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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 %{s:67}] 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.
Adolescents living with HIV need information and services through adolescent-friendly HIV services on a number of topics, including disclosure, safer sex, contraception, safe motherhood and gender-based violence. Studies found that health providers were unprepared to discuss HIV and contraception with adolescents who acquired HIV through perinatal transmission, despite the fact that significant numbers of these adolescents were already sexually active. Another study found that these adolescents need skills to disclose their serostatus to sexual partner. WHO recommends that perinatally infected adolescents be advised of their positive serostatus by age 6 (WHO, 2013) but there is little guidance on disclosure for adolescents. Facilitated disclosure by parents and providers to adolescents living with HIV may lead to higher retention in HIV care (Arrive et al., 2012). Parents living with HIV whose adolescents may be living with HIV also need assistance to disclose to their adolescents, as parents fear rejection from their children. Positive health dignity and prevention interventions can help people living with HIV lead healthy lives and reduce HIV transmission, but tailored interventions for adolescents and their parents have not been evaluated for effectiveness, although a trial is currently ongoing (Cunningham, 2015; Mofeson and Cotton, 2013). One study found that 29% of young women aged 16 to 24 living with HIV reported being forced to have sex. No validated curriculum that was shown to be effective for reducing unsafe sex among adolescents living with HIV was found, although some manuals have been developed (Parker et al., 2013c; UNESCO and GNP+, 2012).
Care and Support
Care and support generally includes both care of people living with HIV and AIDS and of families and children affected by HIV and AIDS. UNAIDS includes in its definition home- and community-based care (HCBC), palliative care, psychological support, carer support, and nutrition support. Among these, HCBC is meant to be the foundation on which national antiretroviral treatment programmes are buil...
Advancing Education
Increasing girls' access to education is critical to combating the AIDS pandemic. "There is a well-established protective effect of schooling on HIV risk" (Pettifor et al., 2008a; Hargreaves et al., 2008a; Jukes et al., 2008 cited in Pettifor et al., 2012a: 1). Education of girls is associated with delayed marriage and childbearing, lower fertility, healthier babies, and increased earning poten...
Adolescents can achieve viral suppression and remain adherent, with low loss to follow up
Increasing Access to Services
3 studies
Gray
IIIb
Jamaica, South America, adherence, treatment, young people
Africa, Asia, Cambodia, India, Indonesia, Malaysia, North America, Thailand, Vietnam
Women and Girls
By all estimates, most care and support is provided in the home and women provide two-thirds or more of that care and support (Ogden et al., 2006; Homan et al., 2005b; Akintola, 2006; UN, 2008b; Nyangara et al., 2009b; Surkan et al., 2010). However, this means that one-third of care and support is provided by men, and some have argued that making this more visible can shift gender norms and inc...
Community or school-based HIV education can reduce stigmatizing attitudes towards those living with HIV
Mitigating Risk
6 studies
Gray
IIIa, IIIb, V
Lao PDR, adolescents, communication, education, knowledge, self-perception, sex education, sexual behavior, stigma
China, South Africa, Thailand, Uganda
Pre-Conception
Although many women do not learn their HIV status until they become pregnant, for those women who know they are HIV-positive prior to choosing to become pregnant, pre-conception assessments may inform both her and her partner of the safest way to become pregnant without HIV transmission to the infant or HIV transmission between serodiscordant couples. Therefore, throughout their reproductive ye...
Women Who Have Sex With Women (WSW)
At least seventy-six countries criminalize consensual samesex relations, making access to HIV prevention, treatment and care a challenge for women who have sex with women (UN General Assembly, 2011). According to a report by the International Gay and Lesbian Human Rights Commission, although prevalence rates are lower than heterosexual women, same-sex practicing South African women self-report ...
Transforming Gender Norms
Gender norms stand in the way of reducing HIV; indeed, a recent study states that, "The global HIV pandemic in its current form cannot be effectively arrested without fundamental transformation of gender norms" (Dunkle and Jewkes, 2007: 173). As former U.S. Secretary of State Hillary Clinton stated: "Achieving our objectives for global development will demand accelerated efforts to achieve gend...
Preventing Unintended Pregnancies
Reducing unmet need for family planning so that all women who do not want to become pregnant now or in the future have access to contraception could have a significant effect on preventing perinatal transmission of HIV -- in part because many women do not know their HIV status. "Increasing voluntary contraceptive use had been an underused approach, despite clear evidence that preventing pregnan...
Preventing unintended pregnancies can reduce perinatal transmission.* [See also %{c:15}]
Preventing Unintended Pregnancies
4 studies
Gray
V
PMTCT, contraception, family planning, pregnancy, treatment
Botswana, Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Guyana, Haiti and Vietnam, India, Kenya, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, Zimbabwe
Increasing Access to Services
While the literature on access to HIV services by adolescents is limited, the literature on access to sexual and reproductive health services more broadly demonstrates that youth-friendly approaches can increase use of reproductive health care services by female adolescents (Gay et al., 2015). Young peoples service needs are frequently overlooked in HIV programming that is not specifically for ...