What Works for Women and Girls

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1. Interventions are needed to screen and treat both male and female sexual partners for STIs.Studies found that efforts are needed to reach both men and women: if both partners werenot treated, women can get recurrent infections.Gap noted, for example, in Uganda (Kacwamu, 2008); South Africa (Fox et al., 2007).2. While treatment of all STIs can improve everyone’s health and well-being, further interventionsare needed to screen and treat ulcerative STIs, which have the most impact onHIV susceptibility and transmission. Studies have found however, that, to date, regimensto suppress genital herpes and other STIs have not been effective in reducing HSVtransmission.Gap noted, for example, in Uganda and Zimbabwe (Van der Pol et al., 2008); Tanzania(Watson-Jones et al., 2008, Riedner et al., 2006); India (Reynolds et al., 2006b); generally(Klausner, 2009).74 CHAPTER 3 PREVENTION FOR WOMEN
Chapter 4.Prevention for Key AffectedPopulationsA. Female Sex WorkersB. Women Drug Users and Female Partners of Male IDUsC. Women Prisoners and Female Partners of Male PrisonersD. Women and Girls in Complex EmergenciesE. Migrant Women and Female Partners of Male MigrantsF. Transgender Women and MenG. Women Who Have Sex with Women (WSW)Some women are particularly at risk of HIV acquisition due to their occupational exposures,their behavior or that of their sexual partner(s), their sexual identity and/or their sexual orientation.These women live in particularly challenging situations. These groups of women—sexworkers, injecting drug users (IDUs) or female partners of IDUs, transgender people, migrantwomen and female partners of male migrants, women prisoners and female partners of maleprisoners, women and girls in complex emergencies and women who have sex with women—have specific needs in prevention and are often marginalized within their societies. It is key toaddressing the needs of women and girls to acknowledge the specific needs of these marginalizedgroups of women.While public health epidemiology can clarify which groups in which countries are the mostat risk of HIV acquisition, an understanding is needed of the fluidity between some groups.For example, sex workers are rarely considered as the focus of PMTCT programs, despiteabundant evidence that sex workers get pregnant and have children. In some parts of theworld, substantial overlap occurs between sex work and drug use: an estimated 20–50% of75
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WHAT WORKSFOR WOMEN AND GIRLSEviden
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Authors:Jill Gay, MAKaren Hardee, P
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Jose Esparza, MD, Ph.D.Senior Advis
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Shyam Kottilil, MD, Ph.D.Staff Clin
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Larry Slutsker, MD, MPHChief, Malar
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Table of ContentsList of Abbreviati
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List of Abbreviations3TCACTAHIANCAP
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PEPPHAPHRPIDPLHAPMTCTPPEPPTPRPTPRBP
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MethodologyMeasuring “what works
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2. Hormonal contraception is safe f
Page 26 and 27: outcomes has been more difficult to
Page 28 and 29: 2. Promoting contraceptives and fam
Page 30 and 31: International Political Commitments
Page 32 and 33: established national action plans o
Page 34 and 35: Organization of the DocumentThis do
Page 36 and 37: Table 1.1Countries included in What
Page 38 and 39: understanding the epidemic in any g
Page 40 and 41: girls in school, for example. The c
Page 42 and 43: Within each intervention, studies a
Page 45 and 46: Chapter 3.Prevention for WomenA. Ma
Page 47 and 48: Special Risks for WomenStill, despi
Page 49 and 50: AIDS cases reported from 1982 to 20
Page 51 and 52: experience observed in clinical tri
Page 53 and 54: Female Condoms Are the Only Female-
Page 55 and 56: condom if it gives them more pleasu
Page 57 and 58: Correct use of the female condom ha
Page 59 and 60: A two month prospective study from
Page 61 and 62: A study of trends from Demographic
Page 63 and 64: 8. Peer education for women can inc
Page 65 and 66: 3B. Prevention for Women: Partner R
Page 67 and 68: matic focus on partner reduction, y
Page 69 and 70: of HIV acquisition, but were either
Page 71 and 72: four visits, each participant was i
Page 73 and 74: What Works—Prevention for Women:
Page 75: vention immediately following the b
Page 79 and 80: 2010). Transgender men and women al
Page 81 and 82: confidentiality—violate human rig
Page 83 and 84: there were major socio-demographic
Page 85 and 86: and post-intervention were used to
Page 87 and 88: tent condom use and 1.5 times more
Page 89 and 90: to their peers, distribute condoms
Page 91 and 92: Gaps in Programming—Female Sex Wo
Page 93 and 94: of a sexual relationship with a pri
Page 95 and 96: than were naltrexone or placebo. HI
Page 97 and 98: attributed to …swift introduction
Page 99 and 100: Promising Strategies:5. Sex-segrega
Page 101 and 102: 9. Programming to prevent initiatio
Page 103 and 104: D’Ivoire, Cuba, Estonia, Indonesi
Page 105 and 106: Gaps in Programming—Women Prisone
Page 107 and 108: EVIDENCEPromising Strategies:1. Vol
Page 109 and 110: In fact, as of September 2008, 66 o
Page 111 and 112: Transgender women and men are often
Page 113: 2009). “The invisibility and marg
Page 116 and 117: especially young women, have their
Page 118 and 119: negotiation skills and other critic
Page 120 and 121: to be reached with sex and HIV educ
Page 122 and 123: What Works—Prevention for Young P
Page 124 and 125: 44% and 100% of participants (Kirby
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tudes, self-efficacy, intentions, a
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as young people in this area had li
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ical validity of the findings that
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study reported having received info
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nancy. Almost 87% of men and 89% of
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last sex, having ever used a condom
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Gap noted, for example, in South Af
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Disaggregated Data Is NeededEffecti
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were also effective in increasing u
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Chapter 6.HIV Testing and Counselin
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Equitable Access to Testing and Cou
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they would come for HIV testing, re
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their jobs (Human Rights Watch, 200
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What Works—HIV Testing and Counse
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women. Of all married HIV-positive
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A study in Ethiopia found that inco
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At a provincial hospital in Mombasa
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Between June and December 2007, mob
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Promising Strategies:6. Encouraging
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10. Counseling may reduce risk beha
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women learned violence prevention s
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Chapter 7.TreatmentA. Provision and
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Treatment Has Been Successfully Adm
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HIV Prevention Is Needed as well as
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Gaps in Programming—Provision and
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These practices and tools are usefu
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Non-judgmental, non-stigmatizing in
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percent among ART-experienced patie
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(Donnell et al., 2010). (Abstract)
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The sexual health of women is an im
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[ for women living with HIV]: impro
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Available GuidelinesA number of sex
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advantages of dual method use, alon
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contraception: 57% used hormonal co
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different; and progression to WHO c
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HIV-related behavioral or biologic
