Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide.

The landscape of topical microbicides has changed dramatically in the past decade. Non-specific microbicides were shown to be ineffective at protecting women from acquisition of HIV and other STDs in clinical trials, and some have shown harm. The transition of the microbicide field from non-specific inhibitors to potent antiretroviral-based products has led to the development of new approaches and formulations. The release of conflicting results on the effectiveness of tenofovir gel-based microbicides from two major clinical trials has provided both optimism and concern for the future promise of topical microbicides to prevent HIV and HSV-2 infection. Efforts to incorporate microbicides into multipurpose technologies for HIV/STD prevention and contraception are gaining strong support.

Development of efficacious interventions is only the first step in achieving population level impact. Efficacious interventions impact infection levels in the population only if they are implemented at the right scale. Coverage must be prioritised across subpopulations based on the diversity and clustering of infections and risk in society, and expanded rapidly without delay. It is important to prioritise those who are most likely to transmit infection first.

INTRODUCTION:Increasing access to contraception among women who enter the health system for HIV care is crucial to help them achieve their fertility intentions and reduce vertical transmission of HIV. Identifying intervention strategies that contribute to effective family planning/HIV service integration and synthesizing lessons for future integration programming and research is important to move the field forward.METHODS:Using a standard review methodology, we searched for articles in the peer-reviewed literature published between January 2008 and August 2013 that addressed the integration of family planning interventions into HIV service settings. Eligible studies were assessed in terms of methodological rigor; documented outcomes; and reported process and cost data.RESULTS:Twelve studies met our inclusion criteria. Eight studies documented significant increases in contraceptive use by HIV service clients, and three reported significant increases in completed referrals from HIV services to family planning clinics. The outcomes of the seven studies implemented in public sector facilities were more modest than the five studies embedded in clinical trials. Process evaluation measures for some of the studies indicated weak implementation of the intervention as intended. The average rigor score was low, 3.4 out of 9.CONCLUSION:Our review reveals an expanding evidence base for integrated family planning/HIV service delivery innovations. However, the modest observed effect under typical settings and the evidence of weak intervention implementation emphasize the need for stronger programmatic efforts and implementation research to address the health system obstacles to integrating these two essential services.

This AIDS supplement brings to the forefront the latest advances in family planning/HIV integration research programs and policy. It also offers insights into strategic directions for future investments in this area. Topics include: biomedical and basic science research on the relationship between reproductive health and HIV transmission and disease behavioral research examining contraceptive practices and fertility choices among women and couples affected by HIV implementation science evaluating integrated service delivery innovations and evidence-based recommendations for programming.

Three cheers for the Centers for Disease Control and Prevention (CDC)! As the nation's premier agency for health promotion and disease prevention, CDC has done it again. Long known for its Morbidity and Mortality Weekly Report guidelines on such topics as STD treatment, antitobacco policy and injury prevention, it has ventured into the increasingly complex clinical world (to say nothing of its political implications) of modern contraceptive methods.

In an era when health resources are increasingly constrained, international organisations are transitioning from directly managing health services to providing technical assistance (TA) to in-country owners of public health programmes. We define TA as: 'A dynamic, capacity-building process for designing or improving the quality, effectiveness, and efficiency of specific programmes, research, services, products, or systems'. TA can build sustainable capacities, strengthen health systems and support country ownership. However, our assessment of published evaluations found limited evidence for its effectiveness. We summarise socio-behavioural theories relevant to TA, review published evaluations and describe skills required for TA providers. We explore challenges to providing TA including cost effectiveness, knowledge management and sustaining TA systems. Lastly, we outline recommendations for structuring global TA systems. Considering its important role in global health, more rigorous evaluations of TA efforts should be given high priority.

