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

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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