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Messages that Matter: What Works for Women
and Girls
Melanie Croce-Galis, RN, MPH
AIDS 2012 - Turning the Tide Together
• Compile the evidence on interventions that address the needs of women and girls related to HIV outcomes
Purpose of What Works
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• Translate the evidence into information useful to programs
• Allow access to the evidence for a range of stakeholders
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What is Unique about What Works?
Only one of its kindCovers all aspects of HIV/AIDS
— one stop shopRelated to HIV outcomes
(results-oriented)Comprehensive evidence base of
interventionsWritten for lay (non-research)
audiences without medical/public health training
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 countriesCriteria:
Various search methodologies (wom*n and HIV, etc.) for evaluated interventions
With measurable outcomesPublished prior to January 2012
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What Works vs. Promising
What Works
Strongly rated studies (Gray I, II, or IIIa) for at least two countries and/or five weaker studies across multiple settings
Promising Studies that were strongly rated but in only one setting or a number of weaker studies (IIIb, IV and V) in only one country or region.
Gaps Emerged from the literature
WHAT IS NEW IN 2012
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In the context of:
• Healthy Sexuality• Families• Safe Motherhood
Prevention Messages
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Women’s solidarity pin. www.lovingafrica.com
Healthy Sexuality
In2eastafrica.net
• 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
Condoms, Condoms, Condoms
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“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).
• 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
Women Need Better Guidance about Hormonal Contraception and HIV Acquisition Risk
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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)
Families
blog.lass.uk.org.uk
• 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
Women Are Often the Center of the Family
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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
Still Large Gaps in Services for Key Affected Populations
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Safe Motherhood
• 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
Prevention of Vertical Transmission
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• 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
Not just about the baby…
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“PMTCT is too much about the baby and not enough about the mother.” -Woman in a PMTCT
program in Malawi
WHAT WORKS WEBSITE
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
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www.whatworksforwomen.org
Messages that Matter
Innovative U.S. Prevention Models
Stephanie Cruse, Program Manager
AIDS United
A Snapshot: Women and HIV/AIDS in the U.S.
Women as a Proportion of New AIDS Diagnoses, 1985 -2010
New HIV Diagnoses and U.S. Female Population, by Race/Ethnicity, 2010
Source: Kaiser Family Foundation, Fact Sheet, Women and HIV/AIDS in the U.S., July 2012
Source: CDC, HIV Surveillance by Race/Ethnicity (through 2010)July 2012
The DEBI Model
What’s Needed?
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
Transformative Technical Assistance
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
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
• What we know
• What we need to do more of
• What we need to do differently
Conclusion