What Works for Women and Girls

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Within each intervention, studies are listed in order of Gray Scale, with the strongest studiesfirst (Gray I, II, III, etc.) and abstracts last. In some chapters, such as Chapter 11 that discussesthe enabling environment, where structural interventions cannot be linked as directly withimpact on HIV infection, the authors, based on comments from reviewers, exercised judgmenton “what works,” and promising interventions.Where an intervention could have both positive outcomes for women and negative outcomes,this was noted. For example: microcredit can reduce HIV-related risk behaviors (Pronyk et al.,2008), but it could also increase violence against women if the intervention is not carefullydesigned and appropriate to local context (Schuler et al., 1998; Gupta et al., 2008a).In the course of reviewing the literature to generate “what works,” a number of gapsemerged from the literature.Gaps: programs that need to be implemented to meet women’s needs related to the HIV/AIDS pandemic but did not exist with evaluated data.However, no search mechanism was possible to generate gaps. Where gaps emerged in theliterature, these were noted. Evidence of a gap is not exhaustive but illustrative, providing afew examples. Evidence of a problem—such as the prevalence of violence against women—isdescribed in the introduction to each section.No attempt has been made, as is done in the Cochrane Collaboration, to reanalyze the dataon interventions. For some interventions, many large-scale studies including some randomizedcontrolled trials are listed; for other interventions, supporting research is available fromonly one study using a small sample size. With review articles, the original studies are citedas reported in the review. An attempt has been made to use the original studies and primarysources; but where the original could not be located, the authors relied on review articles.Evidence from review articles is noted (e.g., x cited in y).When possible, objective measures such as a decrease in HIV seroconversion rates ora decrease in rates of other STIs are used as evidence. If these measures are not available,evidence is drawn from studies using self-reported behavior changes such as condom use,monogamy, sexual abstinence and a decrease in number of sex partners. This document doesnot address fully the issues of cost, equity, or sustainability.Where possible, we have included sex disaggregated data. Where an interventions is relevantfor both men and women, but does not have sex disaggregated data, it is included. Forthe chapters that are heavily medical interventions, such as those related to treatment andco-infection, only interventions that apply to women are included in the compendium.In all, the evidence for What Works and Promising interventions includes 455 studies.40 CHAPTER 2 METHODOLOGY
Table 2.2Number of Studies Supporting What Works and Promising Interventions, by Chapter TopicChapter TopicNumber of studies supportingWhat Works/Promising Interventions*Prevention for Women 43Prevention for Key Affected Populations 55Prevention for Young People 43HIV Testing and Counseling for Women 47Treatment 12**Meeting the Sexual and Reproductive Health Needs of Women Living with HIV 33Safe Motherhood and Prevention of Vertical Transmission 83Preventing, Detecting and Treating Critical Co-Infections 17**Strengthening the Enabling Environment 63Care and Support 38Structuring Health Services to Meet Women’s Needs 21Total 455* What works is based on strongly rated studies (Gray I, II, or III) for at least two countries and/or fi ve weaker studies acrossmultiple settings. Promising includes studies that were strongly rated but in only one setting or a number of weaker studies inonly one country.** Most studies conducted on ARV treatment, tuberculosis and hepatitis do not include sex-disaggregated data although manyof the fi ndings are clearly relevant to women as well as men (e.g. the effectiveness of ARV treatment in reducing CD4 counts,strong adherence rates). The studies included attempt to highlight issues women face regarding treatment.WHAT WORKS FOR WOMEN AND GIRLS41
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 36 and 37: Table 1.1Countries included in What
Page 38 and 39: understanding the epidemic in any g
Page 40 and 41: girls in school, for example. The c
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
Page 89 and 90: to their peers, distribute condoms
Page 91 and 92: Gaps in Programming—Female Sex Wo
Page 93 and 94:
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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Page 335 and 336:
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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