However little else they have in common, both Moses and contemporary public health professionals would agree on 1 thing: sex workers have been integral to the spread of sexually transmitted infections (STIs) since biblical times.1 Given such diversity of ideological views linking sex workers to disease (“contagion” for some, source of “infection” for others), we should not be surprised that the targeting of sex workers has marked the socio-medico history of STIs.2 If the need to target sex workers has not been a matter of dispute, the intent of targeting—surveillance, health interventions, moral reform, quarantine, or punishment—has been a source of public health and political tensions. Rwanda is the most recent site of polarized imperatives to target sex workers. As the public health community deliberates 2 recently released reports3,4 that examine the role of sex work in the country's human immunodeficiency virus (HIV) epidemic, national legislators deliberate a bill to criminalize “the profession of prostitution,” with steep fines and multiyear prison terms (Draft Penal Code on prostitution in Rwanda, adopted by the Parliament on December 23, 2009, and presently under debate in the Senate). The accompanying article in this journal5 reporting HIV incidence rates in a cohort of Rwandan sex workers thus enters a knotty terrain of public health scrutiny and moral-legal wrangling. In this context, its value in timeliness matches its scientific merit. First, to its scientific and public health strengths. The study contributes to a critically important (but not particularly abundant) literature on HIV incidence in general and sex worker populations in Africa.6 The Rwanda cohort (N = 397) was young (half, ≤24 years of age), but experienced in sex trade (half, >3 years of sex work). In the first 12 months of follow-up, 13 new HIV infections occurred with an incidence rate of 3.5 infections per 100 person years. This is lower than the HIV incidence in many other African sex worker cohorts.6 The sparsity of incident infections (N = 13) limits analysis and interpretation. The self-reported behavioral data also defy ready interpretation, but are, nonetheless, intriguing. For example, HIV incidence was highest among women who tested frequently for HIV rather than among women who reported the highest number of sex partners or the highest frequency of sex. Despite the statistical limitations, the finding that a higher proportion of repeat testers reported having an HIV-infected partner fits in with our current debates on the epidemiologic impact of partnership concurrency versus discordant couples.7,8 Overall, the study cohort represents a group of women at high sexual risk, confirmed not only by the burden of STI but also by the incidence of pregnancy, a rate of more than 25 pregnancies per 100 women years. The original cohort had excluded women who intended to become pregnant in the first year; hence, we can assume that many of these pregnancies were unintended. Though 75% of the women reported using male condoms for dual protection against both HIV/STDs and unintended pregnancy, findings of the study suggest that condom use was inconsistent. More comprehensive and integrated HIV, STI, and family planning services in interventions oriented to sex workers would help address this situation. To deliver the most effective combination of services, we also need more evidence on the safety and effectiveness of long-acting methods of contraception (hormonal implants, intrauterine devices) in female populations at high risk of HIV/STDs.9 For the field of HIV prevention, the Rwanda study is particularly timely and pertinent. The world has recently been encouraged by studies showing that both topical and oral preexposure prophylaxis with antiretrovirals can reduce the risks of HIV acquisition in high-risk populations.10,11 Findings on the HIV and STD incidence, the pregnancy rate, and the cohort retention rate (especially encouraging at 96%) provide helpful information about an additional population that might be considered for future prevention trials. Incidence findings such as these will be equally important in guiding effective resource allocations to support programs and strategies designed to avert the greatest number of new infections. Reducing infectiousness by treating HIV-infected persons, as well as reducing susceptibility to infection in HIV-negative core-transmitter and bridge populations, will both be a key.12 In an increasingly challenging funding environment,13 targeting our programs for the greatest prevention impact will be critical. Specific to targeting sex workers, the Rwanda HIV/AIDS (MOT) analysis3 reveals an important definitional challenge. Recognizing a difference between full-time commercial sex and more episodic transactional sex, the MOT model presents findings on the following 2 sex worker categories: (1) commercial sex workers and (2) commercial and transactional sex workers combined. In making this distinction, the model assumes that transactional sex involves fewer sex partners (126 per year) compared to commercial sex (520 sex partners per year). Simply acknowledging different levels of women's engagement in the sex trade produces very different projections. Over a 12-month period and using medium size population estimates, the Rwandan MOT model attributes 7% of all new infections to the combined sex worker group versus 27% to the commercial sex worker group; using high population size estimates, the range is even greater: 7% versus 46%, respectively. Rwanda's MOT findings quantify a long-standing qualitative concern about conceptualizations of sex workers in public health research.14 By contextualizing the exchange of sex for money or material goods within broader understandings of social networks and culturally mediated gender relations, several socio-cultural studies in sub-Saharan Africa15–18 challenge some implicit assumptions about sex work in many public health studies. Specifically, such socially thick descriptions19 of sex and material exchange impel us to qualify more precisely what counts as “commercial” and who counts as a “client.” The inclusion criteria of the accompanying article serve as an example.5 Women were included in the cohort if they (1) had exchanged sex for money at least once in the last month, or (2) had multiple sex partners and had sexual intercourse at least twice a week, or (3) both. But do the behaviors at the parameters of this definition really constitute “sex work?” Do exchanges of money, however infrequent and in whatever context, necessarily qualify as sex work? Do all women with 2 sex partners and who have sex with at least 1 of them twice a week qualify as sex workers? Defining the point at which material exchange or multipartnering constitutes “sex work” is in the end an unavoidable judgment call. But rather than being petty semantics, we contend that continued definitional imprecision in epidemiologic studies undermine the interpretive value and clarity of research on the role of sex workers in the spread of STIs. Whether in a concentrated or generalized epidemic, sex workers constitute a population where a disproportionate level of new HIV infections is being transmitted. The challenge for epidemiology is to better capture in its methods the complexity of sex work as a multipatterned social dynamic. A more complete and nuanced comprehension of the organization and structure of sex work20 will help to refine measures of risk within the trade. Attempts to understand the relationship between risk and intensity of engagement in the sex trade is one promising approach. For instance, Rwanda's 2010 Bio-behavioral Surveillance Survey Among Female Commercial Sex Workers4 demonstrated higher HIV prevalence in women reporting 100% of their income from sex work compared to women reporting alternative sources of income that supplement their earnings from sex work. Multidisciplinary modes of inquiry will further our understanding of the complexity of the sex trade and variable risk within it.20 Keeping the science and the programs close together will deliver better knowledge and improved targeting strategies in high-risk interventions. A preoccupation with sex worker definitions is not exclusive to public health scientists and practitioners. In response to the Chamber of Deputies passing the bill to criminalize sex work in Rwanda, the Deputy Speaker of Parliament says, “There is no way you will charge someone for practicing prostitution without a clear basis.”21 An opponent of the bill, the Deputy Speaker elaborates: “Why aren't we asking how these women get in this situation? What is society's role in educating and helping them with prevention and treatment?” (verbal communication with Deputy Speaker, Jean-Damascéne Ntawukuliryayo, December 15, 2010). Fortunately for Rwanda's enlightened legislators, between the MOT study,3 the Bio-behavioral Surveillance Survey,4 and this most recent article,5 a substantial evidentiary base exists describing risk levels and risk behaviors among sex workers in Rwanda. Together, these studies provide a sound basis to advocate for a favorable policy environment for sex worker interventions. They also offer important insights that should provoke an effort to enhance our understanding of sex work as a complex social phenomenon, to refine the definitions of sex work used in our research, and to target approaches in our HIV prevention interventions.

