Structuring Health Services to Meet Women’s Needs
Gaps in Research
- 1.
- Improved integration is needed between maternal, sexual and reproductive health services and HIV treatment services.
- 2.
- Health care providers must have access to gowns, gloves, needle-less systems and eye protection to decrease the risk of occupational exposure to HIV.
- 3.
- Ongoing efforts are needed for safe needle disposal.
- 4.
- Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services.
- 5.
- Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services.
- 6.
- Interventions are needed to scale up CD4 count screening, especially for pregnant women.
- 7.
- Providers and those living with HIV need accurate information on how HIV is transmitted and how most effectively to reduce the likelihood of transmission among serodiscordant couples or between those who do not know their sero-status, including those who wish to become pregnant.
- 8.
- Providers need training on meeting the contraceptive needs of women and couples with HIV, including providing non-directive, informed choice counseling and reducing stigma and discrimination for women living with HIV.
- 9.
- Health service providers must make additional efforts to ensure confidentiality regarding patient’s serostatus.
- 10.
- Health care settings must address the needs of transgendered people and reduce barriers to services.
- 11.
- Health care settings need to offer appropriate, non-discriminatory services—and be attentive to HIV risk behaviors—to meet the sexual and reproductive health needs of WSW.
- 12.
- Interventions are needed to improve quality of HIV treatment and care within health services.
- 13.
- Interventions are needed to screen and treat both male and female sexual partners for STIs.
- 14.
- Programs for male circumcision need to provide women, as well as men, with detailed factual knowledge of the benefits and risks of voluntary medical male circumcision.
- 15.
- Efforts are needed to ensure that providing family-focused HIV care within maternal and child health programs doesn’t discourage men from seeking HIV services.
- 16.
- Policy guidelines, including service delivery guidelines, need to specify how contraception should be addressed in HIV prevention, treatment and care.
- 17.
- Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy and use condoms to reduce the likelihood of HIV transmission upon resumption of sexual activity.
- 18.
- Additional efforts are needed to reduce the risk of TB transmission in high risk, low resource settings.
- 19.
- A combination of infection control strategies may significantly reduce the rate of TB transmission, including drug-resistant TB, in high-risk, low-resourced health care settings.
1. Improved integration is needed between maternal, sexual and reproductive health services and HIV treatment services. A study found that even though 11.6% of 1,369 pregnant women were eligible for ARV treatment based on their low CD4 counts prior to delivery and 6 % were eligible postpartum, these women were not integrated into ARV treatment programs; another study found high rates of HIV in STI patients.
Gap noted, for example, in South Africa (Smit et al., 2011; Lebon et al., 2007; Mhlongo et al., 2010) and Burkina Faso (Windisch et al., 2011).
2. Health care providers must have access to gowns, gloves, needle-less systems and eye protection to decrease the risk of occupational exposure to HIV. [See also Delivery] Studies noted that gowns, gloves and eye protection should be used in all deliveries and in examinations or procedures likely to generate the splashing of blood or amniotic fluid.
Gap noted, for example, in Malawi (Namakhoma et al., 2010); generally (Anderson, 2005).
3. Ongoing efforts are needed for safe needle disposal. Studies found that used sharp needles were observed inside and outside facilities and that neither adequate disposal methods nor separation of medical waste from domestic waster occurred in health facilities.
Gap noted, for example, in South Africa (Mulumba et al., 2008).
4. Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services. [See Antenatal Care - Testing and Counseling]
5. Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services. [See Female Sex Workers]
6. Interventions are needed to scale up CD4 count screening, especially for pregnant women. [See Postpartum]
7. Providers and those living with HIV need accurate information on how HIV is transmitted and how most effectively to reduce the likelihood of transmission among serodiscordant couples or between those who do not know their sero-status, including those who wish to become pregnant. [See Staying Healthy and Reducing Transmission]
8. Providers need training on meeting the contraceptive needs of women and couples with HIV, including providing non-directive, informed choice counseling and reducing stigma and discrimination for women living with HIV. [See Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]
9. Health service providers must make additional efforts to ensure confidentiality regarding patient’s serostatus. [See also HIV Testing and Counseling for Women, Meeting the Sexual and Reproductive Health Needs of Women Living With HIV, Safe Motherhood and Prevention of Vertical Transmission , and Reducing Stigma and Discrimination] Numerous studies found that health workers and the structure of health services, such as services that are only for HIV-positive patients in physically separate parts of hospitals, violate patient confidentiality. In addition, health providers who brought services to women’s homes also violated their confidentiality.
Gap noted, for example, in Malawi (Chinkonde et al., 2009); Dominican Republic (CHANGE, 2009); a study in five countries – South Africa, Malawi, Swaziland, Lesotho and Tanzania (Greeff et al., 2008); and a review in Argentina, Mexico, Peru, Poland, Botswana, Kenya, Lesotho, Namibia, Nigeria, South Africa and Swaziland (de Bruyn, 2006a).
10. Health care settings must address the needs of transgendered people and reduce barriers to services. [See Transgender Women and Men]
11. Health care settings need to offer appropriate, non-discriminatory services—and be attentive to HIV risk behaviors—to meet the sexual and reproductive health needs of WSW. [See Women Who Have Sex With Women (WSW)]
12. Interventions are needed to improve quality of HIV treatment and care within health services. Studies found that guidelines for counseling were missing from facilities and that clients were referred for HIV testing and counseling in geographically distant locations based on donor preference.
Gap noted, for example, in India (Sogarwal et al., 2008); Vietnam (Nguyen et al., 2008b); South Africa (Orner et al., 2008); and Zambia (HRW, 2007).
13. Interventions are needed to screen and treat both male and female sexual partners for STIs. [See Treating Sexually Transmitted Infections (STIs)]
14. Programs for male circumcision need to provide women, as well as men, with detailed factual knowledge of the benefits and risks of voluntary medical male circumcision. [See Voluntary Medical Male Circumcision]
15. Efforts are needed to ensure that providing family-focused HIV care within maternal and child health programs doesn’t discourage men from seeking HIV services. A study found that men were excluded from PMTCT programs.
Gap noted, for example, in Côte d’Ivoire (Tonwe-Gold et al., 2009) and Zimbabwe (Skovdal et al., 2011b).
16. Policy guidelines, including service delivery guidelines, need to specify how contraception should be addressed in HIV prevention, treatment and care. [See Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]
17. Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy and use condoms to reduce the likelihood of HIV transmission upon resumption of sexual activity. [See Postpartum and Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]
18. Additional efforts are needed to reduce the risk of TB transmission in high risk, low resource settings. Studies found that significant TB transmission occurs in health care settings, particularly among nurses.
Gap noted, for example, in a global review (Joshi et al., 2006); Kenya (Galgalo et al., 2008); South Africa (Naidoo and Jinabhai, 2006); Romania (Sotgiu et al., 2008); Russia (Dimitrova et al., 2005); South Korea (Jo et al., 2008).
19. A combination of infection control strategies may significantly reduce the rate of TB transmission, including drug-resistant TB, in high-risk, low-resourced health care settings. A mathematical model was created to simulate TB transmission in high TB/HIV prevalent settings. The model showed that masks alone would prevent 10% of new transmission in an overall epidemic, but could prevent a large proportion of XDR-TB cases among hospital staff. The combination of mask and reduced hospitalization with a shift to outpatient treatment could prevent nearly one-third of XDR-TB cases. Approximately 48% of XDR-TB cases could be averted by the end of 2012, if a combination of mask, reduced hospitalization with shift to outpatient treatment, improved ventilation, rapid drug resistance testing, HIV treatment and TB isolation facilities for highly infectious patients were implemented.
Gap noted, for example, in South Africa (Basu et al., 2007).