What Works for Women and Girls: Evidence for HIV/AIDS Interventions

This resource - What Works for Women & Girls - compiles and summarises evidence for successful HIV/AIDS interventions in a searchable location. Published by the Open Society Institute (OSI), What Works was reviewed by more than 50 experts in the field and contains findings from evaluated interventions in 90 countries, with a focus on developing countries, and contains approximately 2,000 references to programming related to the continuum of HIV and AIDS. Searches were conducted for 2005-2009.

This review has found a number of interventions in all aspects of HIV/AIDS programming that work for women or can be seen as promising; communication-related findings are highlighted below:

• Prevention for women: "...Male and female condoms, partner reduction, male circumcision and treating STIs [sexually transmitted infections] are all important components of prevention efforts. Prevention efforts are also strengthened by addressing factors such as gender norms, violence against women, income and education....Partner reduction, particularly concurrent partnerships, can be effective in reducing transmission of HIV....STI counseling, diagnosis and treatment represent an important access point for women at high risk of HIV..."
• Prevention for key affected populations: communication-centred elements outlined here are related to sex workers (e.g., comprehensive prevention programmes that include components such as peer education, medical services, and support groups; clinic-based interventions with outreach workers; policies that involve sex workers, brothel owners, and clients in development and implementation of condom use can increase condom use; and providing accessible, routine, high quality, voluntary, and confidential STI clinical services that include condom promotion); female injecting drug users (IDUs) and partners of male IDUs (e.g., peer education) and female prisoners and partners of male prisoners (e.g., harm reduction strategies such as education, peer distribution of clean needles, and condom provision).
• Prevention for young people:
  • Encouraging behaviour change:
    • "Sex and HIV education with certain characteristics prior to the onset of sexual activity may be effective in preventing transmission of HIV by increasing the age at which girls first engage in sexual activity, and, for those who are sexually active, increasing condom use and reducing the number of sexual partners.
    • Training for teachers to conduct age-appropriate participatory sexuality and AIDS education can improve students' knowledge and skills.
    • Mass media and social marketing campaigns are modestly effective in persuading both female and male adolescents to change risky behaviors."
    • Communication between adults and young people about reproductive health information can increase protective behaviours.
  • Increasing access to services: providing clinic services that are youth friendly, conveniently located, affordable, confidential and non-judgmental can increase use of clinic reproductive health services, including voluntary counselling and testing (VCT), which can help women know their HIV infection status and increase their protective behaviours. Also, as noted here: providing VCT together with other health services can increase the number of people accessing VCT; mass media interventions can increase the numbers of individuals and couples accessing VCT; community outreach and mobilisation can increase uptake of VCT; and home testing, consented to by household members, can increase the number of people who learn their serostatus.
• Treatment
• Meeting the sexual and reproductive health (SRH) needs of women living with HIV - e.g., promoting contraceptives and family planning counselling as part of routine HIV services (and vice versa), providing information and skills-building support to HIV-positive people, and crafting interventions to support disclosure so as to increase condom use in discordant couples.
• Safe motherhood and prevention of vertical transmission: Communication-related strategies include: Informed and appropriate counselling during antenatal care can lead to increased discussion between partners and increased protective behaviours such as condom use; and involving partners, with women's consent, can result in increased testing and disclosure.
• Preventing, detecting, and treating critical co-infections (tuberculosis (TB), malaria, etc.)
• Strengthening the enabling environment:
  • Transforming gender norms: training, peer and partner discussions, and community-based education; and mass media campaigns concerning gender equality as part of comprehensive and integrated services;
  • Addressing violence against women: community-based participatory learning approaches involving men and women; establishing comprehensive post-rape care protocols; microfinance programmes.
  • Transforming legal norms to empower women, including marriage, inheritance, and property rights.
  • Promoting women's employment, income, and livelihood opportunities.
  • Advancing education.
• Reducing stigma and discrimination: community-based interventions that provide accurate information about HIV transmission; and training for providers.
• Care and support:
  1. Women and girls: Continued counselling (either group or individual) for those who are HIV-positive and those who are caregivers "can relieve psychological distress. Peer support groups can be highly beneficial to women living with HIV."
  2. Orphans and vulnerable children: one strategy highlighted here is that psychological counselling and mentoring for orphans and vulnerable children improves their psychological well-being.
  3. Structuring health services to meet women's needs. Ideas outlined here include: integrating HIV testing and services with family planning, maternal health care, or within primary care facilities; promoting contraceptives and family planning as part of routine HIV services (and vice versa); providing VCT together with other health services; scaling up prevention of mother-to-child transmission (PMTCT) programmes; scaling up clinic-based interventions with outreach workers; providing accessible, routine, high quality, voluntary, and confidential STI clinical services that include condom promotion; facilitating home testing, with the consent of household members; training providers to reduce discrimination against people with HIV/AIDS; establishing comprehensive post-rape care protocols; providing clinic services that are youth-friendly, conveniently located, affordable, confidential, and non-judgmental.

"Overall, the review demonstrates that while there is significant evidence for what works, there are still many programming gaps related to women and girls for which no effective evaluated interventions were found. In addition, many studies still do not include sex-disaggregated data to begin the process of addressing the specific needs of women and girls. Structural interventions to improve the enabling environment, such as transforming gender norms and legal reform, are clearly critical but are more difficult to correlate with HIV outcomes. Evidence-based interventions that have been shown to work must be scaled up with clear understanding of local epidemical and gender contexts."