What Works for Women and Girls

Chapter 13.Structuring Health Servicesto Meet Women’s NeedsThe manner in which health services are structured has an impact on HIV prevention, treatmentand care services for women and girls. Women often need multiple reproductive healthservices such as family planning in addition to HIV prevention,treatment and care, but most health care facilities arenot structured to provide integrated services. Integrationof services, especially HIV and family planning provides away to capture the missed opportunities to counsel womenand couples on contraceptives and other sexuality issuesas well as provide HIV services. Sexual and reproductivehealth services are also excellent locations for providingHIV services, reaching potential ART users (WHO, 2003a;Interact Worldwide et al., 2008). If family planning isoffered separately or if HIV service providers cannot counselon contraceptives and sexuality issues, women may not begetting the full range of services they need.Integration of Services Is Key to Ensuring WomenReceive Comprehensive Health Care“I feel like mothers benefi ting fromPMTCT must be assisted quicklyat the antenatal clinic unlike whatwe see today. We keep waitingfrom early in the morning to latein the evening without beingattended to. We remain hungryall day long and our children keepcrying out of hunger as well. At theANC there is not even a place tolay down and rest.”—Woman attending PMTCTprogram, Malawi(Bwirire et al., 2008: 1997)“Women are willing to use sexual and reproductive healthclinics and outreach services because they do not attract thestigma” (Titus and Moodley, 2009: 138) often attached to HIV services such as HIV testing.“Women already attend clinics or community-based distribution programs for contraceptiveadvice, and when pregnant, millions of women in under-resourced countries make at least onevisit to a prenatal clinic and a significant proportion make at least one postnatal clinic visit”(Titus and Moodley, 2009: 138). Recent studies in Kenya and Zambia found that family plan-369