Papers by Melanie Croce-galis
Strategies for Change: Breaking Barriers to HIV Prevention, Treatment, and Care for Women examine... more Strategies for Change: Breaking Barriers to HIV Prevention, Treatment, and Care for Women examines innovative empowerment, legal, economic, and health services strategies for a more "woman-friendly" response to HIV. Produced by OSI, this report highlights the efforts of HIV activists, women's advocates, and health experts to address the needs of women who are often marginalized by society, including sex workers, drug users, and women living with HIV. The programs described in this report vary widely in scope, targets, and implementation, but they all put women at the center. They were designed for, and in many cases by, the women whose needs are being addressed, whether they are rural grandmothers in Swaziland or sex workers in Rio de Janeiro.
Antiretroviral treatment (ART) for women living with HIV is vital to ensuring safe motherhood and... more Antiretroviral treatment (ART) for women living with HIV is vital to ensuring safe motherhood and reducing vertical transmission. Each year, as many as 42,000 women living with HIV die of HIV and pregnancy-related complications. While significant progress has been made with 93% of pregnant women in 22 priority countries who have accessed combination ART (or cART, formerly called HAART), not all pregnant women can access treatment. In low- and middle-income countries in particular, treatment access for pregnant women living with HIV has been hampered by availability of medications and standardized treatment eligibility criteria that traditionally prioritized prevention of HIV transmission to the infant over treatment for the health of the woman. This brief summarizes the issues, interventions, and evidence as of 2016.
This report is part of a larger project, conducted in Burkina Faso, Ghana, Malawi and Uganda, tit... more This report is part of a larger project, conducted in Burkina Faso, Ghana, Malawi and Uganda, titled Protecting the Next Generation: Understanding HIV Risk Among Youth. The project was designed to contribute to the global fight against the growing HIV/AIDS epidemic among adolescents by documenting and analyzing young people's sexual and reproductive health needs; communicating the new research findings to a broad audience to raise awareness; and stimulating the development of improved policies and programs to serve youth. Many individuals contributed to the successful implementation of the Protecting the Next Generation project. The research design, instruments and analytic approaches were developed by Georges Guiella and Christine Ouedraogo,
Protecting the Next Generation in Uganda: New Evidence on Adolescent Sexual and Reproductive Health Needs was
copyedited by Susan London, independent consultant.
This brief offers priority interventions for programmers based on evidence from successful progra... more This brief offers priority interventions for programmers based on evidence from successful programming for women and girls; though a number of the interventions listed also benefit men and boys. The brief is divided into three parts: evidence-informed priority areas for programming; implementation and research gaps that must be addressed; and considerations for scaling up successful programming for girls and young women. The interventions described here are based on a thorough review of global evidence; however, each country and community response must be tailored to meet the specific opportunities and challenges faced locally.
This brief offers priority interventions for programmers based on evidence from successful progra... more This brief offers priority interventions for programmers based on evidence from successful programming for women and girls; though a number of the interventions listed also benefit men and boys. The brief is divided into three parts: evidence-informed priority areas for programming; implementation and research gaps that must be addressed; and considerations for scaling up successful programming for girls and young women. The interventions described here are based on a thorough review of global evidence; however, each country and community response must be tailored to meet the specific opportunities and challenges faced locally.
The surveys could not have been fielded successfully without the participation and hard work of t... more The surveys could not have been fielded successfully without the participation and hard work of the field supervisors and interviewers, who are listed on the inside back cover.
The purpose of this book is to provide the evidence necessary to inform country-level programming... more The purpose of this book is to provide the evidence necessary to inform country-level programming. What Works is a comprehensive review spanning 2000 articles and reports with data from more than 90 countries that has uncovered a number of interventions for which there is substantial evidence of success: from prevention treatment care and support to strengthening the enabling environment for policies and programming. It also highlights a number of gaps in programming that remain.
Review article Strengthening the enabling environment for women and girls: what is the evidence in social and structural approaches
in the HIV response?
the 90-90-90 goal. Given that there are few evaluated gender interventions for HIV treatment, the... more the 90-90-90 goal. Given that there are few evaluated gender interventions for HIV treatment, these priority actions, along with additional questions for implementation science, are based on programmatic and technical expertise, as well as a review of the literature. The actions can be carried out at multiple levels such as at the community, clinic and policy levels and, though far from a comprehensive list, illustrate how a gender lens can be useful in ensuring equity in treatment access and adherence. Further dialogue, research, programming, and importantly-evaluation-is needed with input from multiple stakeholders.
