What Works for Women and Girls

and a number of promising strategies to help women protect themselves from HIV. Whilepartner reduction can potentially have the greatest impact, less evidence exists for how peoplecan be encouraged to reduce the numbers of concurrent sexual partners, both as adults andadolescents. Each of these topics is discussed in more depth in sections A–D of this chapter.Preventions efforts must be informed by “what works to support women and girls,” particularlyto strengthen the enabling environment by transforming gender and legal norms; addressingviolence against women, legal capacity, inheritance and property rights; increasing opportunitiesfor employment and income, reducing stigma and discrimination, and promotingwomen’s leadership. [See Chapter 11. Strengthening the Enabling Environment] Women havemultiple types of sexual partnerships: some women have only one sexual partner but are stillat high risk for HIV acquisition from their sexual partner; some women have multiple sexualpartnerships to survive economically [See Chapter 4. Prevention for Key Affected Populations];some women are young and are engaged in cross-generational sex, placing them at high risk[See Chapter 5. Prevention for Young People and Chapter 12B. Care and Support: Orphans andVulnerable Children]. HIV prevention efforts will need to be tailored to a wide spectrum of risksfor women. Women, themselves, have been leaders in HIV prevention efforts and creatingawareness of the epidemic both at grassroots community levels as well as at the highest levelsof government in fighting for prevention efforts to meet their varied needs. These efforts mustbe encouraged and promoted.Some Women Are Overlooked in PreventionProgrammingOlder women and women with disabilities also need attention in HIV prevention programmingbut are often neglected. Additional research is necessary to discern the major risks facingthese women and to evaluate interventions addressing those risks.Women Over the Age of 50“Grandmothers are too oftenand incorrectly assumed to besexually inactive.”(Sepulveda et al., 2007)Women past the age of childbearing are often ignored in HIV prevention (Conde et al., 2009).HIV prevention and education efforts are needed for people over the age of 50. A WHO reviewof HIV in developing countries found that “sexual activity of older individuals in the developingworld is barely researched. Many older individuals everywhere are sexually active” (Schmid etal., 2009: 162). A study in hospital of 706 cataract surgerypatients over age 50 in Ethiopia found an HIV seroprevalencerate of 5% (35 out of 706) (Kassu et al., 2004). Areview of medical records at a health center in Kampala,Uganda found 45 clients over the age of fifty who wereHIV-positive, over half of whom were women. Condomuse was low and many had multiple partners and low levelsof treatment literacy (Nabaggala, 2008). In Brazil, 51,25546 CHAPTER 3 PREVENTION FOR WOMEN