What Works for Women and Girls

1. Improved integration is needed between maternal health services and HIV treatmentservices. A study found that even though 11.6% of 1,369 pregnant women were eligiblefor ARV treatment based on their low CD4 counts prior to delivery and 6 % were eligiblepostpartum, these women were not integrated into ARV treatment programs.Gap noted, for example, in South Africa (Lebon et al., 2007).2. Providers must have access to gowns, gloves and eye protection to decrease the risk ofoccupational exposure. [See also Chapter 9D. Safe Motherhood and Prevention of VerticalTransmission: Delivery] Studies noted that gowns, gloves and eye protection should be usedin all deliveries and in examinations or procedures likely to generate the splashing of bloodor amniotic fluid.Gap noted, for example, in Georgia (Butsashvili et al., 2008); Nigeria (Ohajinwa, 2008);generally (Anderson, 2005).3. Ongoing efforts are needed for safe needle disposal. Studies found that used sharp needleswere observed inside and outside facilities and that neither adequate disposal methods norseparation of medical waste from domestic waster occurred in health facilities.Gap noted, for example, in South Africa (Mulumba et al., 2008) and Nigeria (Bankole etal., 2008).4. Reliable drug and lab supplies are necessary to ensure adherence. A study found that 10%of 578 people (27% female) reported missing doses of ARV therapy due to shortages indrug supplies.Gap noted, for example, in Peru (Giron et al., 2008).5. Improved record keeping on HIV counseling, serostatus, and treatment is needed toimprove referrals and linkages with other health care services. [See Chapter 9C-1. SafeMotherhood and Prevention of Vertical Transmission: Testing and Counseling]6. Health care provider training is needed to increase confidentiality and decrease discriminationagainst sex workers seeking health services. [See Chapter 4A. Prevention for Key AffectedPopulations: Female Sex Workers]7. Providers need training on contraception, including non-directive counseling and reducingstigma and discrimination for women living with HIV. [See Chapter 8. Meeting the Sexualand Reproductive Health Needs of Women Living With HIV]8. Health service providers must make additional efforts to ensure confidentiality regardingpatient’s serostatus. [See also Chapter 6. HIV Testing and Counseling for Women, Chapter8. Meeting the Sexual and Reproductive Health Needs of Women Living With HIV, Chapter384 CHAPTER 13 STRUCTURING HEALTH SERVICES TO MEET WOMEN’S NEEDS