Showing 41 - 60 of 107 Results for "Malawi"

Results

Women’s right and access to, and control over, an equitable share of marital property and inheritance, including land, needs to be recognized and protected in law and practice.
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Health service providers must make additional efforts to ensure confidentiality regarding patient’s serostatus. [See also %{c:11}, %{c:15}, %{c:17}, and %{s:67}] 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.
Structuring Health Services to Meet Women’s Needs
1 study
Programs are needed that link interventions addressing HIV/AIDS and child abuse. One report found that no PEP access guidelines exist for children who were raped and were under the age of 14. Other studies found high risk behavior among those who had been sexually abused as children.
Addressing Violence Against Women
1 study
Supportive legal and policy frameworks are needed to prevent and redress all forms of violence against women, particularly women living with HIV, women engaged in sex work and women who have sex with women, including in intimate partner settings. [See %{c:7} and %{s:59}]
Advancing Human Rights and Access to Justice for Women and Girls
1 study
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.
Women and Girls
1 study
Further efforts are needed to determine the optimal frequency of testing in order to minimize HIV transmission in a cost-effective way. In some settings, testing for acute infection is warranted which would require testing every three to six months. A study found that 12% of women and 10% of women who had reported testing HIV-negative were found to be seropositive one to two years later. Modeling studies have found that screening one time, annually, can be cost-effective and that yearly testing in a high incidence area found that potential high-risk transmission with high viral load could be reduced by yearly HIV testing.
HIV Testing and Counseling for Women
1 study
Further efforts are needed to guarantee confidentiality of HIV test results. A study found that nurses and physicians did not access HTC because of fears of confidentiality.
HIV Testing and Counseling for Women
1 study
Improvements are needed in health services, such as increased or flexible clinic hours, to reduce wait times and to encourage ART initiation. Interviews with people living with HIV eligible for ART who refused ART found that "the problem is…services….The process is so long" (Musheke et al., 2013a: 236). In addition, waiting to access ART jeopardizes livelihoods. Information systems that can track patients across sites can assist in tracking patients who need care.
Provision and Access
1 study
Research and interventions are needed to better to support people living with HIV with disclosure and reduce stigma so they can adhere to ART and can continue to have a healthy and safer sex life. In-depth interviews with patients in South Africa who were acutely infected found that patients did not retain the information that they are very likely to transmit HIV and that condom use was particularly important, but were focused on identifying who transmitted HIV to them. In addition, patients were still in shock on learning of their HIV status and did not understand how they could be HIV-positive if they tested negative with a rapid HIV test (Wolpaw et al., 2014). Women who were acutely infected in South Africa faced profound "challenges, immediately after HIV diagnosis" (Tomita et al., 2014b: 1118). Focus groups of women living with HIV found that women were concerned that their access to lifelong treatment when becoming pregnant may discourage their men from condom use, as men know that treatment can decrease the risk of transmission.
Staying Healthy and Reducing Transmission
1 study
Further research is needed to understand the links between mastitis and vertical transmission. Studies found that maternal HIV infection was correlated with mastitis and the potential for vertical transmission.
Postpartum
1 study
HIV-positive mothers, fathers, grandmothers and the larger community need clear, consistent, non-contradictory and nonjudgmental counseling on infant feeding practices. Health care providers need training based on accurate information. Studies found that health care providers gave HIV-positive women conflicting information and that simplified structured counseling tools are needed. Studies found that women reported that providers accused them of killing their infants if they breastfed. Women lack access to infant formula but have been told by providers that it is the only way for their infant to survive. Women were told that breastfeeding is a mode of HIV transmission and exclusive breastfeeding is a mode of prevention. Women fear HIV more than diarrheal disease, even though more deaths occur from diarrheal disease. Women were not given choices. Women did not give providers accurate information on how they were feeding their infant for fear of being denied health care. Women were told to feed their infants formula yet did not have adequate food support, most mothers could not do so with few having an income and most with no access to safe drinking water. Women lacked autonomy to decide infant feeding, which was decided by male partners or grandmothers. "Despite the current WHO recommendations to use extended infant prophylaxis as long as the infant is breastfed, no data are yet available from a clinical trial to confirm effectiveness and safety of this regimen beyond the first six months postpartum" (Taha, 2011: 919).
Postpartum
1 study
Further interventions are needed to reduce stigma and discrimination against women, specifically, who are at high risk or living with HIV. [See also %{s:45}] Studies found that women and girls are highly stigmatized if they test positive for HIV. Stigma impacts the HIV-positive woman, herself, as well as her children, her siblings and her family. Some providers also discriminate against those living with HIV.
Reducing Stigma and Discrimination
1 study
Further research is needed on infant transmission risks of malaria and/or HIV in pregnant women who have malaria-HIV co-infection.
Malaria
1 study
Efforts are needed to implement and research interventions to alleviate stigma and discrimination on the basis of HIV status, gender, sexual orientation, gender identity, sex work and drug use in the health care sector, social services, police and the judiciary. [See %{s:67} and %{c:7}]
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Interventions are needed to reduce homophobia, which may lead MSM to have partnerships with women. Studies found that homosexuality was heavily stigmatized and that gender norms pressured MSM to marry and have families.
Partner Reduction
1 study
Sex and age disaggregated data is critical to assess which ages are falling through the cracks in data collection. Current HIV data collection masks critically needed data on adolescents ages 10 to 19. For example, a study that disaggregated ages found that loss to follow up for patients aged 10 to 24 was twice as high for ages 15 to 19 than for ages 10 to 14 (Koech et al., 2014).
Increasing Access to Services
1 study
Adequate supply planning and secure funding are needed to avoid ARV stock-outs and use of obsolete medications. "As ART cannot be interrupted without risk of development of drug resistance – and hence worse survival – people on ART need an uninterrupted supply…" (WHO, 2014a: 32). The Coordinated Procurement Planning Initiative, which monitors the supply of ARVs in 22 countries, found that at any point half of these countries were at high risk of stock out (WHO, 2014a).  Between 30% and 45% of low- and middle-income countries have annually reported stock outs in recent years (WHO, 2014a).  Studies in multiple sub-Saharan African countries report stock shortages and stock outs as major risk factors for treatment interruption. "….Models of supply chain management need to be directly tied to health outcomes to ensure that the priority is improving health rather then reducing costs" (Ying et al., 2014, para 17).
Provision and Access
1 study
Well-functioning laboratory systems are needed to measure viral load via PCR to assess effectiveness of treatment. However, adequate clinical results can also be cost-effective and meet patient needs. A study in sub-Saharan Africa found that more than half of test results for viral load were invalid or inaccurate. A review done in low and middle-income countries showed that lack of routine virologic monitoring in resource limited ART programs led to the development of cross-resistance to the NRTI component of second-line treatment. Even where virological monitoring is available and demonstrates virological failure, delayed switching of patients to alternative antiretroviral therapy regimens occurs.
Provision and Access
1 study
Increased detection of acute infection, along with immediate, effective counseling and support is needed. A trial is underway in Botswana to identify those with high viral loads to initiate treatment (Novitsky et al., 2010 cited in Delva and Abdool Karim, 2014).
Staying Healthy and Reducing Transmission
1 study
Interventions, including community based distribution of cART and/or funds for transport, are needed to reach pregnant women living with HIV who do not access ANC, postpartum care or cART. “Restrictions on women’s mobility and lack of access to transportation and financial resources may limit their ability to seek PMTCT services” (Ghanotakis et al., 2012: table 2).
Antenatal Care - Treatment
1 study