The Centers for Disease Control and Prevention (CDC) Sexually Transmitted Disease (STD) Treatment Guidelines were last updated in 2006. To update the "Clinical Guide to Prevention Services" section of the 2010 CDC STD Treatment Guidelines, we reviewed the recent science with reference to interventions designed to prevent acquisition of STDs, including human immunodeficiency virus (HIV) infection. Major interval developments include (1) licensure and uptake of immunization against genital human papillomavirus, (2) validation of male circumcision as a potent prevention tool against acquisition of HIV and some other sexually transmitted infections (STIs), (3) failure of a promising HIV vaccine candidate to afford protection against HIV acquisition, (4) encouragement about the use of antiretroviral agents as preexposure prophylaxis to reduce risk of HIV and herpes simplex virus acquisition, (5) enhanced emphasis on expedited partner management and rescreening for persons infected with Chlamydia trachomatis and Neisseria gonorrhoeae, (6) recognition that behavioral interventions will be needed to address a new trend of sexually transmitted hepatitis C among men who have sex with men, and (7) the availability of a modified female condom. A range of preventive interventions is needed to reduce the risks of acquiring STI, including HIV infection, among sexually active people, and a flexible approach targeted to specific populations should integrate combinations of biomedical, behavioral, and structural interventions. These would ideally involve an array of prevention contexts, including (1) communications and practices among sexual partners, (2) transactions between individual clients and their healthcare providers, and (3) comprehensive population-level strategies for prioritizing prevention research, ensuring accurate outcome assessment, and formulating health policy.

