What works to prevent child marriage: a review of the evidence.

This article reviews 23 child marriage prevention programs carried out in low-income countries and employing a range of programmatic approaches and evaluation strategies. We document the types of child marriage programs that have been implemented, assess how they have been evaluated, describe the main limitations of these evaluations, summarize the evaluation results, and make recommendations to improve future prevention efforts. The evidence suggests that programs offering incentives and attempting to empower girls can be effective in preventing child marriage and can foster change relatively quickly.

Two sons and a daughter: sex composition and women's reproductive behaviour in Madhya Pradesh, India.

This article examines how the sex composition of women's current children at the start of a pregnancy interval influences both fertility desires and the full range of reproductive actions women may take to realize them, including temporary contraception, abortion and sterilization, in Madhya Pradesh, India, where popular notions of ideal family size and sex composition are dominated by son preference. The analysis is conducted using a dataset of 9127 individual pregnancy intervals from a 2002 statewide representative survey of 2444 women aged 15-39 with at least one child. The results indicate that women's preferences go beyond a singular preference for male children, with the preferred composition of children being two boys and one girl.

Violence in contract work among female sex workers in Andhra Pradesh, India.

Background: Female sex workers (FSWs) are vulnerable to physical and sexual violence at work. This article examines the prevalence of recent physical and sexual violence victimization and associations of type of sex work among a large sample of young FSWs.

Method: We used data from a cross-sectional survey on sex trafficking and sex work in southern India that included 1138 FSWs aged 18-25 years residing in 3 districts of Andhra Pradesh state.

Moving forward on women's gender-related HIV vulnerability: the good news, the bad news and what to do about it.

The global response to AIDS has triggered unprecedented attention to gender inequality and the role it plays in shaping the vulnerability of women. Tragically, however, this attention has not yet led to wide-scale transformations in gender roles, or reductions in gender-related risk. This paper reviews both knowledge and action on the impact of gender inequality on women in the context of HIV prevention, and argues that, while much is known, and while effective strategies do exist, impact on a population level will not be achieved unless gender considerations are integrated into an evidence-informed comprehensive national strategy.

More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa.

Background: 'Transactional sex' was regarded by the mid-1990s as an important determinant of HIV transmission, particularly in sub-Saharan Africa. Little attention has been paid to what the terms used to denote transactional sex suggest about how it is understood. This study provides a nuanced set of descriptions of the meaning of transactional sex in three settings.

Women and reproductive control: the nexus between abortion and contraceptive use in Madhya Pradesh, India.

This article examines the determinants of contraceptive and abortion behavior and how each of these influences the other, with an emphasis on the role of women's life-course stage and experience. We base our approach on life-course theory, which argues that behavior is influenced by current circumstances as well as experiences over the life course. We use data collected for every pregnancy experienced by 2,444 women in Madhya Pradesh, India, to explore use of temporary contraceptive methods (both modern and traditional) and sterilization, as well as abortion attempts.

Evaluation of a peer network-based sexual risk reduction intervention for men in beer halls in Zimbabwe: results from a randomized controlled trial.

While much emphasis has been placed on involving men in AIDS prevention in sub-Saharan Africa, there remain few rigorously evaluated interventions in this area. A particularly appealing point of intervention is the sexual risk behavior associated with men's alcohol consumption. This article reports the outcomes of The Sahwira HIV Prevention Program, a male-focused, peer-based intervention promoting the idea that men can assist their friends in avoiding high-risk sexual encounters associated with alcohol drinking.

Son preference and sterilisation use among young married women in two slums in Bengaluru city, India.

This paper explores the ways in which women's sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16-25 to explore how having sons and the number of children influence a woman's sterilisation decision.

Self-reported abortion-related morbidity: a comparison of measures in Madhya Pradesh, India.

Context: Globally, abortion-related morbidity places a largely unmeasured physical, social and economic burden on women, yet little research has examined population-level morbidity, particularly in developing countries.

Methods: Data were drawn from a representative 2002 survey in Madhya Pradesh, India, of married women aged 15-39 who had at least one child; the analysis examined 966 abortion attempts associated with 737 pregnancies. The prevalence and severity of self-reported morbidity were determined using a symptom-based measure and a bed rest-based measure.

Women's empowerment and reproductive experiences over the lifecourse.

This paper examines the complex interplay between reproductive experiences and women's empowerment using rich life history data from a survey in India. Previous research has examined the influence of a rather limited range of reproductive events, focusing on how many children or sons a woman has borne, and has only superficially incorporated the insights of lifecourse theory. Furthermore, it has often conceptualized empowerment as a static characteristic rather than a time-varying one, and has often failed to examine the influence of empowerment resources or previous empowerment levels.

