Abstract
It is critical to include a sexual and reproductive health lens in HIV programming as most HIV transmission occurs through sexual intercourse. As global attention is focusing on the sexual and reproductive health needs of women living with HIV, identifying which interventions work becomes vitally important. What evidence exists to support sexual and reproductive health programming related to HIV programmes?This article reviews the evidence of what works to meet the sexual and reproductive health needs of women living with HIV in developing countries and includes 35 studies and evaluations of eight general interventions using various methods of implementation science from 15 countries. Data are primarily from 2000-2009. Searches to identify effective evaluations used SCOPUS, Popline, Medline, websites and consultations with experts. Evidence was ranked using the Gray Scale.A range of successful and promising interventions to improve the sexual and reproductive health and rights of women living with HIV include: providing contraceptives and family planning counselling as part of HIV services; ensuring early postpartum visits providing family planning and HIV information and services; providing youth-friendly services; supporting information and skills building; supporting disclosure; providing cervical cancer screening; and promoting condom use for dual protection against pregnancy and HIV. Provision of antiretrovirals can also increase protective behaviours, including condom use.While many gaps in programming and research remain, much can be done now to operationalize evidence-based effective interventions to meet the sexual and reproductive health needs of women living with HIV.
Highlights
It is critical to include a sexual and reproductive health lens in HIV programming as most HIV transmission occurs through sexual intercourse
Eight studies in this review show that providing antiretroviral treatment to people living with HIV, along with counselling on safer sex, can increase HIV prevention behaviours, including condom use [53,54,55,56,57,58,59,60]
A study of 372 sex workers in Ethiopia found that those women who used condoms for contraception were more likely to use condoms consistently (65% compared with 24%) [65]
Summary
A meta-analysis of 14 articles with studies that included 3324 HIV-positive people, most in the USA, found that motivational and behavioural skills building concerning sexual risks increased condom use [45]. One study in Zambia with 180 women found safer sex skills training on HIV prevention and transmission, communication, conflict resolution and sexual negotiation resulted in female participants reporting increased condom use, with 94% of the women reporting using condoms all of the time [47]. Eight studies in this review show that providing antiretroviral treatment to people living with HIV, along with counselling on safer sex, can increase HIV prevention behaviours, including condom use [53,54,55,56,57,58,59,60]. A study of 372 sex workers in Ethiopia found that those women who used condoms for contraception were more likely to use condoms consistently (65% compared with 24%) [65]
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