What Works for Women and Girls

Sexual behaviors and the sharing of injection equipment that cause most HIV infectionsworldwide occur due to a variety of motivations (e.g., reproduction, desire, peer pressure,desire to please, access to material goods, gender norms, coercion, etc.). Epidemiologicalstudies have shown that multi-partner sex, paid sex and STIs are important risk factors in theAIDS pandemic, no matter what stage of the epidemic (Chen et al., 2007b). Sustaining behavioralchange among individuals, couples, families, peer groups, networks, institutions and/or communities is no easy task, but can occur through educational, motivational, peer-group,skills-building or community normative approaches (Coates et al., 2008).“A quarter of a century of AIDS responses has created a huge body of knowledge aboutHIV transmission and how to prevent it, yet every day, around the world, nearly 7,000 peoplebecome infected with the virus…with no vaccine in sight and the number of new infectionsoutpacing the progress in access to treatment, we clearly need to take a long-term view in planningour actions…Prevention work takes the longest time, is largely outside of health services,and has no ‘quick win.’ If not tackled, prevention work will also continue to undermine all theother gains” (Piot et al., 2008: 845, 855, 857).Prevention Efforts Can SucceedPrevention successes among women and men have been reported in Cambodia, Kenya, Zambia,Zimbabwe, India and Haiti. In these countries sizable shifts in behavior have occurred, througha combination of government leadership and community activism (Global HIV PreventionWorking Group, 2007). In Zambia, among women younger than age 17, HIV seroprevalencedeclined from 12% in 2002 to 7.7% in 2006 (Stringer et al., 2008). In Kenya, adult prevalencehas declined from 10% in the late 1990s to less than 7% by 2004 (Cheluget et al., 2006).Thailand and Uganda reduced rates of HIV infection. Senegal averted an epidemic. Brazil,Côte d’Ivoire, Malawi, Tanzania, Zimbabwe have all reported decreases in HIV transmissionrelated to changes in sexual behavior, as has rural parts of Botswana, Burkina Faso, Namibiaand Swaziland and urban parts of Burundi and Rwanda (Kippaz and Race, 2003; Stoneburnerand Low-Beer, 2004; UNAIDS, 2001 cited in Coates et al., 2008). Prevalence decreased from15% in 1995 to 11% in 2002 in Côte d’Ivoire (Msellati et al., 2006). As of 2008, Namibia hasincreased HIV prevention skills in 79% of secondary schools; as a result, sex before the ageof 15 years and the percentage of people reporting multiple partners has dropped (UNAIDS,2008 cited in Coates et al., 2008). 11 Attributing prevention efforts as a direct cause of HIV prevalence decline is speculative. If HIV prevention programsare implemented when HIV epidemics are at or near their peak, the subsequent decrease in prevalencemight be incorrectly attributed to prevention programs (Chin and Bennett, 2007).44 CHAPTER 3 PREVENTION FOR WOMEN