What Works for Women and Girls

understanding the epidemic in any given population. R 0“is the number of secondary caseswhich one case would produce in a completely susceptible population [which] depends on theduration of the infectious period, the probability of infecting a susceptible individual during onecontact, and the number of new susceptible individuals contacted per unit of time” (Dietz, 1993:23). Not surprisingly, the reproductive number for HIV varies considerably within and acrosscountries and among groups within countries. For this reason, interventions need to be carefullytailored for various groups.Operating in specific socioeconomic, cultural (including gender), and demographicsettings, interventions, such as counseling and testing, must affect “proximate determinants”such as number of concurrent partners, condom use, blood safety practices, etc., which mustact through biological determinants (exposure, efficiency of transmission per contact and durationof infectivity) to affect HIV transmission. “The distinction between underlying and proximatedeterminants is important for the conceptualization of pathways through which underlyingdeterminants, including interventions, may affect infection” (Boerma and Weir, 2005:S64). Thus, when interventions are determined to work in this compendium of evidence, theyhave been shown to work through a pathway to affecting HIV—or at least a proximate determinant,such as partner reduction or condom use. Yet, a word of caution is due unless biologicaloutcomes are measured. For example, it is possible for an intervention to increase condom usebut “the effect of such an increase would depend on the extent to which condoms were usedduring sexual contact between infected and susceptible partners” (Boerma and Weir, 2005:S66). In this compendium, examples of interventions that improve proximate determinantswith no impact on HIV are noted.Rates of HIV prevalence reflect infections that have happened in the past. Therefore, it isimportant that programs and policies be based on the question: “Where will the next 1,000infections occur?” (Bertozzi et al., 2008: 833). Policy and program responses to this questionmust be based on a clear understanding of the epidemiology of HIV, an understanding of thecontexts in which women and girls live and the factors that make them vulnerable to HIVinfection and evidence of what works.Search MethodologyTo search for relevant interventions that had been evaluated, SCOPUS 2 searches were conductedfor 2005–2009, using the search words HIV or AIDS and women. Additional topics wereresearched using “syphilis and HIV;” “gender and HIV;” “malaria and HIV;” “breastfeedingand HIV;” and “abortion and HIV.” For the years 2005 to 2009, a total of 7,744 citations weregenerated. Of these citations, approximately 2,500 articles were reviewed in full. If the articletitle indicated that there might be an intervention that could be replicated; then the article2 Scopus is the largest abstract and citation database of peer-reviewed literature and quality web sources withsmart tools to track, analyze and visualize research (http://info.scopus.com/scopus-in-detail/facts/)36 CHAPTER 2 METHODOLOGY