic
Page 85 and 86: and post-intervention were used to
Page 87 and 88:
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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counseling tools are needed. Studie
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Chapter 10.Preventing, Detecting an
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latent infection. Some immunocompro
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concurrent active TB and HIV infect
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mortality of HIV-positive people re
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in a 65% decline in mortality and t
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1. Efforts are needed to reduce TB-
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al., 2004 cited in Slutsker and Mar
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stillbirths by 33%. Three cluster-r
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Gaps in Programming—Malaria1. Fur
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dose global coverage was just 27% i
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Chapter 11.Strengthening the Enabli
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combining microfinance and training
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pants meeting once per week for thr
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the men believed that they should n
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in the intervention village were si
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positive impacts. The quasi-experim
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Samoa, Serbia and Montenegro, Thail
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factor associated with sexual assau
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What Works—Strengthening the Enab
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worked with women’s groups, radio
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of school in addressing gender-base
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11C. Strengthening the Enabling Env
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also widely used worldwide and part
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ecognize women’s property rights
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Promising Strategies:2. Community o
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11D. Strengthening the Enabling Env
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Page 323 and 324:
more likely to report having used a
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likely than illiterate women to kno
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of the women surveyed were HIV-posi
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countries extending the fee aboliti
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families and separated from their c
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used the resource “Understanding
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6. Support groups for people living
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11G. Strengthening the Enabling Env
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EVIDENCEPromising Strategies:1. Inv
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Chapter 12.Care and SupportA. Women
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ical care provided by family member
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dealing with their sorrow, grief, a
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What Works—Care and Support: Wome
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2. Peer support groups can be highl
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discriminated unjustly against them
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6. Home-based antiretroviral therap
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12B. Care and Support: Orphans and
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(Thurman et al., 2007). As of 2008,
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care and services were provided, wh
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for treatment can be safely monitor
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A study done in Kenya (year not giv
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ather than a narrowly defined HIV/A
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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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What Works for Women and Girls

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