The International Conference on Family Planning, held in Kampala, Uganda, from November 15–18, 2009, drew over 1300 family planning researchers, program managers and health ministry officials from across the globe. This conference marked the reinvigoration of a global commitment to family planning.

Studies in Family PlanningVolume 41, Issue 2 p. 125-128 Reaching the Underserved: Family Planning for Women with HIV Rose Wilcher, Rose Wilcher Senior Technical Officer, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709. E-mail: [email protected].Search for more papers by this authorWillard Cates Jr., Willard Cates Jr. President, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709.Search for more papers by this author Rose Wilcher, Rose Wilcher Senior Technical Officer, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709. E-mail: [email protected].Search for more papers by this authorWillard Cates Jr., Willard Cates Jr. President, Family Health International, Post Office Box 13950, Research Triangle Park, NC 27709.Search for more papers by this author First published: 07 June 2010 https://doi.org/10.1111/j.1728-4465.2010.00233.xCitations: 21AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References Abrams, Elaine J., P.B. Matheson, P.A. 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Reynolds, Heidi W., Barbara Janowitz, Rose Wilcher, and Willard Cates, Jr. 2008. “Contraception to prevent HIV-positive births: Current contribution and potential cost-savings in PEPFAR countries. Sexually Transmitted Infections 84 (Supplement II): ii49–ii53. Reynolds, Heidi W., Markus J. Steiner, and Willard Cates, Jr. 2005. “Contraception's proved potential to fight HIV. Sexually Transmitted Infections 81(2): 184–185. Richey, Catherine and Ruwaida Salem. 2008. “ Elements of success in family planning programming. Population Reports Series J(57). Baltimore , MD : INFO Project, Johns Hopkins Bloomberg School of Public Health. Rochat, T.J., L.M. Richter, H.A. Doll, et al. 2006. “Depression among pregnant rural South African women undergoing HIV testing. Journal of the American Medical Association 295(12): 1,376–1,378. Smith, Rhonda, Lori Ashford, Jay Gribble, and Donna Clifton. 2009. “ Family planning saves lives.” Washington , DC : Population Reference Bureau. 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Results of the CAPRISA 004 microbicide randomised trial 1 Karim Q Abdool Karim SS Abdool Frolich JA et al. on behalf of the CAPRISA 004 Trial Study GroupEffectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010; (published online July 19.)https://doi.org/10.1126/science.1193748 Crossref Scopus (2009) Google Scholar recently electrified the AIDS 2010 Conference in Vienna, Austria. This groundbreaking safety and effectiveness study (funded by the US Agency for International Development [USAID]) showed that a vaginal gel containing 1% tenofovir significantly reduced a woman's risk of being infected with HIV or genital herpes. Tenofovir gel, used before and after sex, reduced the risk of HIV infection by 39% in the primary intent-to-treat analysis. The absolute difference in HIV-infection rates between the two groups was 3·5 infections per 100 women-years (5·6 vs 9·1 in the tenofovir and placebo groups, respectively). High adherence to the gel seemed to reduce the risk by 54% in an exploratory non-randomised comparison. Additionally, the pre/post gel regimen reduced the risk of HSV-2 infection by 51%.

