What Works for Women and Girls

Special Risks for WomenStill, despite the many documented successes of prevention programs, in 2007 fewer than10% of individuals at risk worldwide received key prevention services (Merson et al., 2008).Those that do receive prevention services are not always the only appropriate target. “WhenHIV programmes largely focus on sex work, drug use and male-to-male-sex, it contributes tolow HIV risk perceptions in the general population. Intimate partners are often left out andthere is [a] lack of couple communication about sexual matters” (UNAIDS, 2009e: 15). Thereis also lack of communication about related matters, such as alcohol use, which is associatedwith risky sex. A review of 73 articles representing research conducted in 19 differentsub-Saharan countries published between 1992 and 2007 found that HIV seropositivity andhigh-risk sexual behavior was correlated with alcohol use (Woolf and Maisto, 2008). Alcoholuse inhibits judgment and can lead to unprotected sex and violence. A survey of 3,073 peoplein Tanzania found that lifetime alcohol users and those who reported intoxication in the pastmonths had greater odds of having recent unprotected sex (Kilonzo et al., 2008b) and a studyof 12 focus group discussions in rural Uganda in 2002 found that both men and womenviewed men’s alcohol use as related to rape; agreeing with the assumption that women whoaccept alcohol from men will agree to have sex (Wolff et al., 2006).Rape survivors need timely access to post-exposure prophylaxis (PEP), as do health providerswho have an occupational exposure. Despite the absence of a randomized clinical trial on efficacyof PEP, there is significant evidence from animal transmission models, perinatal HIVtransmission studies, observational studies, studies of PEP in health care workers, and metaanalysisindicating that PEP is effective in reducing HIV transmission (CDC, 1998; Bell, 1997;Young et al., 2007 cited in Siika et al., 2009). Although the efficacy of post-rape antiretroviralprophylaxis has not been determined, zidovudine reduces the transmission of HIV afterneedle stick injury by 81% (Cardo et al., 1997; Petra Study Team, 2002 cited in Carries et al.,2007). “As such, there is current consensus that HIV prophylaxis should be provided immediatelyafter an exposure where there is judged to be risk of HIV acquisition” (Siika et al., 2009:48). [See also Chapter 11B. Strengthening the Enabling Environment: Addressing Violence AgainstWomen]More prevention interventions are needed on a universal level so that everyone—includingmarried women, for example, who may not realize their level of risk—can communicate withtheir partners and protect themselves.What Works in Prevention for WomenA number of prevention strategies already work to help women prevent HIV. These includemale and female condom use, partner reduction, and seeking treatment for sexually transmittedinfections. In addition, male circumcision works for men and will likely, in the longrun, also protect women. Each of these areas has substantial evidence to justify their useWHAT WORKS FOR WOMEN AND GIRLS45