What Works for Women and Girls

What Works—Prevention for Women: Treating Sexually Transmitted Infections1. STI counseling, diagnosis and treatment represent an important access point for women athigh risk of HIV, particularly in the earlier stages of the epidemic.Promising Strategies:2. Screening for and treating STIs on a continuous, accessible basis improves overall healthsystems, and has been associated with reducing the risks of HIV acquisition in a setting withhigh STI prevalence.3. Providing VCT together with STI services can reach women at high risk for HIV.EVIDENCE1. STI counseling, diagnosis and treatment represent an important access point for womenat high risk of HIV. [See also Chapter 9C-1. Safe Motherhood and Prevention of VerticalTransmission: Testing and Counseling]A systematic review and meta-analysis of 1,064 reports between 1998 and 2000 foundthat genital ulcerative disease appears to have a greater impact than nonulcerativedisease on the susceptibility to HIV. Men were more affected than women by the effectsof STIs Untreated concurrent STIs in an HIV-positive individual increases the rateof progression towards AIDS. “A better and more quantitative understanding of theinteractions between HIV infection and classic STDs is needed ...Sexual behavior is thecommon risk factor for contracting both HIV and STDs” (Rottingen et al., 2001: 592).(Gray I) (STIs, genital ulcers)A review of 2,101 articles in Medline and International Conferences on AIDS foundthat both ulcerative and non-ulcerative STIs promote HIV transmission. Risk estimatesfound in prospective studies from four continents ranged from two to over 23. “Owingto the greater frequency of non-ulcerative STIs in many populations, these infectionsmay be more responsible for more HIV transmission than genital ulcers” (Fleming andWasserheit, 1999: 3). (Gray I) (STIs, genital ulcers)A 2004 to 2006 cross-sectional survey study of female sex workers in India found thatof the 976 women who had symptoms of an STI, more than 78% sought medical treatment;behavior that was protective for both HIV and STIs. HIV infection was stronglyassociated with lifetime and active syphilis (Mishra et al., 2009). (Gray III) (STIs, syphilis,India)In a study where 109,500 samples were tested during a nine-month period frompatients in STI clinics in the US, Malawi and South Africa, 1 to 2 percent had acute HIVWHAT WORKS FOR WOMEN AND GIRLS71