In 1994, the International Conference on Population and Development (ICPD) was held in Cairo, Egypt. 1 It brought forward faith leaders, clinicians, researchers, program managers, and government officials to unite around a common vision: universal access to reproductive health and education. The ICPD focused on girls and women, their economic empowerment, their reproductive rights, and the role of family planning in reducing maternal and child mortality. On January 8, 2010, more than 15 years after this landmark event, Secretary of State Hillary Clinton reaffirmed the United States’ dedication to the “Cairo commitments,” while recognizing that we have not yet reached them. 2 Universal access to family planning is not only one of the Cairo commitments but also key to achieving each of the eight Millennium Development Goals (MDGs). 3, 4 In November 2009 in Kampala, Uganda, the first International Conference on Family Planning addressed years of pent-up demand for evidence on the topic. 5 More than 1,300 participants from across the globe convened to share the latest advancements in contraceptive technology and the best practices in family planning program implementation. Conference participants left Kampala with a shared sense of responsibility for reinvigorating the global commitment to family planning. As Khama Rogo of the World Bank put it, “We wouldn’t consider a child health program without immunization; how can we think about women’s health without family planning?” 6 Secretary Clinton’s reaffirmation of the Cairo commitments reminds us that we must act upon lessons learned since Cairo to be able to carry forward the momentum begun in Kampala. What did we learn in Kampala and, most importantly, what do we do in the second decade of the new millennium? Let’s start with what we learned. Three themes framed much of the dialogue: Family Planning and the MDGs: Rightsbased family planning choices, where individuals are empowered with knowledge and supported to determine their own reproductive intentions, free from coercion, are important to achieving all eight of the Millennium Development Goals. 3, 4 Evidence-Based Policies: A comprehensive body of evidence has demonstrated the effectiveness and cost-effectiveness of family planning in advancing women’s education, child and maternal health, HIV prevention, and environmental sustainability. African Ownership : African leaders must provide the leadership to promote family planning in their countries, because without such ownership, we cannot achieve universal access. How did these key themes emerge? The Kampala conference attracted a unique mix of researchers, program managers, care providers, government officials, and funder representatives. We have synthesized the evidence and experience presented there into eight categories to help us answer the question, What do we do now ?

Access to reproductive health services for women with HIV is critical to ensuring their reproductive needs are addressed and their reproductive rights are protected. In addition, preventing unintended pregnancies in women with HIV is an essential component of a comprehensive prevention of mother-to-child transmission (PMTCT) programme. As a result, a call for stronger linkages between sexual and reproductive health and HIV policies, programmes and services has been issued by several international organizations. However, implementers of PMTCT and other HIV programmes have been constrained in translating these goals into practice. The obstacles include: (i) the narrow focus of current PMTCT programmes on treating HIV-positive women who are already pregnant; (ii) separate, parallel funding mechanisms for sexual and reproductive health and HIV programmes; (iii) political resistance from major HIV funders and policy-makers to include sexual and reproductive health as an important HIV programme component; and (iv) gaps in the evidence base regarding effective approaches for integrating sexual and reproductive health and HIV services. However, we now have a new opportunity to address these essential linkages. More supportive political views in the United States of America and the emergence of health systems strengthening as a priority global health initiative provide important springboards for advancing the agenda on linkages between sexual and reproductive health and HIV. By tapping into these platforms for advocating and by continuing to invest in research to identify integrated service delivery best practices, we have an opportunity to strengthen ties between the two synergistic fields.

