What Works for Women and Girls

ning providers, antenatal care and family planning clients, and HIV-positive women identifiedthe need for family planning in a context of high HIV prevalence (Banda et al., 2004; Gichuhiet al., 2004).A recent review of PMTCT program failures in developing countries concluded that keyfactors include “the lack of linkages between prevention of mother-to-child transmissionprograms and primary prevention, family planning, and most importantly, the provision ofcare and treatment” (McIntyre and Lallemant, 2008a: 139). However, it is critical that policymakersand program managers know and understand the client population before decidingwhether service integration is likely to be effective (Gillespie et al., 2009).Integrating PMTCT into reproductive and child health services in Tanzania between 2006and 2007 showed a positive association with the PMTCT program including antenatal clinicattendance, syphilis testing and malaria prophylaxis among pregnant women (Giphart et al.,2008). TB screening as part of antenatal and postpartum care is also important due to theincreased risk of maternal and infant mortality associated with TB and HIV co-infection duringpregnancy and postpartum (Mofenson and Laughton, 2007).Women should be viewed as individuals with health care needs. Access to antiretroviraltreatment for pregnant women in ANC clinics should not be seen to emphasize prevention ofperinatal transmission at the expense of the women’s own health. Focus on HIV for womenonly during pregnancy often shifts services to only preventing HIV transmission to the babiesand neglects the health needs of the women themselves. Importantly, health care providersmust practice in a respectful, non-discriminatory manner.Health Care Providers’ Needs Must Also Be MetNurses occupy a pivotal position in relation to the HIV/AIDS epidemic, especially in Africa,where they face a disproportionate risk of infection, the largest burden of caring for sick familyor orphans, and as health care workers, risk of occupationalexposure (Zelnick and O’Donnell, 2005). A review of“Where workers have the potentialto encounter blood or other bodyfluids in the course of their work,employers have an obligation totrain them in infection controland to ensure ready access toprotective equipment and postexposureprophylaxis”(UNAIDS, ND).human resources for health care in Kenya found that manyhealth care workers are themselves living with HIV, sufferfrom stigma and cannot afford the services or treatmentthey prescribe for others (Munene and Simiyu, 2008).In order to provide quality care, health care workersmust have access to the means of universal precautions(e.g. gloves, masks and other protective equipment) so theycan protect themselves from HIV transmission. Health careworkers must be assured of the use of this personal protectiveequipment, which can reduce fear of treating peoplewith HIV and thus reduce stigma and discriminationagainst women living with HIV who access health services. [See also Chapter 11F. Strengtheningthe Enabling Environment: Reducing Stigma and Discrimination]370 CHAPTER 13 STRUCTURING HEALTH SERVICES TO MEET WOMEN’S NEEDS