What Works for Women and Girls

experience observed in clinical trials, focusing on sexual pleasure may increase future use.Microbicides for anal use are also under development.The first generation of microbicides is expected to be less than 100 percent effective andwill ideally need to be used with a condom. However, even if used alone, a partially effectivemicrobicide could have a significant impact on HIV incidence (assuming risk taking doesnot increase with the use of this method). However, in 2009, leaders in the field of HIV/AIDS noted, “….we are still many years away from either a vaccine or a microbicide to protectagainst HIV transmission” (Piot et al., 2009: 1). Women need access to both contraceptive andnon-contraceptive microbicides, because some women will want to prevent HIV, STIs, andpregnancy, while other women will want to conceive without the risk of disease transmission.Pre-Exposure ARTPre-exposure prophylaxis with antiretroviral drugs is currently being studied as a preventiontechnique. Delivery of pre-exposure prophylaxis with ART can be by oral ART pills, topical(vaginal or anal) formulations such as gels, films, suppositories, rings or injectable/implantableantiretrovirals. Pre-exposure prophylaxis would be delivered orally and microbicideswould be delivery topically. “To date, …topical products …have not proven effective” (Mastroet al., 2008: 5). Seven human randomized, placebo controlled clinical trials of the safety andefficacy of oral ART pre-exposure are either ongoing or planning to start in 2009 (Mastro etal., 2008). One study of daily use of pre-exposure ART in HIV-negative women did not find anassociation with clinical or laboratory adverse events (Peterson et al., 2007). The implicationsfor women of ART for prevention, including through “test and treat,” approaches, needs tobe considered carefully. For example, an increased push for HIV testing could have negativeimplications for women. [See Chapter 6. HIV Testing and Counseling for Women and Chapter 9.Safe Motherhood and Prevention of Vertical Transmission]Prevention for All Women and GirlsThe prevention strategies in this chapter are applicable for all women; however certain groupsof women and girls have particular prevention needs. Therefore, while this chapter presentswhat works for generally for all women, the two following chapters (Chapter 4. Prevention forKey Affected Populations and Chapter 5. Prevention for Young People) provide additional considerationsand strategies for groups such as sex workers, female drug users, women and girls incomplex emergencies, young people, etc. The three chapters should be viewed together as awhole to identify what works in prevention for women.WHAT WORKS FOR WOMEN AND GIRLS49