Women of reproductive age are disproportionately affected by the HIV/AIDS epidemic especially in sub-Saharan Africa where women account for nearly 60% of people living with HIV[1].Consequently the family planning and HIV fields intersect in a number of crucial ways: (1) Many women are simultaneously at risk for both unintended pregnancy and HIV infection. Countries with the greatest burden of HIV also have high levels of unmet need for family planning [2]. (2) Like all women HIV-positive women have a right to make reproductive decisions free of coercion. (3) For women with HIV who want to become pregnant use of antiretroviral prophylaxis during pregnancy can reduce mother-to-child transmission of HIV. Afterwards family planning services that promote healthy timing and spacing of pregnancies are important to reduce the risk of adverse pregnancy outcomes such as low birth weight preterm birth and infant mortality [3-5]. (4) For women with HIV who do not wish to become pregnant family planningis a proven cost-effective strategy for preventing mother-to-child transmission of HIV (PMTCT) and therefore reducing the number of children needing HIV treatment care and support [26-9]. (5) Barrier methods of contraception -namely male and female condoms -can protect against both unintended pregnancy and sexual transmission of HIV. (6) HIV services provide an opportunity to reach women and men at risk of and living with HIV with family planning information and services. (7) Family planning services particularly in generalized epidemics provide an opportunity to increase access to HIV counseling and testing and other HIV services. However rather than being natural allies family planning and HIV have remained strange bedfellows [1011]. Despite the established connections between the fields they are not effectively bridged in practice. Rates of unintended pregnancies remain alarmingly high in women with HIV and family planning interventions have been underutilized in HIV prevention care and treatment programs [12-14]. In addition HIV programs have emerged primarily as separate silos and only minimal efforts have been made to leverage and integrate them with existing family planning infrastructures. This supplement originated from the belief that more evidence is needed to compel funders policymakers program planners and implementers to act on the synergies between the two fields and enhance the public health impact of reproductive health and HIV programs. The contents of this supplement represent research being conducted within three broad areas: behavioral research examining contraceptive practices and fertility desires of HIV-positive women and couples; biomedical research addressing the safety and effectiveness of contraceptive methods for HIV-positive women; and programmatic research evaluating service delivery approaches to integrating family planning and HIV services. Taken together the studies published in this supplement expand the evidence base regarding how the family planning andHIV fields are related and how they can be better integrated in practice.

Over the past 2 years, The Lancet has proactively championed HIV prevention science. It published a state-of-the-art series on HIV prevention, timed for the 2008 Mexico City International AIDS Conference, 1 Horton R Das P Putting prevention at the forefront of HIV/AIDS. Lancet. 2008; 372: 421-422 Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar and six other primary publications from key HIV-prevention trials. The two trials that showed male circumcision protected against HIV acquisition were uplifting. 2 Bailey RC Moses S Parker CB et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007; 369: 643-656 Summary Full Text Full Text PDF PubMed Scopus (1785) Google Scholar , 3 Gray RH Kigozi G Serwadda D et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007; 369: 657-666 Summary Full Text Full Text PDF PubMed Scopus (1756) Google Scholar Disappointingly, four other trials failed to show that the diaphragm, 4 Padian NS van der Straten A Ramjee G et al. the MIRA TeamDiaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet. 2007; 370: 251-261 Summary Full Text Full Text PDF PubMed Scopus (286) Google Scholar prophylaxis for herpes simplex virus type 2, 5 Celum C Wald A Hughes J et al. the HPTN 039 Protocol TeamEffect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial. Lancet. 2008; 371: 2109-2119 Summary Full Text Full Text PDF PubMed Scopus (376) Google Scholar an HIV vaccine, 6 Buchbinder SP Mehrotra DV Duerr A et al. for the the Step Study Protocol TeamEfficacy assessment of a cell-mediated immunity HIV-1 vaccine (the Step Study): a double-blind, randomised, placebo-controlled, test-of-concept trial. Lancet. 2008; 374: 1881-1893 Summary Full Text Full Text PDF Scopus (1426) Google Scholar and now Carraguard as a topical microbicide 7 Skoler-Karpoff S Ramjee G Ahmed K et al. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trial. Lancet. 2008; 372: 1977-1987 Summary Full Text Full Text PDF PubMed Scopus (434) Google Scholar are effective in preventing HIV. Such is the ecstasy and the agony of HIV-prevention research. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trialThis study did not show Carraguard's efficacy in prevention of vaginal transmission of HIV. No safety concerns were recorded. Full-Text PDF