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What Works

What Works for Women and Girls: Evidence for HIV/AIDS Interventions Melanie Croce-Galis, PHI Jill Gay, HPP Consultant Karen Hardee, HPP/Futures Group. What Works. 2012 Update funded by PEPFAR, Gender Technical Working Group through the Health Policy Project and Open Society Foundations

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What Works

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  1. What Works for Women and Girls: Evidence for HIV/AIDS InterventionsMelanie Croce-Galis, PHIJill Gay, HPP ConsultantKaren Hardee, HPP/Futures Group

  2. What Works • 2012 Update funded by PEPFAR, Gender Technical Working Group through the Health Policy Project and Open Society Foundations • Website supported by the Public Health Institute

  3. Purpose of What Works • Compile the evidence on interventions that address the needs of women and girls related to HIV outcomes • Translate the evidence into information useful to programs • Allow access to the evidence for a range of stakeholders

  4. What Works Website

  5. Who Needs the Evidence Base? • Government ministries and national AIDS programs • Donors • CCMs • Civil society organizations • Country programmers • Researchers • Advocates

  6. What is Unique about What Works? • Only one of its kind • Covers all aspects of HIV/AIDS • one stop shop • Related to HIV outcomes (results-oriented) • Comprehensive evidence base of interventions • Written for lay (non-research) audiences without medical/public health training

  7. Key Features of the Redesign • Improved search function • How to use the site • News section • Social media buttons • Chapter downloads • Quotes • Hover allows view of full citation, terms • Meta tags for search engines

  8. What Works Methodology

  9. Methodology • Focused on developing countries • Searched SCOPUS, Popline, Medline, websites • Guided by consultations/reviews by over 100 experts • Used data primarily from 2008–2011 • Ranked evidence using Gray’s typology

  10. What Is the Evidence Base? • Contains: • Approximately 4,000 citations • 641 interventions with outcomes summarized – highlights evidence with programmatic implications focusing on the global South • Data from 94 countries • Criteria: • Various search methodologies (wom*n and HIV, etc.) for evaluated interventions • With measurable outcomes • Published prior to January 2012

  11. Rating the Evidence

  12. What Works vs. Promising

  13. Strength of the Evidence *Abstract from a recent conference

  14. Countries Included

  15. What is New in 2012

  16. Covering • Main themes • Prevention • Treatment • Strengthening the enabling environment Women’s solidarity pin. www.lovingafrica.com

  17. Main Themes • Exciting time with new prevention and treatment modalities • Gender equitable interventions still need to be devised and scaled up • Critical Prevention Approaches Still Under Development – Vaccines, Pre-exposure Prophylaxis, Microbicides

  18. Prevention In2eastafrica.net

  19. Prevention • Wide agreement that prevention is still critical and needs to be scaled up • WHO et al., 2011b; Zachariah et al., 2011; Over, 2011; Padian et al., 2011; Kurth et al., 2011; Katsidzira and Hakim, 2011; Dieffenbachbach and Fauci, 2011. • Prevention challenges for women remain • Key affected populations, are underserved • Focusing on key affected groups can leave out other women also at risk of HIV • Meeting the prevention needs of young women is particularly critical • Addressing the enabling environment is key

  20. Treatment as prevention: ARV therapy reduces (but does not eliminate) the risk of HIV transmission is an additional prevention strategy(Works)

  21. Treatment as prevention (challenges) • Monogamy cannot be assumed in serodiscordant couples • In one study, 28% of the cases HIV transmission occurred from another partner rather than from the HIV-positive partner on treatment (Cohen et al. (2011) • Early treatment will not stop transmission from those who are acutely infected but cannot know their serostatus with rapid HIV tests (Cohen, 2011b) • Other challenges include: • long-term adherence, the possibilities of drug resistance, and the concerns that condom use and other preventive measures would decrease (Shelton, 2011) • A continued focus on all prevention modalities is warranted (Nguyen et al., 2011)

  22. Voluntary Medical Male Circumcision Can Help Women • VMMC averts HIV infection among women, because as more men are circumcised, women are less likely to encounter sexual partners who are living with HIV (Njeuhmeli, 2011; Hankins et al., 2011; Ally et al., 2012; Hallett et al. 2011) • MC programs could be a platform to promote gender equityand all HIV risk reduction strategies as well as men and women’s sexual and reproductive health with increased couple communication(Wamai et al., 2011; Doyle et al., 2010b).

