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      Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS

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          Abstract

          Introduction

          The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.

          Methods

          A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines.

          Results and discussion

          The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research.

          Conclusions

          This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women's health outcomes.

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          Most cited references103

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          Intersectionality and the determinants of health: a Canadian perspective

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            Social stigma concerns and HIV medication adherence.

            The threat of social stigma may prevent people living with HIV from revealing their status to others and serve as a barrier to HIV treatment adherence. We evaluated the effect of such concerns on self-reported treatment adherence using a short, three-item measure among 204 people living with HIV. Overall, the mean age of participants was 40.1 years, 45% were African American, and 80% were male. People with high HIV stigma concerns were 2.5 times less likely to define and interpret the meaning of CD4 count correctly and 3.3 times more likely to be nonadherent to their medication regimen than those with low concerns. Concern over revealing HIV status was the only statistically significant, independent predictor of adherence in multivariate analysis. Clinical care directed to individuals living with HIV should therefore include considerations for patient sensitivity to social stigma, such as modifications to medication schedules and referrals for counseling prior to enrollment in antiretroviral therapies.
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              HIV/AIDS in women: an expanding epidemic.

              More than 20 years into the human immunodeficiency virus-type 1 (HIV-1) epidemic, women account for nearly half of the 40 million people living with HIV-1 worldwide, with an even higher proportion existing in developing countries. Social determinants of female vulnerability to HIV-1 include gender disparities, poverty, cultural and sexual norms, lack of education, and violence. Women are also more susceptible to HIV-1 because of hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases. Prevention strategies must address the wide range of gender inequalities that promote the dissemination of HIV-1.
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                Author and article information

                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                JIAS
                Journal of the International AIDS Society
                International AIDS Society
                1758-2652
                11 January 2013
                2013
                : 16
                : 1
                : 17433
                Affiliations
                [1 ]Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
                [2 ]British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
                [3 ]Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
                [4 ]McGill University Health Centre, Montreal, Canada
                [5 ]Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada
                [6 ]McMaster University, Faculty of Social Work, Hamilton, Ontario, Canada
                [7 ]ViVA, British Columbia, Canada
                [8 ]All additional research team members are listed at the end of the article
                Author notes
                [§ ] Corresponding author: Mona R Loutfy, Women's College Research Institute, Women's College Hospital, 790 Bay Street, Room 743, Toronto, Ontario M5G 2N8, Canada. Tel: 011 1 416 351 3732. Fax: 011 1 416 351 3746. ( mona.loutfy@ 123456wchospital.ca )
                Article
                17433
                10.7448/IAS.16.1.17433
                3545274
                23336725
                69b5b9a2-9008-4b24-8918-5efac8a8cf54
                © 2013 Carter AJ et al; licensee International AIDS Society

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 May 2012
                : 25 October 2012
                : 05 December 2012
                Categories
                Review Article

                Infectious disease & Microbiology
                chiwos,gender,health services,hiv,hiv/aids programming,women,women-centred care,women-specific services

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