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What works for women and girls: evidence for HIV/AIDS interventions

What works for women and girls: evidence for HIV/AIDS interventions

A comprehensive review of data from HIV/AIDS interventions for women and girls in nearly 100 countries has revealed several overarching themes. What Works highlights successful interventions for a range of women and girls living with or at risk of HIV: adolescents, adult women, sex workers, injection drug users, orphans, women who do not know their serostatus, women who want to reduce the risk of transmitting HIV to their infants, HIV-positive women who have an unmet need for contraception, women living with HIV who are co-infected with malaria, tuberculosis, or Hepatitis C, and women who provide the bulk of care and support to their families.

Treatment works and prevention is key With no cure, more people acquire HIV than the number on treatment. Prevention efforts can succeed. In a number of countries sizable shifts in behavior have occurred, through a combination of government leadership and community activism. Still, despite the many documented successes of prevention programs, in 2007 fewer than 10 percent of individuals at risk worldwide received key prevention services. A number of strategies already work to help women prevent HIV, including male and female condom use, partner reduction, and provision of treatment for sexually transmitted infections.

Prevention efforts for married women have been neglected. Marriage is often portrayed as a haven for women and girls and married women are thus not often the recipients of prevention programming. However, due to gender norms of multiple partnerships for men, married women may be at an increased risk of HIV acquisition. Further efforts are needed to challenge traditional gender norms if women are to be successfully supported in prevention programming. Improving comprehensive sex education and protective sexual behavior, including condom use, among young people is critical. There is evidence of successful strategies to improve young people’s use of condoms including promoting dual use for both pregnancy and HIV; providing sex and HIV education programs with certain key characteristics; and promoting communication between young people and adults.

Meeting women’s sexual and reproductive health needs Given that most HIV transmission occurs through sexual intercourse, it is critical to include a sexual and reproductive health lens in HIV programming. Because many people still do not know their HIV status, and because negotiating condom use is not always possible, expanding access to contraceptives for all women who need and want them through rights-based, voluntary services, is an important component of HIV programming and is cost-effective.

Further attention is needed for women living with HIV who become pregnant. PMTCT programs have traditionally focused on the infant more than on the woman herself, although new guidelines from the WHO differentiating treatment for the woman versus prophylactic treatment to prevent transmission are a step in the right direction. Important questions remain, however, about the prophylactic treatment effect on the woman’s later health.

Integrated programming can be ideal The concept of integration permeates much of what works for women. The evidence demonstrates that integrating HIV services within family planning, maternal health care, or primary care can increase uptake of HIV testing and treatment and other reproductive health services and can remove the stigma that is associated with going to an exclusive HIV service. Offering education about future planning or legal advice in conjunction with health care is also promising. For effective integration, however, policy makers and programmers must know and understand the client population and ensure that women’s rights are respected.

Women need more support – especially from their peers Where women are supported, behavioral and health outcomes are better. Couple counseling has been shown to improve condom use. Individual or group counseling as well as linking outside assistance to home- or community-based care and support is helpful to women. Information from and the support of peers successfully increase protective behaviors such as condom use or HIV testing. Peer education has been repeatedly shown as either a proven or promising strategy in programming for sex workers, drug users, and transgender men and women.

Strengthening the enabling environment is an urgent priority Transforming gender norms and advancing education, employment, and legal rights, along with reducing stigma, discrimination, and violence against women, remain urgent priorities in HIV programming. Although determining impact on HIV is difficult—for example, the pathway from changing gender norms to women being able to refuse sex or insist on condom use and thereby reduce the risk of HIV transmission is indirect and can be influenced by many other factors—the environment in which women and girls live and work plays an enormous role in women’s vulnerability to HIV. Successful interventions in overcoming the challenges women face include peer, partner, and community discussions about gender norms, stigma, and violence; enforcing laws that allow widows to retain their property; increasing employment opportunities; abolishing school fees; and training providers to reduce discrimination in health care settings.

It’s time to scale up A number of programs linger in the pilot stage long after they’ve been shown to work. After more than 25 years, numerous successful interventions based on evidence have been documented. What Works provides the evidence for successful strategies in HIV prevention, treatment, care, and support. It’s time to scale up programs that work for women and girls. (Open Society Institute and Soros Foundations Network (OSI) 2010)

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