What Works for Women and Girls

vention immediately following the baseline survey, while six comparison communitiesreceived the intervention after the follow-up survey two years later. HIV incidence wasconsistently lower in the intervention community than the comparison community inall six matched pairs. After two years of the intervention, there were 48 seroconversions(1.2%) in the intervention group and 82 (1.9%) in the comparison group. HIV incidencewas approximately 42% lower in the intervention group. Prevalence and incidence ofSTIs was measured in a random cohort consisting of 1,000 adults in each community.STI services were based on syndromic algorithms recommended by WHO (WHO,1991). The intervention program had five components: 1) Establishment of an STIreference clinic and laboratory to monitor the effectiveness of treatment algorithms;2) Existing staff from health centers received one week of classroom training and twoweeks of practical training at the STI clinic. Staff also were trained to provide patientswith health education and to offer free condoms; 3) A special delivery system of drugswas established to supplement the national essential drugs program supplies; 4) Regularsupervisory visits by a program officer were conducted to provide in-service trainingand to check drug supplies and patient records; 5) Periodic visits by health educators tovillagers were conducted to provide information on STIs, inform villagers of availabletreatment, and encourage prompt attendance for treatment of symptomatic STIs. Menwith a positive LED test and those reporting or found to have urethral discharge wereasked to provide a urethral swab. Urethral swabs were tested for Neisseria gonorrheaby pram stain and for Chlamydia trachoatis by antigen capture immunoassay. HIV wastested by ELISA assay. Positive samples received a second ELISA assay, and in caseof discrepant or indeterminate ELISA results, a western blot test. Serological tests forsyphilis were conducted using RPR and TPHA. Evaluation of the impact of the interventionon the prevalence of STIs was based on the seroprevalence of active syphilis andon the prevalence of confirmed urethritis, N gonorrhea and C traehomanis infectionin men. Surveys indicated that condom use did not increase nor did sexual behaviorchange during the course of the intervention (Grosskurth et al., 1995). (Gray III) (STIs,health facilities, treatment, Tanzania)3. Providing VCT together with STI services can reach women at high risk for HIV. [SeeChapter 6. HIV Testing and Counseling for Women]Gaps in Programming—Treating Sexually Transmitted Infections1. Interventions are needed to screen and treat both male and female sexual partners for STIs.2. While treatment of all STIs can improve everyone’s health and well-being, ulcerative STIshave the most impact on HIV susceptibility and transmission. However, to date, regimens tosuppress genital herpes have not been effective in reducing HSV transmission.WHAT WORKS FOR WOMEN AND GIRLS73