Messages that Matter: What Works for Women and Girls Melanie Croce-Galis, RN, MPH

1. Messages that Matter: What Works for Women and Girls Melanie Croce-Galis, RN, MPH

2. Purpose of What Works • Translate the evidence into information useful to programs • Allow access to the evidence for a range of stakeholders Compile the evidence on interventions that address the needs of women and girls related to HIV outcomes 2

3. 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 3

4. 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 4

5. What Works vs. Promising 5

6. WHAT IS NEW IN 2012

7. Prevention Messages In the context of: • Healthy Sexuality • Families • Safe Motherhood Women’s solidarity pin. www.lovingafrica.com

8. Healthy Sexuality In2eastafrica.net

9. Condoms, Condoms, Condoms • Improve condom use by: • Expanding access to female condoms • Increasing couple communication through training in negotiation skills • Promoting dual use of condoms as contraception as well as HIV prevention 9

10. “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).

11. Women Need Better Guidance about Hormonal Contraception and HIV Acquisition Risk • Six analyses found significantly increased risk • Nine analyses have found no association • Three analyses found no association between Net-En and HIV acquisition • Two of sixteen prospective studies found an increased risk with oral contraceptive use

12. Guidance should be “translated into clear, simple language that allows women to make genuinely informed decisions about family planning and HIV risk reduction. This means explaining what is known and unknown based on today’s data” (Mworenko, 2012)

13. Families blog.lass.uk.org.uk

14. Women Are Often the Center of the Family • Transforming gender norms can reduce violence • E.g., Stepping Stones; One Man Can • What Works in transforming gender norms: • 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 • Education - the “window of hope” in HIV prevention - reduces risk across the developing world

15. Still Large Gaps in Services for Key Affected Populations For example, • Women who inject drugs are at high HIV risk due to • Needle sharing • Gender norms where men use needles first • Sexual transmission • Involvement in sex work But are reluctant to go to treatment centers for fear of losing custody of their children 15

16. Safe Motherhood

17. Prevention of Vertical Transmission • WHO Guidelines: • Triple antiretroviral treatment temporarily for prevention of vertical transmission for women with CD4 counts above 350 (prophylaxis) • Triple antiretroviral treatment permanently for women with CD4 counts at or below 350 for their own health (treatment) • Unknowns about long-term effects of stopping and starting ART - especially for women with multiple pregnancies • WHO guidelines on infant feeding practices still confusing for women 17

18. Not just about the baby… • “PMTCT is too much about the baby and not enough about the mother.” -Woman in a PMTCT program in Malawi Focusing just on infant outcomes places blame on mothers Babies with healthy mothers have a better quality of life Orphans who’ve lost their mothers are at greater risk for HIV later in life Women with HIV have changing fertility preferences and stigma must be reduced 18

19. WHAT WORKS WEBSITE

20. Thank You!What Works for Women & Girls is supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Open Society Foundations and is being carried out under the auspices of the USAID-supported Health Policy Project and the Public Health Institute www.whatworksforwomen.org

22. Messages that Matter Innovative U.S. Prevention Models Stephanie Cruse, Program Manager AIDS United

23. A Snapshot: Women and HIV/AIDS in the U.S. New HIV Diagnoses and U.S. Female Population, by Race/Ethnicity, 2010 Women as a Proportion of New AIDS Diagnoses, 1985 -2010 Source: CDC, HIV Surveillance by Race/Ethnicity (through 2010) July 2012 Source: Kaiser Family Foundation, Fact Sheet, Women and HIV/AIDS in the U.S., July 2012

24. The DEBI Model

25. What’s Needed?

26. Furthering Innovation GENERATIONS: Strengthening Women and Families Affected by HIV/AIDS Since 2005, GENERATIONS has enabled 22 organizations to implement evidence-based programming Creating or adapting evidence-based interventions for at-risk populations of women, primarily women of color Capacity-building program for community based organizations Support included robust technical assistance

27. Transformative Technical Assistance

28. AIDS Alabama • Intervention: Beauty In Knowing • Population: African-American women enrolled in cosmetology school • Celebrating healthy sexuality and protection of families • Adapted from SISTA & GEN II curriculum

29. Chicano Federation of San Diego County • Intervention: De Mujer a Mujer Project • Population: Latinas, ages 18 and over from five San Diego-area ZIP codes • Celebrating healthy sexuality • Homegrown intervention De Mujer a Mujer

30. Conclusion • What we know • What we need to do more of • What we need to do differently