What Works—Structuring Health Services to Meet Women’s Needs
Gaps in Research
- 1.
- Improved integration is needed between maternal health services and HIV treatment services.
- 2.
- Providers must have access to gowns, gloves and eye protection to decrease the risk of occupational exposure.
- 3.
- Ongoing efforts are needed for safe needle disposal.
- 4.
- Reliable drug and lab supplies are necessary to ensure adherence.
- 5.
- Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services.
- 6.
- Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services.
- 7.
- Providers need training on contraception, including non-directive counseling and reducing stigma and discrimination for women living with HIV.
- 8.
- Health service providers must make additional efforts to ensure confidentiality regarding patient’s serostatus.
- 9.
- Health care settings must address the needs of transgendered people and reduce barriers to services.
- 10.
- Where abortion is legal, providers should be trained not to discriminate against HIV-positive women who want to terminate their pregnancies.
- 11.
- Interventions are needed to improve quality of HIV treatment and care within health services.
- 12.
- Interventions are needed to screen and treat both male and female sexual partners for STIs.
- 13.
- 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.
- 14.
- Policy guidelines need to specify how contraception should be addressed in HIV prevention, treatment and care.
- 15.
- Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy.
- 16.
- Additional efforts are needed to reduce the risk of TB transmission in high risk, low resource settings.
1. Improved integration is needed between maternal 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.
Gap noted, for example, in South Africa.
Lebon, A., R. Bland, N. Rollins, A. Coutsoudis, H. Coovadia and M. Newell. 2007. “CD4 Counts of HIV-Infected Pregnant Women and their Infected Infants – Implications for PMTCT and Treatment Programmes.” Tropical Medicine and International Health12(12): 1472-1474.
2. Providers must have access to gowns, gloves and eye protection to decrease the risk of occupational exposure. 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 Georgia (Butsashvili et al., 2008); Nigeria (Ohajinwa, 2008); generally (Anderson, 2005).
Butsashvili, M., G. Kamkamidze, M. Kajala, M. Topuridze, W. Triner and L. McNutt. 2008. “Moving Toward Universal Precautions in Practice: Understanding the Hospital Environment in Georgia, 2006-2007.” Abstract MOPE0284. XVII International AIDS Conference. Mexico City, Mexico. August 3-8.
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) and Nigeria (Bankole et al., 2008).
Mulumba, R., M.L. Field-Nguer, J. Sekgothe, C. Lombard, N. Swebushe, Q. rgers-Bloch and J. Nicholson. 2008. “What Do Expanded HIV Services Leave Behind? Finding and Implications from South Africa’s First National Survey on Injection Safety and Health Care Management.” Abstract WEPE0240. XVII International AIDS Conference. Mexico City, Mexico. August 3-8.
4. Reliable drug and lab supplies are necessary to ensure adherence. A study found that 10% of 578 people (27% female) reported missing doses of ARV therapy due to shortages in drug supplies.
Gap noted, for example, in Peru.
Giron, J., R. Valverde, E. Segura, A. Rosasco and C. Caceres. 2008. “People Living with HIV/AIDS’ Perceptions about Health Care Services and ARV Uptake – Partial Finding of the Global HIV/AIDS Initiatives Network’s Peru-Based Study.” Abstract MOPE0898. XVII International AIDS Conference. Mexico City, Mexico. August 3-8.
5. Improved record keeping on HIV counseling, serostatus, and treatment is needed to improve referrals and linkages with other health care services.
Back to Top6. Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services.
Back to Top7. Providers need training on contraception, including non-directive counseling and reducing stigma and discrimination for women living with HIV.
Back to Top8. Health service providers must make additional efforts to ensure confidentiality regarding patient’s serostatus. 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).
Chinkonde, J., J. Sundby and F. Martinson. 2009. “The Prevention of Mother-to-Child HIV Transmission Programme in Lilongwe, Malawi: Why Do So Many Women Drop Out?” Reproductive Health Matters 17 (33): 143-151.
9. Health care settings must address the needs of transgendered people and reduce barriers to services.
Back to Top10. Where abortion is legal, providers should be trained not to discriminate against HIV-positive women who want to terminate their pregnancies. A study found that even where abortion is legal, women living with HIV who wanted an abortion experienced discrimination based on their HIV-positive serostatus.
Gap noted, for example, in Vietnam.
Nguyen, T., P. Oosterhoff, Y. Ngoc, P. Wright and A. Hardon. 2008f. “Barriers to Access to Prevention of Mother-to-Child Transmission for HIV Positive Women in a Well-resourced Setting in Vietnam.” AIDS Research and Therapy 5:7.
11. 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 VCT 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).
Sogarwal, R., D. Bachani and K. Rao. 2008. “Situational Analysis and Client Satisfaction Evaluation of ART Centers in India.” Abstract MOPE0887. XVII International AIDS Conference. Mexico City, Mexico. August 3-8.
12. Interventions are needed to screen and treat both male and female sexual partners for STIs.
Back to Top13. 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, B., D. Ekouevi, C. Bosse, S. Toure, M. Koné, R. Becquet, V. Leroy, P. Toro, F. Dabis, W. El Sadr and E. Abrams. 2009. “Implementing Family-Focused HIV Care and Treatment: The First 2 Years’ Experience of the Mother-to-Child Transmission-Plus Program in Abidjan, Côte d’Ivoire.” Tropical Medicine and International Health 14(2): 204-212.
14. Policy guidelines need to specify how contraception should be addressed in HIV prevention, treatment and care. _[_See Chapter 8. Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]
Back to Top15. Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy. _[_See Chapter 9E. Safe Motherhood and Prevention of Vertical Transmission: Postpartum and Chapter 8. Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]
Back to Top16. 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).
Joshi, R., A. Reingold, D. Menzies and R. Pai. 2006. “Tuberculosis among Health Care Workers in Low- and Middle-Income Countries: A Systematic Review.” PLoS Medicine3 (12): e94. www.plosmedicine.org