  23. Condoms Are Still Critical • “Condom issues are difficult. We know we can prolong our lives if we do not infect each other. On the other hand, marriage is also important… We cannot survive without men. Who will help us meet our needs?”—Woman who dropped out of a PMTCT program, Malawi (Chinkonde et al., 2009: 14). • There is still a need to scale up female condoms and continue a focus on condom promotion (Abdool Karim et al., 2010; Hughes et al., 2012) • Condom negotiation skills and peer education for women works (Weschberg et al., 2010; Kaponda et al., 2011).

  24. Sex Workers and Females Who Inject Drugs/Partners of Males Who Inject Drugs are Underserved • HIV prevention is not being scaled up sufficiently among vulnerable groups • Fewer than half of all sex workers are reached in Asia (Baral et al. 2012) • Only 1 in 5 IDU reached in Asia (Low-Beer and Sarkar, 2010) • Modeling suggests 60-80% coverage needed to reduce HIV • Key affected groups need prevention, care, and treatment • Often not reached with testing and counseling (WHO et al., 2011) • Issues around treatment access (e.g., prosecution of health workers) (Schwartlander et al. 2011)

  25. Sex Workers – We Know What Works; We Need to Do It What works • Comprehensive prevention programs • Clinic-based interventions with outreach workers • Policies that involve sex workers, brothel owners and clients • Providing STI clinical services • Peer education • Creating a sense of community and empowerment among sex workers. • Sex workers can be as adherent to antiretroviral therapy as other populations Promising strategies • Interventions targeting male clients can increase condom use and thus reduce HIV risk for sex workers Still needed • Access to information and services for contraception and dual method use

  26. Women Who Inject Drugs/Partners of Men Who Inject Drugs • What Works: • Comprehensive harm reduction programs, including needle exchange programs, condom distribution, opioid agonist therapy and outreach, and nonjudgmental risk reduction counseling. • Peer education • Sex-segregated group sessions • Instituting harm reduction programs in prisons • Drug users benefit from and can be adherent to antiretroviral therapy. • Promising Strategies: • Offering no-cost HIV testing and counseling to people who use drugs

  27. Treatment blog.lass.uk.org.uk

  28. Treatment • Treatment is a huge success story for both women and men. • Between 1995 and 2009, an estimated 14.4 million life-years have been gained among adults as a result of ART (Mahy et al., 2010b) • Universal access and loss to retention and follow-up remain concerns. • Gender roles and norms affect treatment access for women and men (e.g., Skovdal et al., 2011b; Foster et al., 2010b; Fox et al., 2010a; Thomas et al., 2009; Arrivillaga et al., 2009)

  29. Strengthening the Enabling Environment

  30. Strengthening the Enabling Environment “Almost uniformly across the world, women have less access to and control of productive resources outside the home. Evidence for this imbalance in power includes the gender gaps in literacy levels, employment patterns, access to credit, land ownership and school enrollment fees. This imbalance in access to, and control of, productive forces and resources translates into an unequal balance in sexual relations in favor of men”(Abdool Karim et al., 2010: S126).

  31. Aspects of the Enabling Environment • Transforming gender norms • Addressing violence against women • 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 • Promoting women’s leadership, starting with girls

  32. Transforming Gender Norms • Traditional gender norms lead to behaviors that put women – and men – at risk for HIV (Stephenson, 2010; Pulerwitz et al. 2010). Interventions to address gender norms and reduce HIV need to work with “men and women, boys and girls, in an intentionally and mutually reinforcing way that challenges gender norms, catalyzes the achievement of gender equality and improves health”(Greene and Levack, 2010: vi).

  33. Transforming Gender Norms What Works • Training, peer and partner discussions, and community-based education that questions harmful gender norms • Mass media campaigns that take up gender equality as part of comprehensive and integrated services Promising Strategies: • Changing norms regarding the acceptability of multiple and concurrent partnerships Still needed • Interventions to change gender norms need to be scaled up

  34. What Works Website

  35. Thank You! www.whatworksforwomen.org

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