What Works for Women and Girls

infection, which greatly increases the risk for transmission of HIV (Cohen, 2006b).(Gray III) (STIs, Malawi, South Africa, United States)A retrospective study of 174 monogamous couples in Uganda in which one partner wasHIV-positive, found that higher viral load and genital ulceration are the main determinantsof HIV transmission per coital act. Transmission probabilities increased from.001 per act at viral loads of less than 1,700 copies/mL to .0023 per act at 38,500 copies/mL or more and were .0041 with genital ulceration versus .0011 without (Gray et al.,2001). (Gray III) (STIs, sexual partners, Uganda)Ulcerative STIs, particularly chancroid, herpes simplex virus type 2 and syphilis are themost important STI cofactors for HIV transmission. Control of curative genital ulcers—chancroid and syphilis—is highly feasible and correlates well with stabilization of HIVepidemics. Effective antibiotic treatment of gonorrheal or chlyamydial infection reducesHIV viral load to normal levels. “Evidence supporting the role of STIs as HIV cofactorsis extensive and indisputable” (Steen et al., 2009: 862). (Gray V) (STIs, genital ulcers)A study of 495 people living with HIV in South Africa, of whom more than 70% werewomen, found that 59% had a validated STI symptom assessed by STI symptom algorithm(Maarschalk et al., 2008). (Gray V) (STIs, South Africa)A retrospective medical review of 1,457 deliveries and 1,071 aborted pregnancies amongHIV-positive women in Russia from 2003 to 2005 found that 37% of postpartum and21% of abortion clients had STIs. Approximately 20% of those with STIs did not receivetreatment for their STIs (Karpushkinal et al., 2008). (Gray V) (abortion, STIs, Russia)The prevalence of genital shedding of herpes simplex virus (HSV)-2 and related riskfactors was evaluated in a prospective population of 355 women attending the MaternityJoséphine Bongo, in Libreville, Gabon. Researchers found a high prevalence (66%) ofHSV-2 seropositivity, with a high proportion, 14%, of women harboring HSV-2 DNAshedding in their genital secretions. HSV-2 genital shedding was positively associatedwith previous episodes of genital blisters, current genital ulcer, current genital blister,HIV seropositivity and HSV-2 seropositivity (Ozouaki et al., 2006). (Gray V) (herpessimplex, Gabon)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 settingwith high STI prevalence.A randomized trial was conducted over two years in rural Tanzania. STI treatment wasprovided in the intervention communities to assess the impact on HIV transmission.Strong evidence indicates that the STI intervention program had a substantial effecton HIV incidence in this rural African population. Six communities received the inter-72 CHAPTER 3 PREVENTION FOR WOMEN