Alcohol and sexual risk behavior among migrant female sex workers and male workers in districts with high in-migration from four high HIV prevalence states in India.

This paper examines the association between alcohol use and sexual risk in two critical migrant populations living within the same geographical areas--migrant men and female sex-workers (FSWs). Data are drawn from two independent surveys of migrant FSWs and male workers in 14 districts of four high HIV prevalent Indian states. In the paper we have examined the independent effects of degree of mobility and alcohol use prior to sex on HIV risk behaviors.

Using participatory mapping to inform a community-randomized trial of HIV counseling and testing.

Participatory mapping and transect walks were used to inform the research and intervention design and to begin building community relations in preparation for Project Accept, a community-randomized trial sponsored by the U.S. National Institute of Mental Health (NIMH).

Combating HIV stigma in health care settings: what works?

The purpose of this review paper is to provide information and guidance to those in the health care setting about why it is important to combat HIV-related stigma and how to successfully address its causes and consequences within health facilities. Research shows that stigma and discrimination in the health care setting and elsewhere contributes to keeping people, including health workers, from accessing HIV prevention, care and treatment services and adopting key preventive behaviours.Studies from different parts of the world reveal that there are three main immediately actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour.

Questioning gender norms with men to improve health outcomes: evidence of impact.

This article describes a review of 58 evaluation studies of programmes with men and boys in sexual and reproductive health (including HIV prevention, treatment, care and support); father involvement; gender-based violence; maternal, newborn and child health; and gender socialisation more broadly. While few of the programmes go beyond the pilot stage, or a relatively short-term timeframe, they offer compelling evidence that well-designed programmes with men and boys can lead to positive changes in their behaviours and attitudes related to sexual and reproductive health; maternal, newborn and child health; their interaction with their children; their use of violence against women; their questioning of violence with other men; and their health-seeking behaviour. The evidence indicates that programmes that incorporate a gender-transformative approach and promote gender-equitable relationships between men and women are more effective in producing behaviour change than narrowly focused interventions, as are programmes which reach beyond the individual level to the social context.

The quality of HIV testing services for adolescents in Cape Town, South Africa: do adolescent-friendly services make a difference?

We used adolescent simulated clients to evaluate whether HIV testing services in clinics participating in an adolescent-friendly initiative in Cape Town were superior to regular clinic services. We found improved accessibility to HIV testing, but no impact on adolescent's experience of negative attitudes from health workers and confidentiality breaches.

Structural approaches to HIV prevention.

Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear definition; lack of operational guidance; and limited data on the effectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps.

Women deliver for development.

There is a large amount of research into maternal health as a health issue, but maternal health as a development issue has been less explored. This Review analyses the evidence from the past 20 years on the links between maternal health and development to examine maternal health within a development framework. We note that although existing evidence suggests that these links are strong, further research is needed to definitively substantiate how and to what extent maternal health and development affect each other.

Micro-credit, women's groups, control of own money: HIV-related negotiation among partnered Dominican women.

A sample of 356 members of women's groups, aged 18-49, in the Dominican Republic were interviewed by trained female interviewers. Data among 273 partnered women were analyzed. The dependent variable, a measure of HIV-related negotiation, was examined for associations with control of own money, level of women's group participation, and ever having received a loan through a micro-credit program.

Measuring HIV stigma: existing knowledge and gaps.

The growing recognition of the reduction of HIV stigma as central to effective programs across the HIV/AIDS prevention to care and treatment continuum is leading to an increasing number of programs focused on stigma reduction. Correctly evaluating the impact of these programs depends on having a good set of measures that effectively capture and distinguish the complexities of HIV stigma. This paper reviews the existing literature on HIV stigma measurement and identifies key gaps that remain.

Expanding the care continuum for HIV/AIDS: bringing carers into focus.

This review explores the specific issues that cluster around the provision of 'care' in the context of the global HIV/AIDS pandemic. We argue that the economic concept of the 'care economy' provides a useful lens through which to view the HIV/AIDS pandemic, as it illuminates the increased labour, time and other demands placed upon households and shows that the assumptions on which norms and expectations of care provision are based are increasingly being challenged. While some strides are being made in policy and programming around HIV and AIDS-related care, much more needs to be known and done to enable individuals, families and households to survive in a world shaken by AIDS.

Women's empowerment and domestic violence: the role of sociocultural determinants in maternal and child undernutrition in tribal and rural communities in South India.

Background: Moderate malnutrition continues to affect 46% of children under five years of age and 47% of rural women in India. Women's lack of empowerment is believed to be an important factor in the persistent prevalence of malnutrition. In India, women's empowerment often varies by community, with tribes sometimes being the most progressive.

What's in a country average? Wealth, gender, and regional inequalities in immunization in India.

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992-93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states.