Women and Girls

1. Further interventions are needed to provide support (physical, psychological, technological, economic) to patients and caregivers. Studies showed that patients and caregivers have many physical, psychological, and economic unmet needs, with high rates of depression and poverty, and in some cases, rely on their young children or relatives to provide care with no outside support. Some studies show that caregivers suffer from stigma attached to caring for someone HIV-positive. [See also Reducing Stigma and Discrimination] Some studies showed that women have a lower quality of life than men. A study in a high HIV prevalence area showed that for women, lack of control in sexual decision-making was associated with depression, while for men, intergenerational sex was associated with depression.

Gap noted, for example, in India (Das and Leibowitz, 2011; Steward et al., 2011); South Africa (Petersen et al., 2010; Goudge et al., 2009; Sorsdahl et al., 2010; Casale, 2011; Peltzer and Ramlagan, 2011; Schatz et al., 2011; Kagee and Martin, 2010; Ogunmefun et al., 2011; Akintola, 2006); Mozambique (Pearson et al., 2009); Malawi (Mkandawire-Valhmu and Stevens, 2010; Fan et al., 2011); Thailand (Li et al., 2009); Nepal (Yadav, 2010); China (Lv et al., 2010; Zhou, 2008); Botswana (Lawler et al., 2011; Rajaraman et al., 2006; Shaibu, 2006); Malaysia (Hasanah et al., 2011); Tanzania (Marwick and Kaaya, 2010; Pallangyo and Mayers, 2009; Nyangara et al., 2009a); Brazil, India, Thailand and Ukraine (Skevington et al., 2010); Uganda (Maling et al., 2011; O'Hare et al., 2005; Kaharuza et al., 2006; Ssengonzi, 2007); Nigeria  (Abasiubong et al., 2010; Muoghalu and Jegede, 2010); China (Jin et al., 2010); Botswana (Gupta et al., 2010); and Jamaica (Clarke et al., 2010).

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2. Interventions are needed to support parents and caregivers on taking care of children living with HIV. Needs include information and training as well as combating stigma and discrimination against HIV-positive children.

Gap noted, for example, in Vietnam (Chi et al., 2010a); South Africa (Demmer, 2010; Boon et al., 2010a; Boon et al., 2010b; Boon et al., 2009; van Graan et al., 2007).

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3. The increased vulnerability of female-headed households requires targeted interventions. Studies found that female-headed households risk losing farmland and property and need targeted interventions.

Gap noted, for example, in Kenya (Yamano and Jayne, 2004 cited in Gillespie and Kadiyala, 2005); Uganda (Kanyamurwa and Ampek, 2007); and Malawi (Shah et al., 2001 cited in Gillespie and Kadiyala, 2005).

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4. Interventions are needed to support women living with HIV to disclose their serostatus to their children and families. Studies found that HIV-positive women found it extremely difficult to disclose their serostatus to their children and to their families and wanted specific counseling to address this need. A study also found that women wanted support on how to talk to their children about the loss of a sibling from AIDS.

Gap noted, for example, in South Africa (Demmer, 2010) and Uganda (Rwemisisi et al., 2008; Manchester, 2004).

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5. Interventions are needed to increase access to palliative care. Studies found that a significant proportion of patients needed palliative care, which should be integrated into home-based care.

Gap noted, for example in Africa (Downing et al., 2010); China (Sheng et al., 2010); and Tanzania (Collins and Harding, 2007).

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6. Caregiver training for male and female community health workers may benefit from critical reflections on gender roles and responsibilities. A study found that men and women competed for remunerated caregiving, with training needed on gender roles.

Gap noted, for example, in Lesotho (Newman et al., 2009).

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7. Further interventions are needed to improve quality of life for women living with HIV. A study found that women with HIV had lower quality of life scores than men.

Gap noted, for example, in India (Solomon et al., 2008).

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8. Support is needed for religious leaders in coping with the many AIDS-related deaths.

Gap noted, for example, in South Africa (Eriksson et al., 2010).

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9. Care and support programs should address gender-based violence. [See also Addressing Violence Against Women] A study of women who received home-based care found that significant numbers experienced violence.

Gap noted, for example, in Uganda (Apondi et al., 2007).

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10. Research is needed on treating anemia, malnutrition and other dietary conditions as well as on optimum micronutrients for patients accessing HAART and for patients prior to accessing treatment. [See also Treatment] Increased clarity is needed for providers, caregivers and patients on nutritional needs in settings of marked food insecurity. A Cochrane review which included 16 studies with weak methodologies found that “the evidence-base for the specific effect of micronutrient supplements in children and adults with HIV is limited, but sufficient to make some recommendations for practice. In the absence of population-specific adverse effects, there is no reason to decline similar recommendations for HIV-infected populations” (Irlam et al., 2010: 16).

Gap noted in Brazil (Silva et al., 2010); South Africa (Walshe et al., 2010); Lesotho (Makoae, 2011); Kenya (Kuria, 2010); Uganda (Komwa et al., 2010); and globally (De Pee and Semba, 2010; Raiten et al., 2011).

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