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use was positively associated with
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Gaps in Programming—Meeting the S
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Interactions between ARVs and oral
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Chapter 9.Safe Motherhood and Preve
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Pillar 1: Preventing Primary HIV In
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mission of HIV. HIV testing and cou
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EVIDENCE1. Preventing unintended pr
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Gaps in Programming—Reducing Unin
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9B. Safe Motherhood and Preventiono
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EVIDENCEPromising Strategies:1. Dis
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Gaps in Programming—Pre-Conceptio
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9C-1. Safe Motherhood and Preventio
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tion (Kershaw et al., 2006). “…
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outine tests. Fifty percent of the
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An evaluation of UNICEF-funded PMTC
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and syphilis (by rapid plasma regai
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2. Additional efforts are needed to
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for their own disease” (ITPC, 200
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own health needs has never been eva
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dine and lamivudine during pregnanc
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chose elective cesarean section to
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their current pregnancy or a past p
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Promising Strategies:5. Integrating
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Gaps in Programming—Treatment1. I
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cesarean, and 221 were non-elective
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3. Efforts are needed to ensure tha
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“There is no doubt that there are
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formula feeding increases the risk
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of age. For breastfed infants, the
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weeks of gestation and continued un
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A study in Côte d’Ivoire with 54
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during breastfeeding compared with
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3 times higher for infants who were
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counseling tools are needed. Studie
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Chapter 10.Preventing, Detecting an
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latent infection. Some immunocompro
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concurrent active TB and HIV infect
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mortality of HIV-positive people re
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in a 65% decline in mortality and t
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1. Efforts are needed to reduce TB-
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al., 2004 cited in Slutsker and Mar
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stillbirths by 33%. Three cluster-r
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Gaps in Programming—Malaria1. Fur
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dose global coverage was just 27% i
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Chapter 11.Strengthening the Enabli
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combining microfinance and training
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pants meeting once per week for thr
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the men believed that they should n
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in the intervention village were si
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positive impacts. The quasi-experim
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Samoa, Serbia and Montenegro, Thail
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factor associated with sexual assau
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What Works—Strengthening the Enab
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worked with women’s groups, radio
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of school in addressing gender-base
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11C. Strengthening the Enabling Env
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also widely used worldwide and part
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ecognize women’s property rights
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Promising Strategies:2. Community o
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11D. Strengthening the Enabling Env
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more likely to report having used a
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likely than illiterate women to kno
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of the women surveyed were HIV-posi
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countries extending the fee aboliti
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families and separated from their c
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used the resource “Understanding
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6. Support groups for people living
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11G. Strengthening the Enabling Env
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EVIDENCEPromising Strategies:1. Inv
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Chapter 12.Care and SupportA. Women
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ical care provided by family member
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dealing with their sorrow, grief, a
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What Works—Care and Support: Wome
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2. Peer support groups can be highl
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discriminated unjustly against them
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6. Home-based antiretroviral therap
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12B. Care and Support: Orphans and
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(Thurman et al., 2007). As of 2008,
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care and services were provided, wh
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for treatment can be safely monitor
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A study done in Kenya (year not giv
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ather than a narrowly defined HIV/A
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7. Further interventions to provide
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ning providers, antenatal care and
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What Works—Structuring Health Ser
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counts available at primary health
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Pregnant women reported feeling out
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Before implementation of the PMTCT
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accessing PMTCT. An evaluation of 3
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A mathematical model based on TB tr
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1. Improved integration is needed b
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15. Additional efforts are needed t
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Community-based Care is holistic ca
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Microfinance is often defined as fi
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Sexuality is a central aspect of be
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Akabaysh, H. and G. Psacharopoulos.
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Andia, I., A. Kaida, M. Maier, D. G
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Barker, P., C. McCanno, N. Mehta, C
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Berer, M. 2008b. “Male Circumcisi
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Druce, N. and A. Nolan. 2007. “Se
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“What Works compiles a wealth of
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