Given that moving evidence from a study to policy, programs and practice can often take a decade ... more Given that moving evidence from a study to policy, programs and practice can often take a decade or more, what is the best way to get evidence in the hands of those developing policies and programs to speed its use? Enhancing the use of evidence in policies and programs through an innovative web-based knowledge platform, What Works for Women: Evidence for HIV/AIDS Interventions (www.whatworksforwomen.org), resulted in major changes in National Strategic HIV Plans plus Concept Notes submitted to the Global Fund for AIDS, TB and Malaria in fourteen countries in Africa, Asia, and Latin America. Additionally, the What Works platform has been a key resource for key institutions in the HIV pandemic: PEPFAR, Global Fund, UNAIDS and civil society organizations. Lessons learned from the creation and dissemination of this knowledge platform may be useful for many other potential applications to increasing evidence-informed, gender responsive policies.
Reproductive health, Jan 23, 2017
Although the range of contraceptives includes methods for men, namely condoms, vasectomy and with... more Although the range of contraceptives includes methods for men, namely condoms, vasectomy and withdrawal that men use directly, and the Standard Days Method (SDM) that requires their participation, family planning programming has primarily focused on women. What is known about reaching men as contraceptive users? This paper draws from a review of 47 interventions that reached men and proposes 10 key considerations for strengthening programming for men as contraceptive users. A review of programming shows that men and boys are not particularly well served by programs. Most programs operate from the perspective that women are contraceptive users and that men should support their partners, with insufficient attention to reaching men as contraceptive users in their own right. The notion that family planning is women's business only is outdated. There is sufficient evidence demonstrating men's desire for information and services, as well as men's positive response to existing ...
Journal of the International AIDS Society, 2011
It is critical to include a sexual and reproductive health lens in HIV programming as most HIV tr... more 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 youthfriendly 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.
Journal of the International AIDS Society, 2014
There is growing interest in expanding public health approaches that address social and structura... more There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women's employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows' ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Background: Adolescent girls face unique challenges in reducing their risk of acquiring HIV becau... more Background: Adolescent girls face unique challenges in reducing their risk of acquiring HIV because of gender inequalities, but much of HIV programming and evaluation lacks a specific focus on female adolescents. Methods: This article, based on a review of 150 studies and evaluations from 2001 to June 2013, reviews evidence on programming for adolescents that is effective for girls or could be adapted to be effective for girls. The evidence suggests specific interventions for adolescent girls across 3 critical areas: (1) an enabling environment, including keeping girls in school, promoting gender equity, strengthening protective legal norms, and reducing gender-based violence; (2) information and service needs, including provision of age-appropriate comprehensive sex education, increasing knowledge about and access to information and services, and expanding harm reduction programs for adolescent girls who inject drugs; and (3) social support, including promoting caring relationships with adults and providing support for adolescent female orphans and vulnerable children. Discussion: Numerous gaps remain in evidence-based programming for adolescent girls, including a lack of sex-and agedisaggregated data and the fact that many programs are not explicitly designed or evaluated with adolescents in mind. However, evidence reinforces bolstering critical areas such as education, services, and support for adolescent girls. Conclusions: This article contributes to the growing body of literature on HIV and adolescent girls and reviews the vulnerabilities of girls, articulates the challenges of programming, develops a framework for addressing the needs of girls, and reviews the evidence for successful programming for adolescent girls.
What Works Association aims to improve the lives of women and men through evidence-based guidance... more What Works Association aims to improve the lives of women and men through evidence-based guidance on policies and programs that promote gender equality.
What Works for Women and Girls: Evidence for HIV/AIDS Interventions for Women Drug Users
While female intravenous drug users (IDUs) are at high risk of acquiring HIV from needle sharing ... more While female intravenous drug users (IDUs) are at high risk of acquiring HIV from needle sharing and unsafe sex in numerous countries in Asia, Africa, Latin America and Eastern Europe, most programs have been designed for male IDUs. Harm reduction programs have been found to be effective and can be scaled up. Opioid substitution therapy is effective and can be used during pregnancy. Peer eduction can increase behaviors which protect against HIV acquisitioni. Harm reduction programs can also reduce HIV prevelance in female prison populations. Soem promising strategies include sex-segregated group sessions for IDUs to increase condom use and safe injections behaviors. Women's clubs can reduce HIV prevalence. Programming to prevent initiation of drug use can reduce behaviors that place women at risk of acquiring HIV. Many couples still need a better understanding of the risks of acquiring HIV through both sex and needle sharing. Increased access is needed for harm reduction. Interv...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Background: Adolescent girls face unique challenges in reducing their risk of acquiring HIV becau... more Background: Adolescent girls face unique challenges in reducing their risk of acquiring HIV because of gender inequalities, but much of HIV programming and evaluation lacks a specific focus on female adolescents.
Journal of the International AIDS Society, 2011
Background: Adolescent girls face unique challenges in reducing their risk of acquiring HIV becau... more Background: Adolescent girls face unique challenges in reducing their risk of acquiring HIV because of gender inequalities, but much of HIV programming and evaluation lacks a specific focus on female adolescents.
Journal of the International AIDS Society, 2014
There is growing interest in expanding public health approaches that address social and structura... more There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women's employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows' ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.
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Papers by Melanie Croce-galis